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Fee fi fo fum. Opposing full-fee students is dumb

Andrew Laming

by Andrew Laming

11 Sep 05:35am

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Filed under: Education, Fees, Medicine, Students, Universities

34 comments

Buying your place in medical school. It evokes images of lazy rich kids displacing slaving battlers out of the noble caring profession of medicine to keep elite societal structures intact. The truth is actually the complete opposite.

Without committed, fee-paying students, our hospitals would be on a skeleton staff

That’s what makes last week’s attack on full-fee paying places by Australia’s Medical Students’ Association (AMSA) so surprising. Apparently arranging a loan to study generates inequities of some sort. Being such a long-held view, it’s probably time for a re-think.

Australia can be proud of its blended public and private service provision. We do it better than any other nation. Roughly half of us take out private health cover and over a third attend non-state schools.

In yesterday’s fee-paying fatwa, published on the Medical Observer, AMSA opposed private students because medicine is chronically and severely under funded. That doesn’t even compute. One would have thought that each $125,000 of new money from fee-payers would have eased this concern for universities.

They claim private students simply cannot afford to foot the bill, but surely that is a personal decision, not one for AMSA. Last, AMSA fears paying the full fee, rather that the publicly subsidised fee, would deter disadvantaged students. But student loans are granted on future earning capacity and ability to repay, not on whether you arrived as a refugee or have English as a third language.

Truth is, fee-paying places help the slaving battlers displace the rich lazy kids. Perhaps that is what makes the medical students nervous. Fee-payers are typically passionate, demanding and utterly committed. They are worthy additions to the cohort.

That is why we need to move away from the notion that a medical place exists only if government funds it, to where government funds a proportion and the remainder are left to the market. The current workforce crisis is ample evidence that exclusively government-funded places got us into the severe shortages we are now correcting.

If Australians who meet university entry criteria want to pay their way, let them. After all, each fee-payer is one less person whose uni bills are paid by Aussie tax-payers, most who will never get their kids to uni. Labor want every single place government funded because they are petrified by the ignorant stereotype of trust babies rolling through medicine for no better reason than they can. With medicine increasingly not viewed as an ‘easy money’ degree, such a stereotype is correspondingly rare.

By definition, those with top marks will take the ‘free place’ paid for by you and me. Beyond that number, the question is should those who ‘just miss out’ on a Commonwealth supported place have an alternative pathway? If they are keen enough to seek out a bank loan, scholarship or grandma’s inheritance, I say, why the bloody hell not? If you really want that career, then odds are you are passionate and committed. More of you I say.

For those opposed to financing a fee-paying place, there are many other avenues. They include applying to a medical school with a lower cut-off, repeating at school, re-sitting your medicine entry exams, do a year in another course then switch, or re-apply as a post-graduate.

In an era of strict medical school entry requirements, not to mention the highly competitive nature of the admissions process, I am not even remotely concerned about full-fee paying students ‘buying’ their way in to medicine. The argument is a furphy.

The hypocrisy by AMSA here is that they are happy to see overseas students pay for and study non-Commonwealth supported medical places, fight for their internship places which ultimately leads to a long and prosperous medical career in Australia – yet in the same breath, they tell Aussies also wanting to access private places to study something else.

The issue of fee-paying places is complex. It is a shame that we get nothing more nuanced than a simple ‘no’ from the political elite of the medical students.

Every dogma has its day, and it’s probably time Australia’s medical student body overcame their resistance to full-fee paying places in our medical schools.

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34 comments

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    • bec says:

      06:57am | 11/09/12

      I dunno. With my experience in the uni sector and friends who remain in lecturing and teaching there, full-fee paying students aren’t necessarily more likely to have a strong work ethic. They may want their degree even more, but along with that comes an expectation that they will pass regardless of the actual work they put into the subject.

