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ss nucleus - spring 1998,  Medical Student Debt

Medical Student Debt

Debt is a problem which often plagues the minds of medical students. The recently published Dearing Report has turned the spotlight on it once more.

The scale of the problem

Dr Sandy Macara, chairman of the British Medical Association (BMA) Council, has reported that the average graduating medical student leaves with a total debt of £6,758 - nearly twice that of the average student.[1] This figure has been increasing steadily for the last few years and the rise shows no sign of abating. Debt is a universal problem in the student community; however, there are several reasons why we as medical students are worse off.

Intense five or six year courses mean longer to clock up debt; shorter holidays give less time for working to pay off loans. We face greater expenditure on books and equipment. There is the increased expense of being professionally dressed for ward work as well as travelling to peripheral attachments. In addition to this, student loans are designed for 30 week courses, not 45 week clinical medical courses.

We should not, of course, be surprised at the changing situation. Many look back to the halcyon days of the 1960s when students lived in comparative luxury. However, this is clearly unfeasible today: the government's drive towards better, more extensive higher education has resulted in a huge increase in the number of students. In the 1960s, one in twenty young people went to university; today the proportion is around one in three.[2] It would be impossible to continue the same level of government funding today. The questions therefore are more those of how and from where the money should be raised.

These questions were set to Sir Ron Dearing, a civil servant who was appointed as chairman of the National Committee of Inquiry into Higher Education. The committee's recent report has caused much controversy with proposals to make students pay part of their tuition fees. The logic is that graduates earn more as a result of their extra education and that it is therefore reasonable for them to contribute to the cost. The government has set these fees at £1,000 per year, regardless of the course; these will be means-tested so that low-income families will not have to pay. A recent concession means that medical students will be exempt in their final year.[3]

Another recent government decision has been to halve the maintenance grant next year before scrapping it completely in 1999. Put together, these changes have led the BMA medical student committee to estimate that medical student debt could soon rise to £15,000.[4]

Getting the right perspective

It is easy to shout and demand our 'rights' to a free education. All of the recent cuts in funding for students have been met with strong opposition. Of course, we should oppose injustice in this sphere as much as any other, but there is a distinct danger of being selfish.

If we look carefully around us, we will see that our situation is still very privileged. As potential doctors we can reasonably look forward to a stable career with virtually no chance of redundancy. Many graduates in other fields have no such security and face uncertain job prospects. Our high earning potential means that we can pay off large debts without significant trouble. We must keep in mind that the repayment comes after qualification and not before. The student loans are very safe as debts go: we will never have to repay them unless we are in a financial position to do so. Though not relishing the prospect, we must admit that we can cope with debts far more than most.[5]

Before we cry too loud about the dire economic straits that we find ourselves in, we should look further afield and spare a thought for those in developing nations, especially Latin America and Sub-Saharan Africa. In 1994, developing nations owed £1.3 billion. In effect, each man, woman and child in the western world receives over £150 from the third world in debt repayments each year. Even this does not meet their debt service obligations.[6]

We may not be enthusiastic about the prospect of paying for some of our tertiary education yet millions of children in developing nations are unable to afford secondary or even primary education. Many do not even have the chance to read and write. The whole issue of third world debt, its causes and the part played by developed nations is very important and has been discussed in the graduate CMF Journal.[7]

Even considering the situation of medical students in other countries can be very instructive. In 1992, US medical students owed on graduation an average of $56,000.[8] For overseas students studying at the Royal College of Surgeons of Ireland, debts of £60,000 at graduation are not uncommon.

Biblical economics

The Bible has much to say about lending and borrowing. Many debt problems, including the current international debt crisis, would have been completely avoided if those involved had followed some simple biblical principles.

The principle of loving our neighbours as ourselves[9] underlies virtually everything that the Bible has to say on this subject. We are to lend to others, give to those in need and borrow when necessary in exactly the same way we would want others to do these same things for us.

Looking back through history, God's instructions to the Jews through Moses were that lending to those in need should be interest-free,[10] allowing interest only to foreigners.[11] Jesus went even further than this minimum, saying that we should even lend to our enemies, expecting nothing in return.[12] The teaching of the church (right up until the Reformation) was that the taking of interest was wrong: those who did so were often excommunicated.[13] The NIV footnotes[14] make a distinction between 'interest' (legitimate repayment for a loan) and 'usury' or 'excessive interest', which may sound attractive but is difficult to justify from the text.[15]

God also instituted a seven-year cycle for the cancelling of debts. Properly adhered to, these and many other injunctions meant that no-one got too rich or too poor.[16] It is quite clear that the proverb, 'The borrower is servant to the lender',[17] only applies when God is disobeyed.

Talking about debt forgiveness is all very well but may be a little theoretical for us when the boot is firmly on the other foot. The Bible is certainly not silent on the responsibilities of the borrower, which is far more applicable to us at our current stage of life. In the Torah, those who were destitute had a duty to work for their living;[18] Paul also had some stern words against laziness: 'If a man will not work, he shall not eat' (2 Thes 3:10). It is not a biblical option simply to sit around and lap up state benefits. We in our turn must do all we reasonably can to repay the debts which we incur.

