The pressures upon medical academia mean that our medical education and research is under great threat. This is down to the new Health and Social Care Bill, changes to university fees, and modifications to the funding of clinical teaching. Students are being deterred from entering academic medicine.
Medical students starting their training in 2012 will face up to £70,000 debt on graduating, due to the governments’ increase in university fees to £9,000 per annum. This would increase further if you chose to undertake any postgraduate training or intercalation studies. £70,000 debt, effectively a second mortgage for graduates, is a massive disincentive for many medical school applicants. It asks potential medics to decide between altruism versus income. It is likely to result in a population of medical students that does not accurately represent our society.
So, what does this mean for further education in medicine? Intercalation is a popular and enriching opportunity for many medical students. A year in research or study in a particular field of interest is an important part of academia and future educators. An extra year or more of fees could dissuade students from investing time into further learning. Yet, our medical community needs education and research for us to move forward and improve.
Further challenges arise with the proposals set out in the National Health Service reforms. The Health and Social Care Bill 2011 represents the biggest shake-up within the NHS since it began. It comes at a time that our economy is financially struggling and society is facing more and more health problems. Despite the significance of research and education in tackling these problems, the bill makes little mention of research and no mention of medical education.
With regards to the government’s plan to change to a GP commissioning consortia in the NHS, Michael Rees, co-chairman of the Medical Academic Staff Committee (MASC), says “we do not want to see medical education reduced to issues of price and we do not want to see research falter and fail because no one on these consortia has the knowledge to deal with these issues.” He also expressed MASC’s concern that the provisions in the white paper, “Developing the Healthcare Workforce” laid out by the government, will sweep away existing academic structures that work.
The medical Service Increment for Teaching (SIFT) supports the additional costs incurred by NHS organisations in providing clinical placements for medical undergraduates in England. It is not, however, a payment for teaching; rather it is designed to ensure that the NHS supports undergraduate medical education. Modification to the SIFT funding contributes to the destabilisation of medical academia in this country.
Over the past 15 years, the number of medical academics has halved while the number of students entering medical school each year has almost doubled. The current academic base can barely handle the large student to teacher ratio, without adding any of the proposed changes discussed above.
The future of clinical research networks is yet to be seen in a new NHS system. Nonetheless, research is an important part of our health service. By exploring and analysing areas of medicine, it brings about new techniques and innovative changes to health provision that helps improve healthcare.
Despite a depressing mix of components, speaking at the Conference of Medical Academic Representatives 2011 (COMAR), Sir Alan Langlands reassures us that “the glass is still half full.” Sir Alan, the chief executive of the Higher Education Funding Council for England, is responsible for promoting and funding high quality education and research in universities and colleges with Higher Education programmes. He believes that the long term outlook for medical education is positive, and that the NHS has ended its once casual relationship with science. However, he urges that investment in clinical academic medicine is tremendously important and should remain a key aspect of medicine.
Medicine today is facing several “grand challenges,” including climate change, global health, technological advances, and international relations, amongst others. With our population nearing the 7 billion mark and the increasingly aging demographics, a decrease in public funding makes these challenges even greater. Teaching and research in medicine is one of the major ways in tackling such issues.
However, with academic routes less appealing in the current circumstances, something has to be done to ensure that the significant leadership skills of medical academia remain an important aspect of the NHS and medicine as a whole.
Sarah Welsh is the Clegg Scholar, BMJ