      The number of times I’ve had conversations with friends and mentors about their experiences with being forced to pass full-fee paying students who should have failed simply because the uni doesn’t want to lose their source of income is staggering. Couple this to the fact that a lot of these students are also happy to outsource their assignments to essay mills or private tutors (if you can buy a place in a course, why not buy the work to go along with it) or just straight-up plagiarise (which one is more likely to need to do if they’re not of an intellectual or academic calibre to get into a CSP-place), and I’d say that full-fee paying places are going to attract exactly the worst kind of student to study medicine.

      Reply

    • Aaron says:

      03:31pm | 11/09/12

      I’m currently studying engineering and it’s a very similar situation. I would guess that roughly 2/3rds of the students in my class are full-fee paying students. Of these, a very large number (roughly 60-70%) still struggle with very basic engineering concepts, and this is the final year of the degree. These are the people who will be designing the planes that you fly in, and I find it disturbing. My uni was actually pulled into a Senate enquiry for giving unfair advantage to these lazy full-fee students, allowing them to resubmit assignments and re-sit tests. In one case these students were actually given the end of year exam paper before the sitting date.

      By no means am I implying all full-fee students are lazy and incompetant, in some of my groups the full-fee students are some of the most competant and hard working and I definitely commend that, but the majority are simply buying their degree.

      It’ll be the same in medicine, it’ll be the same in other disciplines. Full-fee students expect a return for their money, whether they work for it or not. Degree’s should be earned, not bought.

    • rat says:

      06:58am | 11/09/12

      I would agree with this, provided that applicants still are required to meet a minimum GAMSAT or UMAT score, say five points under the CSP or bonded cut-off.
      Any other Puncher sitting GAMSAT 2013?
      Eff you Ochem.

      Reply

    • Bitten says:

      09:16am | 11/09/12

      Here. Having missed out consistently by 1 GAMSAT score for UQ for the past 2 attempts, I’m hoping this year’s my year. (Well, next year smile )

    • bananabender says:

      11:08am | 11/09/12

      @Bitten

      just apply to another university with lower entrance requirements eg Newcastle.

    • TheHuntress says:

      11:47am | 11/09/12

      I’m looking to sit the GAMSTAT in 2013. I have no objection to full fee paying students as long as they meet the same entry criteria as everyone else and are correspondingly marked throughout the degree at the same level as everyone else. I would not be happy if I found out people who should be failing are passing because they are full fee paying. It happened in my undergrad degree and it irritates me as I get dragged down on the bell-curve because of it.

    • acotrel says:

      07:21am | 11/09/12

      When I was in the sixth form at Melbourne High School in about 1960, there were 300 boys studying for their matriculation exams,  - 90 became medical doctors.  ... ‘Those that can do, those that can’t .... ’ ?

      Reply

    • bananabender says:

      10:52am | 11/09/12

      The cut off score for medicine was VASTLY lower in 1960 than it is today. Entrance scores for medicine didn’t become extremely high until the mid 1980s.

      Currently a student with a maximum ATAR score of 99.95 isn’t guaranteed a place in an undergraduate medical course.

    • acotrel says:

      07:24am | 11/09/12

      ’ Fee-payers are typically passionate, demanding and utterly committed. They are worthy additions to the cohort.’

      Nice to see people motivated for the right reason - Money !

      Reply

    • KH says:

      07:35am | 11/09/12

      Wouldn’t universities be encouraged to favour full paying students over the commonwealth supported ones because there is more money in it?  No matter how you look at it, you can only have so many students at one time, as eventually there are only going to be so many residencies at one time.  Lets say there are 100 places - how do you determine how many are full fee paying and how many are supported?  What if there are more than 100 candidates of high quality that would all be commonwealth supported, and say 60 people willing to pay full fees, but most of whom scored lower on entrance requirements to the potential supported students (but still over the university requirements) - how does the university resolve this?  Do they simply create 60 more places?  How would this work when it comes to the business end and there are still only 100 residency places?  Do they kick out 60 high quality supported students and take the ones with money?  Does this revenue mean extra money for the university, and thus, extra incentive to take them over supported students?  I can see quite easily how inequalities would quickly creep in - and force some students who more than satisfy the entrance requirements to get loans to avoid being displaced by a fee payer.  As for the universities, they could take only the best students from the 100 who are all supported, but then the money would go to another university with lower entrance requirements, which in turn would bolster its programs and attract more first choices. 

