If you find yourself in the accident and emergency ward in the middle of the night and are wondering which of the junior doctors it would be best to bet your life on, here’s a tip: keep an eye out for the medics who look a little older, a little calmer and a little less hunted. They tend to be the doctors who went to medical school after having completed a degree in a different subject - the graduate-entry medics. And this is what they’re like: they hit the wards in those terrifying first years with a bit more maturity and are generally better prepared than their peers who headed straight into medicine.
But graduate entry to medicine runs the risk of becoming a casualty of the tuition fee hike. At the moment, students who have already done a degree before entering medical school can choose either an accelerated four-year medical degree or a more traditional five-year course. Those enrolled on four-year courses have, until now, been ineligible for maintenance loans from the Student Loans Company. However, they get support towards their tuition fees in all but the first year of their studies. Graduates who enrol on a five-year course, meanwhile, are eligible for a loan but get tuition fee support only in the final year - and beyond if they decide to study for a BSc or MB PhD. In both cases, the tuition fee support comes from the NHS Bursary Scheme, which makes entry to a medical degree programme, as a graduate, just about affordable - but only just.
For both versions of the graduate route through medical school, the new fee cap of £9,000 a year will present a significant financial hurdle. Furthermore, there remains the very real possibility that the Department of Health, itself facing a hefty rise in the contributions it has to make as a result of the increase in fees, will eventually withdraw its support for the NHS Bursary Scheme. Combined, these two changes would make graduate entry to medical degrees an unworkable proposition for all but the very wealthiest of individuals.
Supporting graduates who want to go on to study medicine helps to diversify intake. Medical schools have long sought to attract a body of students that more closely resembles the demographic of the real population it will one day treat. And while graduate entry to medicine is by no means a complete solution to the problem of how to attract traditionally under-represented socio-economic groups to medical school, it is a good start. Graduate medical students are different in terms of ethnicity, philosophy, academic approach and accumulated life experience and tend to come from lower income backgrounds; they bring a texture to the course that is otherwise absent.
For large numbers of graduate medical students, pursuing medicine simply wasn’t an option earlier in life. For some it was never flagged as a realistic possibility; for others personal circumstances got in the way; for many it’s just that the vocation reveals itself later in life. And medicine is a career that is all about vocation, about duty of care and public service. Don’t get me wrong, the Establishment does its best to kick that the hell out of you along the way, but as an applicant these principles are your first motivation.
Last week, there was a glimmer of hope. David Willetts, the universities and science minister, announced a set of temporary measures that - for the time being - would help protect graduates currently enrolled on four- and five-year courses. For now, the NHS Bursary Scheme will remain intact, and those graduates enrolled on four-year programmes will be eligible for reduced-rate loans. This is laudable, and the measures buy the minister time while he thinks the problem through. But the future of graduate-entry medicine remains uncertain.
There are some harsh realities to face. If the NHS Bursary Scheme continues, higher tuition fees will likely cost the DoH tens of millions of pounds a year. But it is also true that the Department for Business, Innovation and Skills stands to save a similar sum due to the reduction in the amount the Higher Education Funding Council for England provides to subsidise tuition fees. So, depending on which way you do the numbers, the net result is in fact more or less cost-neutral to the government.
In the end, medical degree courses that enrol graduates benefit the patient, the health service and the individuals enrolled on these courses. They are essential to the modernising of medical careers and the diversification of the workforce.
By trading the losses incurred by the DoH against the savings made by BIS, there is perhaps a more permanent solution to be had. This is one of those occasions when “joined-up” government should behave as though it were truly joined up and move to protect the future of these programmes.