‘It is isolating’: Medical students are struggling to get by on ‘unliveable’ funding

When Erin went into her fifth year of medical school in Birmingham, her funding nose-dived by a third, making her have to live on a “simply not sustainable” annual budget of £2,900. This amount can’t even cover her rent, but like most med students at this point in their degrees, she’d also started working alongside junior doctors, attending a full-time unpaid placement that comes with extra expenses like formal clothes and transportation. All of these are in addition to trying to keep up with her studies and exams.

“This is forcing final year students to take on additional jobs just so they can afford rent and put food on the table, leading to burnout before they’ve even started work,” she told The Tab.

‘It’s simply not sustainable for final year medical students’

Many students have experienced barely surviving on student loans, but at least they can breathe a sigh of relief after three years. Medical students, on the other hand, have to struggle through an additional two years living on government bursaries that have proven to be far from enough.

Here’s how a typical med student is funded in a nutshell: the first four years are funded by Student Finance England (SFE), while the fifth (and potentially sixth) year will be funded by NHS bursary – possibly also with a reduced loan from SFE.

For Erin and many others involved in the #LiveableNHSBursary campaign on Twitter, the problem came when future medics were expected to live off NHS bursary in their final years, when funding often drops significantly from the years before.

The Tab spoke to founders of the campaign to understand how this has impacted their daily lives, studies, and the medical field as a whole. 

‘In an ideal world, I would not work in the run up to my finals in January, but instead I’m applying for a second job’

While Millicent, a London med student, says the problem with NHS bursary is “absolutely nationwide,” it is particularly difficult for med students in expensive areas.

As someone whose dream had always been to go to uni in the capital, she now thinks she wouldn’t have made this decision if she’d known how difficult it’s to live here.

“It’s not as simple as us living in a horrible place for a lower cost, because in London there would be many people in line for somewhere like that!

“Before [NHS bursary], I was on maximum student loan and was able to live comfortably. I was able to concentrate on the stress of revision and becoming the best doctor I possibly can be. But with the NHS Bursary, I am constantly stressed about my financial situation. I’m even more worried as I am about to embark on my final year, where we receive a further drop in the money we receive.

“In an ideal world, I would not work in the run up to my finals in January, but instead I’m applying for a second job,” she said.

‘There is a stigma attached to having an active social life’

Trisha is a third year med student and a London rep for Doctors Association UK (DAUK). She’s not on NHS bursary yet, but as a lower-income student who entered the programme feeling like “the poorest of the bunch,” she’s worried that her already-stretched finances will take a further hit going forward.

Aside from being “unliveable,” she thinks the underfunding is also harmful in chipping away at her social life. Her filled schedule and capped budget have made it “hard to maintain friendships as you find yourself constantly excusing yourself from outings and plans.

“I am part of a hockey team, but I can count the number of socials I’ve been to in three years on one hand, one. It is isolating and embarrassing. But moreover, it is tiring – you have less opportunity to de-stress and clear your mind following sometimes emotionally challenging days at placement,” she said.

Millicent echoed this, saying that “there is a stigma attached to having an active social life, but it is something that is for many great for a balanced and healthy life and mental health.”

‘It shuns out those who can’t afford to do the course’

The students The Tab spoke to also feel how inaccessible med degrees have become due to the inadequate funding has broader impacts on medicine as a whole.

Trisha thinks even though med programmes “already attracts applicants from more affluent families” with financial barriers like interviews and work experience requirements engrained into the admissions process, those who get in still have to be filtered by whether they can keep up with the tuitions.

“Many low-income students leave a full day of placement and go straight to night shifts, sleep for an hour or two, and then return to placement. There is no time to do CV building in medical school with research projects or expensive conferences, meaning richer peers get ahead and are more likely to become surgeons and cardiologists of the NHS – competitive specialities.”

But she also noticed that “because of how dismal funding is in those final years, even middle-income families also struggle.” She’s been told by middle-income students through the campaign that their parents are still expected to pay “in the region of £5,000-£8,000 each year” with the bursary.

“With the cost-of-living crisis, how many families can afford to do that?”