      Its very messy - introducing the money factor will not increase places - ultimately, the community can only support so many residents - there is no point graduating 1000 students if there are only 500 places for them to complete their training.  Reduction of resident hours is not a solution - that would only decrease the quality in the end.  The money will only entice universities to actively seek those with the capacity to pay, or push other students into getting loans that they don’t want or can’t afford in order to compete for a place that they may have already qualified for.  I’m not seeing how this would inspire equality of opportunity.

      Full fee payers aren’t always that diligent either - in my personal experience of a recent return to univerity, fee payers expected to get passes ‘because they paid for it’, no matter how little work they did - there might be a difference between someone with a massive loan hanging over their heads and someone whose rich parents are footing the bill, but there is still pressure on lecturers to pass students because of the money factor - if they fail them and they drop out, that is lost revenue.

      I’m not saying that there shouldn’t be full fee paying places, but without any strict rules around it, the outcome would probably not be good for those who can’t afford loans or don’t have rich parents.

      Reply

    • Bitten says:

      09:36am | 11/09/12

      I suppose though the question becomes: why are foreign students able to pay full fees for a place in medical schools? If they’re allowed to pay, then clearly universities have capacity for more domestic students than just the Commonwealth quota. Why not have all the current medical school places available to domestic students? Once the domestic quota is filled, it’s all over for Australian applicants who stand by and watch available medical school places be filled by foreign students who are allowed to pay for their place. And, cynical arts graduates aside: yes, morons, they still have to pass. The academic criteria aren’t altered at all for these students. And they work f*ing hard, as hard as any domestic student who got into a Commonwealth funded place.

      And frankly, the suggestion that those who get in under the current strict entry criteria are ‘worthy’ but those who don’t, who miss out by a single score point or so are ‘unworthy’ and if enabled to have access to medical school by paying full fees, would corrupt the quality of the medical school education by coasting, is just offensive. Those of us who go through the process and jump through the hoops aren’t doing it because we’re a bit bored swanning around in mummy and daddy’s Porsche 4WD and are looking for something to do while we wait for our trust funds to mature. I mean, I get it: lazy thinkers enjoy stereotypes, it’s faster. Much easier to pretend we aren’t real people, that we’re simple caricatures of all that is easy in the ‘Aussie battler’ media cliche to despise. How awkward to have to acknowledge that we are real people and we might just be excluded from a place by nothing more than a cap on funding, not because we’re unintelligent lazy rich kids with nothing to do.

      I don’t know about you KH but it’s a mighty leap (and strangely suggestive of longheld envy, no?) to make the synaptic link between: ‘missed out on a Commonwealth funded place in medical school’ and ‘has rich parents’. Most of us are older and work. We pay taxes. We have families. We pay bills and mortgages. Some of us have worked peripherally to medicine and are appalled by some of the standards of care offered by current, qualified medical practitioners thanks to the recruiting short cuts taken by the Australian government in the past two decades. Some of us are willing to make sacrifices, to take cuts in income for years, to ask our families, partners, to understand and support us while we earn the education, become qualified, undertake additional training and specialise.

      Tell me that people who have considered all of those things and are still willing to do it so that the next generations of Australian citizens can have expert, compassionate and well-communicated care are poor little rich kids, undeserving of a place.

