Thank you, Mr. Chair and honourable members of the committee, for the opportunity to speak with you today.
Before we get into the specifics of our submission, I'd like to briefly comment on what the Canadian Federation of Medical Students is and why we're here before you today.
The Canadian Federation of Medical Students, or CFMS, is a national organization that represents over 7,000 medical students who are pursuing their education at 14 medical schools from coast to coast. We represent students in national medical organizations such as the Association of Faculties of Medicine of Canada, the Canadian Medical Association, and other groups. Additionally, we communicate national medical education issues to students, facilitate communication between schools, and provide services that support the needs of medical students. Mr. Mondoux and I are here today as the senior elected representatives of the CFMS.
The issue we're here to talk with you about today is the high debt load incurred as a result of pursuing medical education in Canada and the toll this debt load has on medical learners and their ability to function as front line health care workers. We'll close with a discussion of the solutions we propose to alleviate some of the stress and societal problems associated with these debt loads.
There's one more bit of context I have to provide before proceeding with our discussion. Becoming a fully certified medical doctor in Canada is a process that takes approximately 13 years. Most students must obtain a bachelor's degree of four years' duration, then complete a medical degree of four years' duration, then undertake a mandatory period of supervised practice, known as residency, which takes approximately two to seven years, during which they develop competency for independent practice.
The level of education-related debt learners incur over this 13-year period is $158,000, on average. This is a significant figure when you consider that the $2,000 in monthly payments required to service this debt can represent more than half a resident's take-home pay. This debt load is largely the result of the deregulation of medical student tuition in many provinces that has resulted in a tripling of the average Canadian medical school tuition. Tuition fees for medical students are three times higher than they are for other undergraduates. Tuition at some medical schools now exceeds $20,000 per annum, a figure that exceeds the maximum allowable government student loan for most Canadians. The additional costs of equipment, books, and living expenses must be covered through expensive private bank loans that accrue interest while a student is studying. They can easily exceed $100,000 by the time of residency.
This debt load is very stressful for trainees who are providing front line health care to Canadians. The monthly interest payments may be difficult to comply with and may hamper the ability of a trainee to start a family or buy a home. Ultimately, many residents only incur further debt during their training, despite having completed two university degrees and having provided thousands of hours of care to Canadians.
The cost of medical education may also be having a negative impact on the demographics in Canadian medical schools. The proportion of students from low- and middle-income backgrounds has decreased by over 20% since tuition deregulation, and students from low-income backgrounds are now severely under-represented in Canadian medical schools. Significant tuition fees and debt loads may also influence a student's specialty choice. Most studies suggest that higher costs push students away from primary care and produce fewer physicians who are willing to work in underserviced areas.
All these things considered, it has become clear to us that the government's new repayment assistance program doesn't help Canadian medical trainees.
So what do we propose? We propose that the federal government postpone repayment of principal and defer or provide relief from interest accrual on Canada student loans to medical trainees until after completion of their residency training. Interest relief programs already exist in at least five provinces--Alberta, Ontario, Nova Scotia, Newfoundland, and Saskatchewan. We're thankful for these programs, but unfortunately, these programs could actually negatively influence physician distribution in Canada by preferentially attracting students to provinces with interest relief.
Starting this fall, a student from British Columbia who chooses to do a residency in Ontario rather than in British Columbia could save tens of thousands of dollars by choosing to train in Ontario, because Ontario has an interest deferral program that defers payments on all government student loans in exchange for a five-year return-of-service agreement. Once a trainee has completed five years of residency and an additional five years of return-of-service, that trainee will likely have strong ties to Ontario and will be unlikely to relocate.
A national program of interest deferral could ensure that trainees practice in their province of choice, most often their home province, and not in the province with the most attractive incentive package. The potential for unequal physician distribution as a result of unequal interest relief is one reason we believe the government should adopt our second recommendation: a unified national strategy for debt relief for medical residents.
Our last recommendation is that the federal government increase the yearly limit on student loans for medical students, given that tuition fees alone often exceed maximum medical student loan amounts available, which forces students to seek even more expensive loans from private financial institutions.
It's our belief that a national program that provides interest relief to medical trainees and provides increased government funding to help them pay for their education will decrease medical training stress, help prevent an unequal distribution of physicians across the country, and ultimately will help improve the care that Canadians receive from this important group of health care providers.
Thanks very much. I look forward to your questions.