The potential impact of higher course fees on career choice

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Conference Paper

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Hays, R., Lockhart, K., Teo, E., Smith, J., & Waynfoth, D. (2015). The potential impact of higher course fees on career choice. Paper presented at the AMEE Conference. 5-9 September, 2015. Glasgow, Scotland.

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Most Australian medical student places are government-supported, reducing the cost of tuition to about $10,000 each year, but some private places with fees cost up to $60,000 per year. In North America, debt at graduation is associated with different career choices. We explored the relationship between potential debt at graduation and future career preference.

Summary of Work:

Data were accessed from the Medical Schools Outcomes database Exit Questionnaire for both government-supported and full fee paying (FFP) students from 2008-11 in all Australian medical schools. The influence of gender, age, relationship status and fee-paying status on future career preference (specialty and location) was explored through logistic regression analysis.

Summary of Results:

Domestic FFP students were more likely to nominate as their first preference both urban locations (OR 5.58; 95% CI 2.04-15.26) and higher income specialties (OR 1.37; 95% CI 1.07-1.75), and less likely to nominate ‘in-need’ specialties, specifically general practice (OR 0.48; 95% CI 0.30-0.78). Being married or older increased preference for rural location (OR 0.64; 95% CI 0.15-0.22) and general practice (OR 0.89; 95% CI 0.82-0.96). A rural background increased preference for rural location (OR 0.18; 95% CI 0.15-0.22) and ‘in-need’ specialties, as did being older on entry to medical school (OR 0.96; 95% CI 0.94-0.98). International FFP students were more likely to prefer urban practice (OR 1.77; 95% CI 1.16-2.68).

Discussion and Conclusions:

Domestic FFP graduates are less likely to prefer careers in rural locations and in lower paid, ‘in-need’ specialties, particularly general practice. Current workforce implications may be relatively minor, but should fee contribution levels rise or more FFP places become available, consideration should be given to potential impacts on workforce distribution.

Take-home messages:

Should medical course fees rise, it may be necessary to uincrease financial incentives to encourage choice of lower paid career pathways.

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