The Cost of Medical Education

2Scoops

Here's an issue that has bothered me for a while. Why is the cost of training a medical student in Ireland frequently estimated to be €100-200k? I think it is important to find out how this figure is arrived at because it is being used by some people to support a case for 'return of service' for Irish graduates.

Why is it so high? Unless things have changed drastically in the last few years, my understanding is that most students come in, get lectures in early years not dissimilar from any other college course; then, later in their training, attend the wards and are generally responsible for their own learning, attached to teams that will work away whether they are there or not, with occasional tutorials sprinkled in by NCHDs or consultants who happen to be around. Of note, these doctors, by and large, are not paid for this teaching outside of any academic commitments they may have in their contracts.

So, basically, where does the money go? Students learn independently and what few teachers they have are, apparently, not reimbursed by their colleges. How on Earth do we arrive at a €100-200k figure per student?

With what little information I have, my suspicion is that the figure is a hypothetical based on the fees paid by foreign students (which create record profits for colleges, not break-even balance sheets!), or else is using the going rate for academic consultant salaries to inflate the figures, disregarding the fact that it is only a portion of their duties. But I can't believe it's a legitimate cost. Any insight is appreciated.

chocksaway

Im not 100 percent sure but it might be because of a lot of equipment or reagents and materials required for the practical side of things. I know from my chemistry undergrad that a lot of the stuff we used cost a shed load of money and similarly with other lab stuff that I'm using now. Just a guess though

2Scoops

But what consumables are students using? Very little really, since they are mostly just taking histories. And definitely not a few hundred grand's worth each!

chocksaway

2Scoops wrote: »

But what consumables are students using? Very little really, since they are mostly just taking histories. And definitely not a few hundred grand's worth each!

No not really. There's a heavy enough amount of practical stuff to do too.
Dissections, microbiology and the likes. You'd actually be suprised of the amount if you added it all up. But it'll only be party of it too. Lecturing hours are probably counted too. The consultants will get paid extra for lecturing

2Scoops

chocksaway wrote: »

Dissections, microbiology and the likes. You'd actually be suprised of the amount if you added it all up. But it'll only be party of it too. Lecturing hours are probably counted too. The consultants will get paid extra for lecturing

Granted, I don't know how much it costs to preserve cadavers every year, but I can't see it being very expensive. Microbiology? Students are lectured, they're not in the labs bar maybe a few practicals where the most expensive thing on the bench is an agar plate.

I agree consultants are paid for teaching and many are on academic contracts, but only a part of their salary should be used to calculate the cost of training a medical student, because it's only a part of their job (frequently the smallest part!). Which is my main question, really - where does the 100-200k figure come from? Because if it's being artificially inflated based on the total earnings of academic consultants, then it's a completely bogus figure. And, consequently, any 'return of service' arguments are total nonsense.

Dingle_berry

2Scoops wrote: »

Students learn independently
.

So if students learn independently who directs what they learn? Who sets the syllabus? Who examines their learning? Who acts as second examiners? The permanent teachers are mostly doctors themselves who have left clinical medicine to some degree and they aren't teaching for free! And they wouldn't leave a consultants post for the pay a science or arts lecturer gets either.

When students are in the hospitals, clinics and surgeries, who insures them? (Trips and falls not just professional). They aren't employed by the hospital or HSE. How much more would insurance cost if you were putting your students into buildings full of pathogens, sharp objects and some crazy people? Compared to a big lecture hall?

I've heard that an arts degree costs €6K a year to teach. Science €7-9K. Medicine €13-15K Im also told the government pays a max. of around €10K per student. So the med schools invite forgien students and charge them the cost plus the outstanding balance for a few of their irish/EU classmates.

2Scoops

Well, I don't deny that salaries are a large part of it, I'm just questioning if it really puts the cost into 6 figures. The insurance thing I didn't think of - I wonder how much it actually is per student?