    • rat says:

      10:19am | 11/09/12

      I find your post inspirational Bitten
      I am 26 with wife, kids and mortgage. I work full time and, as stated, I am studying to sit the GAMSAT. It must be heartbreaking to miss out by one mark.
      I wish all the best for Feb- to score as high as you have previously is an accomplishment on its own in your implied circumstances (to those not in the know- get the gamsat practice test online, give yourself 25 seconds per question and try for 75-80%).

      No ubiquitous ‘spoiled rich kid’ could be tenacious enough to get that far.

      I have done (and will need to do) more work on GAMSAT prep than on my whole law undergrad.
      Why did you not go Griffith? Surely you would have got in.

    • KH says:

      11:24am | 11/09/12

      @Bitten - My example clearly stated that all the potential students might qualify for the course - there was no suggestion that they are ‘lazy’, nor was there a suggestion they are undertaking a medical degree out of ‘boredom’, or even that their parents owned porsches.  If revenue becomes a factor for the university in regard to selecting candidates, the ability of a student to pay is an advantage, is it not?  Its easier to apply as a fee paying student if there is someone else (usually parents) who can pay for you - its a much bigger decision to go into massive debt.  I would not like to see a situation where some students are forced into getting huge loans just so they can compete with those who might have parents who can pay (or trust funds etc) - we aren’t talking car loan here - this could be well into the hundreds of thousands of dollars.  Given the revenue issues for most universities, a choice between two equal candidates for one place where only one can pay the full fee is far more likely to go the way of the one with the money - that is just ‘the market’ at work, isn’t it.

      The underlying principle of my comment is that you simply can’t increase the number of places just to accommodate more fee paying students - there are only going to be a finite number of places and residencies etc - its not a bottomless pit of resources.  Universities are always looking for ways to increase revenue.  I never said that people who could pay weren’t qualified or wouldn’t do the work, just that the money makes them ‘more’ qualified than others.  Money does also contribute to a certain type of student who thinks they are purchasing a degree, not just the right to earn it - I have seen this personally - it was a separate point.

    • Nic says:

      09:02am | 11/09/12

      The problem is misrepresented here. With the deregulation of CSPs, the university will admit as many as it can teach. For examples sake, say 150 people with a cutoff ATAR of 85. If we then admit 15 full-fee payers, we have to bump the bottom 15 off the original list. So it becomes 135 full fee payers with a cut-off ATAR of 87. The full fee payers have actually paid to bump off those who did better at school, because there isn’t an infinite number of places.

      Reply

    • Michael says:

      11:50am | 11/09/12

      This is a very good point! However, i’m not sure if it’s still applicable with the deregulation of course numbers by the Govt. The effect on ATAR more or less would depend on whether the full fee payers are counted within the predetermined number of admissions or outside.

    • Mahhrat says:

      09:43am | 11/09/12

      You’re seriously telling me you’d like to pressure the youngest of us - those just coming into adulthood - to taking out loans often into the six figures?

      I applaud anyone with the drive you talk about, but I’d have to see the stats on just how many of them there are.

      That kind of debt at that age - without a guaranteed “asset” (which a degree most certainly would be) - would be considered indentured servitude in other arenas.

      As for those whose parents would pay for it and not have debt - well, why should those successful parents be “punished” financially simply for being rich?  Is this not a huge outcry from those right of the fence anyway?

      The problem with university placements is they never stop to consider what skills the country actually requires.  Now, I’m sure we could use a few more doctros, if the business of any given general practice is anything to go by.  I’m not sure how far and how many though.

      Perhaps the work to be done isn’t in what we fund, but how many we fund.  We’ll fund 100 places because we need 100 doctors.  They best 100 get in, regardless of their financial situation.

      Reply

    • wakeuppls says:

      10:12am | 11/09/12

      Is an Arts degree an “asset”? We would quickly find out by privatising student loans and seeing what an organisation (like a bank) thinks about giving a loan to a person who likely will end up working at the Maccas drive-through.

