Med Student in Need of Help

[HappyAndHopeful]

Hey guys! I don’t know this person personally, but his story tugged at my heartstrings, so I thought I’d share his GoFundMe here in case anyone was interested in donating:

https://gofund.me/9bb12465
 

(Admin please feel free to delete if not allowed  )

[blah1234]

I donated but I am ashamed that the school was not able to accommodate this student at all with regards to tuition cost. It's one year's worth of tuition during an unprecedented time.

[LostLamb]

I donated too because BIPOC physicians (especially those whose first language is not English) are especially needed.

By the time you're in 4th year, tuition should be the least of a student's worries...he has a long way to go even after graduating...but I am happy to help give him a fighting chance.

[zoxy]

This is the second or third time in the past couple of years that an International Medical student in Canada has used a GoFundMe to pay their tuition and it's not like there are that many across Canada. I think only Toronto, Mac, McGill, and Queens accept self-funded internationals, and they accept very few. So something is clearly wrong in how these programs are administered if their students are consistently resorting to GoFundMe. To not find themselves in this situation, most American medical schools that accept international students require them to deposit 4 years of tuition, and sometimes even living costs, in an escrow account before allowing them to matriculate.

It should be noted that this individual has paid tuition for four years of undergrad at UBC and three years of medical school tuition at Queens as an international student. That's 100,000 CAD in undergrad tuition and 270,000 for Medical School tuition, and that's without living costs in Canada for the past 7 years, four of which were spent in the most expensive city in Canada. I'd wager that this fella's family is much better off than even the top 10 percent of Canadians. After all, how many Canadians can afford to spend 370,000 dollars on tuition alone for their child? It should also be noted that at Queens, international students have a separate admission stream with separate quotas than domestic students and do not count towards the 100 positions funded by the Ontario government.

 

[CaRMS2021]

6 hours ago, zoxy said:

This is the second or third time in the past couple of years that an International Medical student in Canada has used a GoFundMe to pay their tuition and it's not like there are that many across Canada. I think only Toronto, Mac, McGill, and Queens accept self-funded internationals, and they accept very few, so something is clearly wrong in how these programs are administered if their students are consistently resorting to GoFundMe. To not find themselves in this situation, most American medical schools that accept international students require them to deposit 4 years of tuition and sometimes even living costs in an escrow account before enrolling in for first year.

It should be noted that this individual has paid tuition for four years of undergrad at UBC and three years of medical school tuition at Queens as an international student. That's 100,000 CAD in undergrad tuition and 240,000 for Medical School tuition, and that's without living costs in Canada for the past 7 years, four of which were spent in the most expensive city in Canada. I'd wager that this fella's family is much better than even the top 10 percent of Canadians. Afterall, how many Canadians can afford to spend 340,000 dollars on tuition for their child? It should also be noted that at Queens, international students have a separate admission stream with separate quotas than domestic students and do not count towards the 100 positions funded by the Ontario government.

 

I wonder if the $100K/yr figure is the true cost of training a medical student if the provincial governments did not subsidize it at all?

[zoxy]

1 hour ago, CaRMS2021 said:

I wonder if the $100K/yr figure is the true cost of training a medical student if the provincial governments did not subsidize it at all?

According to the Feds, it was 65,000 a year in 2002. With 40 percent inflation since 01, it should put the cost at 90,000 a year. 90,000 is essentially what Queens and UofT charge for internationals.

https://publications.gc.ca/collections/collection_2009/sc-hc/H29-1-2009E.pdf

[rmorelan]

1 hour ago, CaRMS2021 said:

I wonder if the $100K/yr figure is the true cost of training a medical student if the provincial governments did not subsidize it at all?

it actually isn't that far off. Medical school is extremely expensive, particular as there is not really as much economy of scale. A lot of government estimates put it around 75-100K. 

doctor ha - we are expensive at every step of the way

I suppose the point is Queen's in this case really isn't ripping him off. Probably even extra costs as there are so few everything is a one off. 

