When Benjamin Hoyt married a fellow medical resident last month, the joyous event was tempered ever so slightly by stark financial reality.
"Between the two of us, we have $212,000 in debt," Dr. Hoyt said.
And the borrowing has just begun.
He is specializing in otolaryngology and his spouse, Lynda, in psychiatry, so they have ahead of them several more years of specialized training that could double their debt load.
The Halifax couple already pay more than $900 a month in interest, and they are not alone. As tuition fees soar at medical schools across Canada (with the exception of Quebec), graduating with a mortgage-sized debt is becoming the norm for future doctors.
"I can't remember exactly what the average debt was in my graduating class, but it was astronomical," said Danielle Martin, president of the Canadian Federation of Medical Students.
"Debt has become the driving force in students' lives. It causes tremendous stress, it's influencing career choices, and it's affecting our ability to get on with our lives and do normal things like having a family and buying a home," she said.
At 28, after four years at the University of Western Ontario, Dr. Martin has $110,000 in debt. She receives a salary of just under $40,000 as part of her residency in family medicine, a sum that allows her only to get by while living in downtown Toronto.
"I have to continue to borrow to break even," she said.
"I have $400 a month in interest payments on my student debt, and I'm paying that on a personal line of credit."
Today's edition of the Canadian Medical Association Journal features a lengthy article on students' rising debt, a problem it says stems from soaring tuition fees and the changing educational landscape.
Annual tuition at the University of Toronto's medical school now exceeds $16,000, and half of Canada's 16 medical schools now charge more than $10,000 a year. Only in Quebec, where tuition fees have been frozen for years, is the cost of medical school similar to the cost of studying arts. The country's lowest tuition is $2,224, at the University of Montreal.
Another factor is that most medical students now complete undergraduate degrees before attending medical school, which lengthens their studies and increases debt.
Irfan Dhalla, co-author of a recent CMAJ article on the impact of soaring tuition fees, said the real problem with the rising cost of medical school is that it closes the door to people who are not wealthy, meaning that members of under-represented groups like visible minorities and the poor will have trouble becoming doctors.
A large debt also pushes medical students toward more lucrative specialties and away from lower-paying but essential fields such as family medicine and public health, Dr. Dhalla said.
Already, hospitals are having trouble filling residency spots for future family doctors.
A costly practice
Tuition fees at Canadian medical schools 2003-04 *(1)
School: Tuition
U of Toronto: $16,207
U of Western Ontario *(2): $14,566
McMaster U: $14,445
U of Ottawa: $14,000
Queen's U: $13,500
Dalhousie U: $10,460
UBC *(3): $10,272
U of Calgary: $9,932
U of Saskatchewan: $9,774
U of Alberta *(4): $8,539
U of Manitoba *(5): $7,595
Memorial University: $6,250
McGill U: $3,559
U of Sherbrooke: $2,729
U of Laval: $2,502
U of Montreal: $2,224
NOTES:
Students must pay other fees in addition to tuition. The total at U of T, for example, if $17,297 and at McGill $5,610.
Students in fourth year pay 4th year pay $10,924.
For new students; $8,415 for students who started in 2002; $7,480 for those who started earlier.
Includes a $2,000 differential fee.
$7,278 in years 2, 3, 4 of school.
SOURCE: CANADIAN MEDICAL ASSOCIATION JOURNAL
André Picard