    • bananabender says:

      12:37pm | 11/09/12

      Most medical students in Australia are postgraduates. They are in their 20s - not teenagers.  There are now also many medical students in their 30s or even 40s. Bond university had 55 yo medical graduate a couple of years ago.

    • Sloan says:

      10:46am | 11/09/12

      “By definition, those with top marks will take the ‘free place’ paid for by you and me. Beyond that number, the question is should those who ‘just miss out’ on a Commonwealth supported place have an alternative pathway?”

      No, they damn well should not.

      Ever heard of a meritocracy Andrew? Some people actually believe it is something worth aspiring to..

      This whole issue only arises because the upper class kids are missing out on degrees like medicine that 20-30 years ago were considerably easier and less competitive to enter and they are now being replaced in medical schools by academically high performing kids from poorer back grounds. It burns them up inside seeing these poor trash (their words, not mine) often 1st or 2nd generation immigrant kids, pushing them down the list and into inferior degrees.

      I live in Hunters Hill and without giving away who I am to fellow residents etc, this is a real problem even in my small street. I have a neighbour a few doors down whose son was meant to follow daddy into medicine and then into the family speciality of ENT. Problem is, the kid is an idiot. I doubt he has the mental agility to work as a night filler up at Coles. He has now sat the HSC twice and still no luck. They are now looking at getting him into a BA and then switching him across to medicine at Newcastle Uni but he did not even get the marks to enter Uni. He is now doing a bridging course at TAFE. They are furious that they can not just pay full fees if they have the means to.

      This kid should not be a doctor and that is all this fuss is about. Paying cash for idiots to obtain qualifications that they are unfit to hold.

      Reply

    • bananabender says:

      10:56am | 11/09/12

      A medical degree is far better investment than a property.

      We encourage young people to get into massive amounts of debt to purchase a property.

      Reply

    • bananabender says:

      11:24am | 11/09/12

      There is a very simple solution to the whole problem. You create scholarships for most of the places and demand a return of service obligation.

      The system benefits both parties.The government can pay much lower salaries (Australian Defence Force medical officers earn about half the pay of their civilian counterparts) and have a very high retention rate. The student gets a free education and a decent living allowance.

      Reply

    • tallpoppy says:

      05:13pm | 11/09/12

      What do mean when you say Bond Uni is owned by UQ (see below)?  Please explain.

    • andrew says:

      11:29am | 11/09/12

      the university i attended had many full fee paying students, predominately from malaysian and korean backgrounds. While I doubt many of them intended to stay in Australia after graduation ( raising the argument that we are losing a skilled graduate) the reality is that they are subsisdising fees for the rest of us. I’m glad i could complete a 3 year degree with a $16K HECS debt that was easily repaid in my first year post graduation, however i imagine that figure would be doubled at least without those international students.

      Are there also full fee paying students that are Australian Citizens?

      Reply

    • bananabender says:

      01:13pm | 11/09/12

      “Are there also full fee paying students that are Australian Citizens?”

      There are Australian citizens at Bond University (owned by UQ) paying $400K for a medical degree.

    • TheRealDave says:

      11:53am | 11/09/12

      I’d rather the best 100 people got the spots rather than 90 plus 10 who could pony up the cash.

      Don’t people already have the option to pay up front? So if we take our theoretical 100 intake and 17 want to pay up front - well good on them….the rest can take out loans. Why should spaces be reserved specifically for ‘full fee’ payers?? Can’t they line up with everyone else and get in on merit first and foremost?

      Reply

    • Cynicsed says:

      12:14pm | 11/09/12

      Full fee paying medical students who score less than HECS paying students in all their entrance criteria, (including interviews and psychological testing) are stealing the places of better, less financial candidates for one reason only - the Universities’ bottom line. That’s why AMSA is protesting, and rightly so. Merit matters more than money.

      Reply

    • bananabender says:

      12:57pm | 11/09/12

      Rubbish.