Edited November 29, 2021 by rmorelan

[Pakoon]

On 11/28/2021 at 12:50 PM, zoxy said:

This is the second or third time in the past couple of years that an International Medical student in Canada has used a GoFundMe to pay their tuition and it's not like there are that many across Canada. I think only Toronto, Mac, McGill, and Queens accept self-funded internationals, and they accept very few, so something is clearly wrong in how these programs are administered if their students are consistently resorting to GoFundMe. To not find themselves in this situation, most American medical schools that accept international students require them to deposit 4 years of tuition and sometimes even living costs in an escrow account before enrolling for first year.

It should be noted that this individual has paid tuition for four years of undergrad at UBC and three years of medical school tuition at Queens as an international student. That's 100,000 CAD in undergrad tuition and 270,000 for Medical School tuition, and that's without living costs in Canada for the past 7 years, four of which were spent in the most expensive city in Canada. I'd wager that this fella's family is much better than even the top 10 percent of Canadians. After all, how many Canadians can afford to spend 370,000 dollars on tuition alone for their child? It should also be noted that at Queens, international students have a separate admission stream with separate quotas than domestic students and do not count towards the 100 positions funded by the Ontario government.

 

That's a really interesting point you bring up, i never considered the cost BEFORE medical school.

What i do wonder is how the schools PR teams just watch this happen, i don't imagine it is a good look for the schools when their students are having to resort to GoFundMe time and time again just to make it through school. 

[blah1234]

7 hours ago, Pakoon said:

That's a really interesting point you bring up, i never considered the cost BEFORE medical school.

What i do wonder is how the schools PR teams just watch this happen, i don't imagine it is a good look for the schools when their students are having to resort to GoFundMe time and time again just to make it through school. 

I agree, this is not a good look for any school.

[shikimate]

International students getting any bachelor degree these days pay >20K / yr, and there are droves of international students here, even in the most "no name" college / universities, so PR has become less of an issue. There is a stereotype that they're all from rich families, which is not the case. But that stereotype has been stuck in many people's minds, and the government is happy to let them subsidize taxpayers.

honestly in recent years there's all kinds of talk about more doctors but basically no action. I think the electorate is being worked up for allowing more "self funded" medical school and even residency spots. Perhaps private medical schools will become more acceptable to the electorate in the future. It's a win win for government of course, they bleed less money on students, and with "capped" total physician spending (eg Ontario for a while, maybe AB), total remuneration will grow at a rate less than the increase in physicians numbers.

[zoxy]

5 hours ago, shikimate said:

"capped" total physician spending (eg Ontario for a while, maybe AB)

When did this happen? I was under the impression the judge didn't impose a cap when negotiations went to arbitration in 2019.

[shikimate]

19 hours ago, zoxy said:

When did this happen? I was under the impression the judge didn't impose a cap when negotiations went to arbitration in 2019.

This was a while ago, there were unilateral fee reductions under the Waynne government. I was too early in training to understand the full scope back then but this is a good summary here:

https://www.oha.com/Legislative and Legal Issues Documents1/OHA-OMA Analysis of Ten-Point Plan for Saving and Improving Service (2015).pdf

 

https://news.ontario.ca/en/backgrounder/31498/physician-services-ten-point-plan-for-saving-and-improving-service

"The average payments have been reduced since 2011/12 to an estimated $354,000 in 2013/14. Spending on physician compensation will continue to increase;"

AKA the total spending back then increases at a slower rate than increase in # of doctors, hence average payments fell.

 

This is a good summary here. The individual bulletins from MOHLTC contains more details about the fee reductions:

https://www.fasken.com/en/knowledge/2019/04/health-bulletin-first-phase-of-ontario-physician-services-arbitration

 

https://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4000/bul4652.pdf

https://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4000/bul4652_2.pdf

"The 2.65% payment reduction is in addition to the 0.5% payment reduction which has been effective since April 1, 2013."

 

https://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4000/bul4657.pdf

"Effective October 1, 2015 a 1.3% payment discount will be applied on all fee-for-service physician payments."

- note this is on top of previous 0.5% and 2.65% reduction.

 

[rmorelan]

He is making some progress there actually - almost at the one half mark. 

It is annoying that after a certainly point trainees cannot actually a least a subset of the student loans given to Canadians. I mean I know there are risks of course but by the time someone gets to their final year of training they are minimal. 

[blah1234]

1 hour ago, rmorelan said:

He is making some progress there actually - almost at the one half mark. 

