OMA fights rising tuition fees with bursaries, other provinces to follow suit
=============================================================================

* Barbara Sibbald

With Ontario's medical school tuition fees more than doubling in the past 2 years, the province's doctors are being asked to help raise $8 million for a new Ontario Medical Student Bursary Fund. Other provinces are following that lead in the face of high tuition fees and related concerns about equitable access to education.

The Ontario Medical Association is spending $500 000 on its campaign, a sum that the CMA and its financial subsidiary, MD Management Ltd., has matched. The CMA and MD Management have committed $1.7 million over 5 years to help provincial associations set up bursary programs. The funding arrives at a crucial time because tuition fees have at least doubled at 10 of Canada's 16 medical schools in the past 7 years (see Table 1). Quebec and British Columbia are the only provinces where tuition fees have remained relatively stable. An ad in the Manitoba Medical Association newsletter is a sign of the times. It encouraged doctors there to contribute to the Manitoba Medical Students Association Bursary Fund. "No contribution too small," said the ad. Several CMA divisions, including New Brunswick, Saskatchewan and Alberta, hope to have bursary programs established by September.

View this table:
[Table1](http://www.cmaj.ca/content/162/10/1477/T1)

Table 1: First year student tuition fees at Canadian schools medicine ($) 

"Fees are a deterrent to potential medical students," says Dr. Briane Scharfstein, executive director of the Saskatchewan Medical Association. In addition to a bursary, the Alberta Medical Association is lobbying governments for solutions, such as deferring repayment of loans until after residency.

The first $200 000 donated to the OMA program, which was set up in consultation with its student section and in partnership with the Ontario Medical Foundation, will be matched dollar for dollar by the Ontario government. The goal of the OMA bursary is to provide at least $2000 to each medical student who demonstrates need. About a third of the 2000 undergraduates at Ontario's 5 medical schools meet the criteria. "From the OMA's perspective, the great concern is that people won't enter medical school because of the cost," says OMA President-Elect Albert Schumacher. His total debt upon leaving the University of Western Ontario in 1982 was $4000, and his final-year tuition fee was $1200. Today, says Schumacher, one-third of Ontario students will be leaving medical school $100 000 in debt.

His concerns are shared by the Canadian Federation of Medical Students. CFMS president Tara Marie Mastracci says rising tuition fees and increases in debt load are bound to inhibit accessibility to the field. "The demographics of the physician population should at least try to match the demographics of the population as a whole," adds Mastracci.

"We might end up deselecting certain groups," agrees Schumacher. "The only ones who will apply are those who are well off, and immigrant and other groups will be missing."

Ontario's tuition fees are the highest in the country due to the 1998 deregulation of fees for some undergraduate professional programs, including medicine. The average 1999 tuition fee for first-year medical students in Ontario was $10 387 - a 108% increase over the 1997 average. Mastracci worries that other provinces will follow Ontario's lead; last year the CFMS formed a national task force to address these financial issues, and it is actively lobbying professional associations and others for assistance. The task force is also asking governments to put their assistance on par with tuition fee hikes. For instance, Ontario will lend $4000 annually for tuition, but fees at McMaster are now $13 000.

The CMA and MD Management decided in December to combine forces to match the bursary contributions from provincial medical associations, but the associations or schools will manage the funds. The CMA has also formed the National Professional Association Coalition on Tuition. Members are from fields such as law and engineering, where tuition fees are also rising. It will attempt to negotiate reasonable tuition fees and ensure that financial support exists for students, says coalition chair Dr. William Easton. "We all fear the impact of the tuition increases," he said.