Medical education: at what cost?

The cost of medical education in comparison to the poverty level

The World Bank has set the international poverty line at $1 for every person a day. People considered to be living in “absolute poverty” if their income is below this line. By this measure, 1.2 billion people are currently living in absolute poverty in developing and transitional economies.¹ The Human Development Index shows that even in affluent industrial countries, 7-17% of the population is poor, which adds more than 100 million people to this number.²

Although poverty is rife throughout the world, the cost of medical education remains high in developed and developing countries and is set to rise further. Research conducted by the Association of American Medical Colleges in 2004 has shown that the average tuition fees at state medical schools during the 2003–4 academic year amounted to $16 153, and the corresponding figure for private schools was $32 588. In the 1984-5 academic year, average tuition and fees were $3877 at state medical schools and $12 973 at private ones. In 19 years, the cost has therefore increased by 317% and 151%, respectively. Further, adding $20 000–$25 000 for living expenses, books, and equipment brings the estimated cost of four years of attendance to about $140 000 and $225 000, respectively.³ This continuing escalation has been accompanied by an enormous increase in the average debt of graduating students. Furthermore, applications to medical schools have dropped from about 47 000 in 1996 to 35 700 in 2004.³

In a developing country such as Nepal, where 31% of the population lives below the poverty line⁴ and where the income per head is $240/year (in 2003)⁵⁶, a medical degree costs $25 …