It is annoying that after a certainly point trainees cannot actually a least a subset of the student loans given to Canadians. I mean I know there are risks of course but by the time someone gets to their final year of training they are minimal. 

I wonder if a broader solution that would benefit all students is the control of tuition costs (across all professional degrees to be honest). I don't think any of my friends from McGill or other Quebec schools are worse physicians than I (but then again I'm not actively comparing our outcomes). I know for a fact that they paid significantly less tuition than what I did in Ontario.

Perhaps some of that is different levels of government subsidization but there has to be some degree of bloat that we are currently paying for. Pre-clerkship is really mostly lectures and coursework. I'm honestly trying to figure out areas of outsized costs and they mostly boil down to "new and innovative" ways of teaching (e.g., simulation lab). Is that stuff truly needed if it inflates tuition costs? Perhaps clerkship is expensive because we need to pay for student insurance and all the costs that come with placing a student in the hospital.

I guess I'm just finding it hard to believe that tuition has increased by so much even since I went to medical school and I honestly do not think the underlying costs to run a medical program for students has truly increased at that rate (and delivered true educational value). 

[who_knows]

1 hour ago, rmorelan said:

I mean I know there are risks of course but by the time someone gets to their final year of training they are minimal. 

If a person does not have at least permanent residency status, the connection to Canada is considered very weak. So there is a big chance that a person will take off if they can't (or don't want to) re-pay.
As I understand, this student does not have the residency status and is not eligible for carms. There is no guarantee that he will get the status. Loaning $400K to a person without good job prospects is unreasonable.

[rmorelan]

43 minutes ago, who_knows said:

If a person does not have at least permanent residency status, the connection to Canada is considered very weak. So there is a big chance that a person will take off if they can't (or don't want to) re-pay.
As I understand, this student does not have the residency status and is not eligible for carms. There is no guarantee that he will get the status. Loaning $400K to a person without good job prospects is unreasonable.

normally sure - but if a person is right at the end of medical training, and they want to capitalize on that achievement there are they doing to go? Your training only works here or the US - and in either case you aren't exactly hard to find. You can take off but.......that is kind of nuts as it is flushing 350K dollars down the drain. 

Plus for him specifically it isn't 400K at this point - he is in his final year. Actually at this point it is about 50K. That's it. 

Might not get permanent status - that is the main risk I would think (?) Not a zero risk of course, but at some point the risk and thus the interest rate become computable to offset that risk. If I was him right now and a bank showed with a 50K loan the interest rate I would accept to get it would probably "crazy" by our standards ha. 

I wonder if he needs to graduate completely to get residency status. bit of chicken and the egg problem there. 

 

Edited December 2, 2021 by rmorelan

[rmorelan]

49 minutes ago, blah1234 said:

I wonder if a broader solution that would benefit all students is the control of tuition costs (across all professional degrees to be honest). I don't think any of my friends from McGill or other Quebec schools are worse physicians than I (but then again I'm not actively comparing our outcomes). I know for a fact that they paid significantly less tuition than what I did in Ontario.

Perhaps some of that is different levels of government subsidization but there has to be some degree of bloat that we are currently paying for. Pre-clerkship is really mostly lectures and coursework. I'm honestly trying to figure out areas of outsized costs and they mostly boil down to "new and innovative" ways of teaching (e.g., simulation lab). Is that stuff truly needed if it inflates tuition costs? Perhaps clerkship is expensive because we need to pay for student insurance and all the costs that come with placing a student in the hospital.

I guess I'm just finding it hard to believe that tuition has increased by so much even since I went to medical school and I honestly do not think the underlying costs to run a medical program for students has truly increased at that rate (and delivered true educational value). 

Valid points -

I am not sure the actual cost of medical school has gone up that much really. It is just that the government has let the schools change over and over again well above the rate of inflation to the tuition fees for 20 odd years. This just reduces the proportion that government is effectively paying for things, but not really changing the cost overall (which is probably just creeping up closer to inflation). Since interest rates are low, massive student loans are just all so available and collectively we haven't gone to war on the subject with the government (in part because we are so happy to just get into medical school and we are masters of delayed gratification) things just keep going up. At this point if the interest rates go up for many students it will be down right scary. 