Although our debt problems are small compared with those of millions around the globe, they are nonetheless real and we would be foolish to ignore them. They will not go away on their own and there is much that we can do to minimise them. Not surprisingly, these fall into ways of decreasing expenditure and increasing income as well as sensible borrowing when necessary.

Decreasing expenditure

There are many ways that we can limit our spending. As rent is often our biggest outlay, we could consider living somewhere which is not our first choice for comfort and style. Travel can cost a lot so it may be appropriate to swap bus fares for bike rides. There are many expenses which can be spread between those living in halls or a shared house. Cooking together when possible may work out significantly cheaper than doing it alone. Making a packed lunch will save on canteen bills. Preparing your own food may be more hassle than microwave meals but is certainly less expensive.

It can be very helpful to keep an accurate record of all our expenditure. This way we can easily spot reasonable areas in which to make cuts if necessary.[19]

Increasing income

The National Lottery jackpot is appealing but unlikely. 'It Could Be You' but you can bet it won't be. As able students there is usually employment available during holidays, especially in the pre-clinical years. It may also be necessary and feasible to find part time evening or weekend work, when studies permit. Although there are many options,[20] some may be more applicable to us. Employment agencies can offer a range of work on a fairly flexible basis, although not always when needed. Auxiliary nursing can often be done in the hospitals in which we study. My wife and I have gained invaluable support (and good experience) from working as medical secretaries through an agency. Medical students' knowledge of terminology is a real boon and some typing skills are often all that's needed: experience can be gained on the job.

Sensible borrowing

Even with the best budgeting, debt is sometimes unavoidable. As mentioned before, the Student Loans Company is designed to be one of the safest ways for students to borrow. The BMA also has a loan package that is designed specifically for the needs of medical students.

Earlier talk of biblical economics leads us to an interesting proposition. What about the possibility of a student/doctor credit union where Christian doctors can offer interest-free loans to hard up Christian students in the local medical school? Terms and agreements could be tailored to fit the situation by those involved. This may be something to discuss with your graduate CMF medical school representative. It is certainly something which we should consider in the future: the next generation of medical students will be even worse off and we will be in a prime position to help them.[21]

Should we give?

As already seen, we as students are far richer than many. It is tempting to say that we cannot give to others in need as we are in need ourselves. There is certainly a degree to which this is true; it is somewhat pointless to put ourselves in debt by helping others. Even so, we all have the responsibilty and privilege[22] of giving in line with our abilities.[23] The Levites were obliged to tithe their own limited income.[24]

We must always look upon the possessions we have as blessings to be used in God's service, not as ours to be guarded at all costs. We need to consider others' needs.[25] They often outweigh our own.


Debt is a real problem for medical students that shows every indication of worsening in the near future. Although serious, we must see it in the context of the vast majority of the world's population whose debt problems make ours pale into insignificance. Having said that, we have a responsibility to protest against unjust proposals for our own sake and for future students. The Bible gives sensible advice on lending and borrowing for us now as borrowers and in the future as potential lenders. Taking a responsible view to our financial situation can make a real difference to the amount that we end up owing when we qualify. Finally, even in our current position, we have a reponsibility to be generous with what God has blessed us with. Our money needs to be seen as it is: a gift from God in our care.

  1. Westall J. No fee for final year medical students. Student BMJ 1997;5:358
  2. Westall J. Free education - rest in peace. Student BMJ 1997;5:266
  3. Westall J. No fee for final year medical students. Student BMJ 1997;5:358
  4. Ibid
  5. Lord H. Student Soapbox: Dearing Report Student BMJ 1997;5:302
  6. Chester T. The Chains of Injustice. London: Tear Fund,1996:6
  7. Saunders P. Death by Debt. Journal of the CMF 1993;July:3-7
  8. Minerva. Student BMJ 1993;1:578
  9. Lv 19:18
  10. Ex 22:25; Lv 25:35-37; Dt 23:19,20
  11. Dt 23:20
  12. Lk 6:32-36
  13. Saunders P, op cit
  14. Ezk 18:8,13,17 with NIV footnotes
  15. Mills P. The Old Testament Ban on Interest. Jubilee Centre Working Paper
  16. Saunders P. Dionysius Dialogues. Nucleus 1995;October:28-34
  17. Pr 22:7
  18. Lv 25:39-46
  19. Tondeur K. A Student's Guide to Better Money Management. Credit Action at 3 Hooper Street, Cambridge CB1 2NZ. (01223) 324 034
  20. Chikwe J. Money Matters. Student BMJ 1995;3:340-342
  21. Detailed advice is available from the Association of British Credit Unions Ltd (ABCUL), Unit 307, Westminster Business Square, 339 Kennington Lane, London SE11 5QY (£2 including P&P)
  22. 2 Cor 9:6-8
  23. Mk 12:41-44
  24. Nu 18:21-32
  25. Phil 2:4
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