Biologic

The hospitals themselves are payed by the colleges for hosting us too. I was told the figure by a consultant a few months back but can't remember. It certainly wasn't staggering, and wouldn't put much of a dent in the 150k quoted.
I'd also imagine a lot of cash goes into the logistics of it all. My school seems to have an army of support staff organising placements, IT, accommodation, allowances etc.
I completely agree though, the figure seems way off. Taking an average estimate of 150k to train an intern, this works out at about 1000 per week in med school for a 9 month academic year. I'd have trouble accounting for 30% of that figure.

dissed doc

2Scoops wrote: »

Here's an issue that has bothered me for a while. Why is the cost of training a medical student in Ireland frequently estimated to be €100-200k? I think it is important to find out how this figure is arrived at because it is being used by some people to support a case for 'return of service' for Irish graduates.

Why is it so high? Unless things have changed drastically in the last few years, my understanding is that most students come in, get lectures in early years not dissimilar from any other college course; then, later in their training, attend the wards and are generally responsible for their own learning, attached to teams that will work away whether they are there or not, with occasional tutorials sprinkled in by NCHDs or consultants who happen to be around. Of note, these doctors, by and large, are not paid for this teaching outside of any academic commitments they may have in their contracts.

So, basically, where does the money go? Students learn independently and what few teachers they have are, apparently, not reimbursed by their colleges. How on Earth do we arrive at a €100-200k figure per student?

With what little information I have, my suspicion is that the figure is a hypothetical based on the fees paid by foreign students (which create record profits for colleges, not break-even balance sheets!), or else is using the going rate for academic consultant salaries to inflate the figures, disregarding the fact that it is only a portion of their duties. But I can't believe it's a legitimate cost. Any insight is appreciated.

And a 3rd SpR has cost the state perhaps €600,000 over the years since internship on training. This is the next wave of slander; it will be calculated based on the salaries paid for a NCHD over 8-9 years.

It's all a matter of perspective. The perspective in Ireland is: doctors are the state's property and slaves to the public.

bill buchanan

The figure has always bewildered me, as has the massive (as a proportion of the figure) discrepancy beteen the higher and lower end of the estimate (100-250k as an "estimate", which is the figure we were always told, has such a huge margin for error that it doesn't sound like it came from somebody who really knew what they were talking about).

But basically I don't care. As an intern or SHO, the money you save the country, relative to your cost of training above what training a science grad costs, is probably acceptable (in terms of not only DALYs and QALYs but in terms of free overtime and not having to pay admin staff to do the crap that we had to do etc and teaching students who bring in cash from their unis etc).

I have zero guilt about leaving the country. It would need to cost about 5 million to train me before I'd feel I haven't paid it back in spades :P

his_dudeness

It is an interesting point that has always puzzled me too; most of the teaching I got in Final Med was from NCHDs who took time out of their day to give us ad-hoc tutorials. There were a small number of fulltime tutors to ensure a consistent level of the cirriculum was covered but the majority of the learning was free or self-directed.

The "return-to-service"/"indentured service" discussion is one that really irks me (had a discussion on national radio with a certain emergency consultant about this a few months back). If there were viable options to wholly complete a training scheme in this country in the private sector, it might be a plausible arguement, but as it stands, all training schemes, and the vast amount of NCHD posts are in the public hospitals, thus all the "service" is going straight back to the public.

Dingle_berry wrote: »

The permanent teachers are mostly doctors themselves who have left clinical medicine to some degree and they aren't teaching for free! And they wouldn't leave a consultants post for the pay a science or arts lecturer gets either.

A lot of the actual clinical tutors tend to be registrars at various levels of training, and the academic salaries can actually be a bump in take-home pay as opposed to the comparative hospital salary. (At least the tutor job I did)

I would suspect that many of those that make the move to fulltime teaching and left clinical medicine behind would also have factored in the loss of earnings with the lack of overtime.

HeadPig

I'd imagine it's a grossly exaggerated sum to guilt us into staying as slaves in Ireland. Every course has lecturers and examiners. We just have to pay a bit extra for teaching from docs. We aren't the only students using cadavers, and we only look at them for less than 2 of the 5 or so years of medical training. We use basically no consumables or lab equipment.