 

[zoxy]

16 hours ago, blah1234 said:

Perhaps some of that is different levels of government subsidization but there has to be some degree of bloat that we are currently paying for.

The demands from the LCME and AAMC to maintain accreditation are intense and constantly increasing. McGill was on LCME probation in 2017, USask in 2013. While some higher education institutions in Canada are bloated (looking at you oil boom UofA and UofC), there really isn't that much fat to cut for most others.

16 hours ago, blah1234 said:

Perhaps some of that is different levels of government subsidization

Quebec spends approximately 80 percent more per student on post-secondary education than Ontario does. The notion of bloated Ontario universities with expensive tuition and lean Quebec ones with cheap tuition isn't accurate.

16 hours ago, blah1234 said:

Pre-clerkship is really mostly lectures and coursework

The most expensive part of pre-clerkship to deliver is undoubtedly clinical skills sessions. Think of how many different preceptors, who must be MDs in order to be accredited, are involved in one semester of clinical skills sessions. Cadaver labs aren't cheap to run either. 

[blah1234]

11 hours ago, zoxy said:

The demands from the LMCC and AAMC to maintain accreditation are intense and constantly increasing. McGill was on LMCC probation in 2017, USask in 2013. While some higher education institutions in Canada are bloated (looking at you oil boom UofA and UofC), there really isn't that much fat to cut for most others.

Quebec spends approximately 80 percent more per student on post-secondary education than Ontario does. The notion of bloated Ontario universities with expensive tuition and lean Quebec ones with cheap tuition isn't accurate.

The most expensive part of pre-clerkship to deliver is undoubtedly clinical skills sessions. Think of how many different preceptors, who must be MDs in order to be accredited, are involved in one semester of clinical skills sessions. Cadaver labs aren't cheap to run either. 

Very interesting. I did not know about the accreditation costs as I'm not close to the details. I still think there must be some element due deregulation of tuition (at least in Ontario). There's no real natural control to schools setting their rates above inflation because student debt is so cheap.

I will say that when my colleagues and I helped with clinical skills session we were given honoraria (relatively small amounts) to help support students. I'm not sure it should be a huge financial drain as most of us are doing it out of the goodness of our heart or it's part of our responsibility as academic affiliated staff. I think getting mock patients can be expensive though but those aren't every session.

I think the anatomy lab is not cheap to setup but that cost shouldn't be a substantial ongoing drain as the infrastructure is built out at schools. You would just need to pay for replacements and ongoing costs. I knew the lab director at my school and it sounded like a lot of the things they were spending their cash on were just "novel" ways of teaching (e.g., ipads, virtual sessions). I have to imagine the old ways of learning with just textbooks and prosections should plateau out in cost at some point.

[zoxy]

3 hours ago, blah1234 said:

Very interesting. I did not know about the accreditation costs as I'm not close to the details. I still think there must be some element due deregulation of tuition (at least in Ontario). There's no real natural control to schools setting their rates above inflation because student debt is so cheap.

I will say that when my colleagues and I helped with clinical skills session we were given honoraria (relatively small amounts) to help support students. I'm not sure it should be a huge financial drain as most of us are doing it out of the goodness of our heart or it's part of our responsibility as academic affiliated staff. I think getting mock patients can be expensive though but those aren't every session.

I think the anatomy lab is not cheap to setup but that cost shouldn't be a substantial ongoing drain as the infrastructure is built out at schools. You would just need to pay for replacements and ongoing costs. I knew the lab director at my school and it sounded like a lot of the things they were spending their cash on were just "novel" ways of teaching (e.g., ipads, virtual sessions). I have to imagine the old ways of learning with just textbooks and prosections should plateau out in cost at some point.

Of course I would agree that this is true, but in my opinion, that's more relevant to how expensive undergrad tuition has gotten in Ontario. Whenever the government gives universities the option to increase tuition and with all students being able to pay it due to government funded student loans, then the universities will choose the option of extracting revenue from students.

But having attended a private American university for undergrad, I saw much more bloat there than at most Canadian schools, which are much leaner.

[blah1234]

2 hours ago, zoxy said:

Of course I would agree that this is true, but in my opinion, that's more relevant to how expensive undergrad tuition has gotten in Ontario. Whenever the government gives universities the option to increase tuition and with all students being able to pay it due to government funded student loans, then the universities will choose the option of extracting revenue from students.