      The only reason medicine requires extremely high entrance criteria is because of high course demand. The demand is high because doctors are very well paid and have high status.

      It doesn’t require a genius IQ to become a doctor. In fact mathematics, engineering and the physical sciences are arguably more intellectually demanding than medicine. [a PhD physicist typically has an IQ at least 15 points higher than a medical specialist].  A hardworking student with an ATAR of 90 or (even 80) is perfectly capable of completing a medical degree and being an effective doctor.

    • Cynicised says:

      02:22pm | 11/09/12

      It would be helpful if you addressed what I was saying, Bananabender, instead of going off on a tangential rant about relative IQ. Once again,, those applying for medical courses with the highest combined entrance qualifications should get the places, instead of entrance being granted on the candidate’s ability to pay. The number of course places is limited to the University’s ability to accommodate them. Fee paying students increase the revenue available to the institution, that’s why they reserve them. It’s simple economics.

      If you think the majority of people only apply to do medicine because of status you’re as deluded as the institutions who turn away top qualified applicants because they’ve run out of HECS places.  It’s simply unfair.

    • bananabender says:

      05:01pm | 11/09/12

      An intern earns over $100k, a GP over $300K and specialists can earn multimillion dollar incomes. if you don’t think that’s a major incentive to study medicine you are incredibly naive.

      One of my friends is an eminent consultant psychiatrist. He told me that a very significant percentage of people applying to study medicine are sociopaths. These people are driven purely by power, status and money.
      A sociopath can easily convince the admissions board that he is primarily motivated by helping the poor and underprivileged. Once he’s got his place he can then proceed with his plan to become a Ferrari driving cosmetic surgeon.

      In most countries where doctors earn modest salaries and don’t have particularly high status (eg Scandinavia) the number of students applying to study medicine is typically quite low and cutoff scores are far lower than in Australia.

    • Cynicised says:

      07:50pm | 11/09/12

      Not denying that status and earning power play a part in SOME applications, but certainly not the majority. Ever heard of a thing called altruism, and the desire to help? But of course, medical students are sociopaths by definition.

      Hoo boy….

      *backs away slowly*

    • George says:

      12:36pm | 11/09/12

      I think unis need an audit. It’s very suspicious that they’re so money hungry.

      You could have more doctors by dropping the HSC score by a couple of points.

      All the people I know who got say 96 would make great doctors. In my experience the quality of doctors isn’t the greatest even with the 99% score requirement.

      Reply

    • MF says:

      01:42pm | 11/09/12

      I work in the university system as a lecturer, and I recall with great clarity the last time the government allowed full-fee paying domestic enrollments. \

      Now granted I do not work in the medical school, but my own experience was that these full-fee paying domestic students had a sense of entitlement that far outstripped others. How do I know they were full-fee paying? I’d have them come to my office and verbally abuse me and threaten me for not giving them the marks they thought they had “paid for”. I had their parents doing the same thing.

      I think in principle it’s not a bad idea, but the reality is that many of these students believe they have this extra entitlement to get good grades (or even just to pass) because they have paid for it. Paying full fees grants you entry into the degree, it in no way guarantees you a passing grade or the piece of paper at the end of it.

      Reply

    • AdamC says:

      02:16pm | 11/09/12

      That seems more like a cultural problem than anything else. After all, some of the American Ivy League universities have coupled academic rigour with a student-pays model for centuries.

    • Shane From Melbourne says:

      01:42pm | 11/09/12

      1) Often the overseas full fee paying students are studying here to pick up permanent residency. The government needs to decouple immigration system from the education system.
      2) Full fees often do not cover the full costs of the course. Does the Australian taxpayer really want to be subsidizing the costs of educating an overseas student that may pack up and leave? (on the other hand Australia has no problem with importing overseas skilled professionals leaving other countries with the costs of educating them.)
      3) Dentists make far more money with less litigation. The smart students are in dentistry.

      Reply
 
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