But having attended a private American university for undergrad, I saw much more bloat there than at most Canadian schools, which are much leaner.

I think when we deregulated tuition in 1998 in Ontario for professional programs that's when we started seeing these crazy annual increases for law, medicine, dentistry (and other programs??). I think tuition before then grew at a much more modest rate.

I'm sure we are less bloated than US institutions, but I cannot make sense of the tuition of professional schools growing at double digit rates as I don't think their necessary cost base is growing at that rate. I think a large factor allowing this to happen is probably the generous lines of credits and government loan support for MDs.

[zoxy]

1 hour ago, blah1234 said:

I cannot make sense of the tuition of professional schools growing at double digit rates as I don't think their necessary cost base is growing at that rate.

Provincial funding has been drastically cut. Cost base isn't growing at double digits but with government support shrinking, and overall costs growing, tuition will grow quicker than overall cost growth. Also professional schools, such as medicine and dentistry, generally can't pull the old charge international students insane sums trick. I know this is what's happening in this story, but I don't think Queens is running a profit on this guy considering how expensive training actually is and also because there aren't many internationals in medicine compared to other programs. But UofT is definitely turning a profit by charging international students 60,000 a year for a sciences undergrad.

1 hour ago, blah1234 said:

I think a large factor allowing this to happen is probably the generous lines of credits and government loan support for MDs.

I think it's not an either or situation. Easy access to funding through LOC and loans, bloat, and decrease in funding all play a role.

https://cfsontario.ca/wp-content/uploads/2017/07/Factsheet-Underfunding.pdf

https://planningandbudget.utoronto.ca/tuition-fee-lookup-tool/

[blah1234]

16 minutes ago, zoxy said:

Provincial funding has been drastically cut. Cost base isn't growing at double digits but with government support shrinking, and overall costs growing, tuition will grow quicker than overall cost growth. Also professional schools, such as medicine and dentistry, generally can't pull the old charge international students insane sums trick. I know this is what's happening in this story, but I don't think Queens is running a profit on this guy considering how expensive training actually is . But UofT is definitely turning a profit by charging international students 60,000 a year for a sciences undergrad.

I think it's not an either or situation. Easy access to funding through LOC, bloat, and decrease in funding all play a role.

https://cfsontario.ca/wp-content/uploads/2017/07/Factsheet-Underfunding.pdf

https://planningandbudget.utoronto.ca/tuition-fee-lookup-tool/

I agree it's a probably a combination of the factors you listed for professional programs. Without analyzing the financial statements of ontario medical schools I can only give my relatively uninformed opinion having worked briefly at an academic center. 

I just strongly feel that the rates of tuition growth are not commensurate with proportionate improvements in medical education. We are probably spending money on things that probably are not needed to deliver a good education. I think the analysis below shows the insanity with the high absolute growth rates and a CAGR that's likely to be in the high single digits. Perhaps the government is constrained in the amount they can subsidize education but there is no pressure for the schools to really control costs either. These tuition increases can easily be supported by student debt and there is still room to go with LoCs. I already fear we are just discouraging applicants from diverse socioeconomic backgrounds. 

https://www150.statcan.gc.ca/n1/pub/81-004-x/2006001/9183-eng.htm

I'll try to look into this more if work slows down as I'm sure there is some public info out there from an Auditor General's report or something. I would genuinely be shocked if professional schools are truly delivering education close to efficiently as possible. That's just not what I have seen during my training and during my employment.

[JohnGrisham]

5 minutes ago, blah1234 said:

I just strongly feel that the rates of tuition growth are not commensurate with proportionate improvements in medical education. We are probably spending money on things that probably are not needed to deliver a good education.

Fairly involved with MedEd in different levels and this is often the case. A lot of bloat and spending on unnecessary things.  Many of which end up trying to be checkboxes for accreditation in some shape or form to justify the existence. 

[ChemPetE]

To be fair, I’m very ok with money being spent with meeting accreditation standards. That’s one of the main reasons we don’t have fly-by-night med schools, maintain quality education standards, and one reason MDs enjoy relatively secure employment. The fact that it is a lot of red tape is a pain, but accreditation itself is very necessary imo.