While shunning out “those who can’t afford to do the course,” Erin, who’s the West Midlands rep for DAUK, thinks the degree is also inaccessible to herself as a student with a disability.

“Due to my condition, I am unable to drive or take public transport. Through the Disabled Students Allowance (DSA) I can access, I get help with the cost of taxis so I can attend my placement every day.

“I am supposed to be able to get reimbursed monthly. However, at its worst, it has taken five months to get any kind of reimbursement, leaving me totally out of pocket,” she said. The NHS Business Services Authority said: “Our SLAs are no longer than 30 working days however we cannot comment on individual cases.”

Erin thinks this inaccessibility to both lower-income and minority students is problematic, considering doctors “treat and help every single person, irrespective of their background.

“We need doctors from a low-income background, doctors with disabilities, we need doctors from every walk of life in order to provide the best care.

“If students with disabilities or from a low-income background can’t afford to do a medicine degree, how can we ever achieve this diversity?”

But even if a student manages to fund their way through a degree, the struggles they face don’t necessarily end there. Millicent said: “The main positive in the eyes of my family was that at the end of the degree, I would have a secure job. But at what cost?

“Personally, I’m completely okay to be in a dire financial situation at graduation, but even that might not get me there. Currently, there is the uncertainty that we will definitely get a job now and that junior doctors are earning 22.4 per cent less than their counterparts in 2008! I can imagine how it would look very unfavourable to join in the profession in 2022.”

‘Becoming a doctor is my dream and the biggest honour I can imagine for my life’

The Tab asked if the students still think the degree is worth it with all these issues. Erin said: “Knowing what I know now, I would have to think a lot more carefully about undertaking this degree.

“Ambition and altruism isn’t enough to get you through this course. I’ve nearly given up multiple times because the stress has been immense, from the course itself, the issues I’ve faced with funding, and managing my health alongside it.

“But the experiences I’ve had on placements where I’ve genuinely been able to make a difference to someone. Those moments are indescribable and what we’re all doing this for.”

Trisha also thinks “it is a privilege to work in healthcare, especially as a doctor,” adding: “I’ve worked so hard to get to where I have – I didn’t have access to private interview courses or private schools like some of my peers had. Why should I be forced to drop out?

“There is nothing better than seeing a patient get better or have the most comfortable end-of-life care possible, but I do think applicants should be aware of how poorly they will be treated. I think the degree and profession is becoming a tough sell.”

And these are why they (alongside Millicent and many others) joined forces in the #LiveableNHSBursary campaign. They want med students to be given funding matched with students of other healthcare courses, access to the NHS Learning Support Fund, and receive reimbursements for travel and rent expenses.

The campaign is also backed by the British Medical Association (BMA). Khadija Meghrawi, co-chair of the BMA medical students committee, said: “It is deeply worrying that students are facing financial hardship because the support they are given during their degree is not enough to pay for their basic needs.

“For years, we’ve heard instances of our fellow students using food banks, overburdened by debt and exhausted by working long hours alongside studying for a medicine degree full-time. No student should have to choose between completing their degree and making ends meet.

“We are a nation in desperate need of more doctors and to grow a medical workforce that is both fit for the future and is reflective of the population that it works to treat, the Government must provide adequate financial support to medical students.”

‘The thought of giving up is unfathomable, so we make it work, whatever way we can’

While encouraging fellow med students to support the campaign, Millicent wants to assure those struggling that “they are absolutely not alone!

“My main advice is to do whatever they need to to get through it. Taking a year out to stock up on savings is not a failure and not the end of the world.

“Universities also have many ‘hardship’ funds – making the most of them is also key. I have been in receipt of one of these funds where I study, and I was embarrassed to share my financial situation with the university. But asking for help available to you is not and will never be embarrassing.”

But in the end, despite all of the struggles she has and will face, she holds that “becoming a doctor is my dream and the biggest honour I can imagine for my life. The thought of giving up is unfathomable, so we make it work, whatever way we can. We should not have to do that.”

In response, a Department of Health and Social Care spokesperson said: “We are committed to supporting medical students in England across all years of study and are keeping funding arrangements for all healthcare students under review.”

If you’d like to support or learn more about the #LiveableNHSBursary campaign, follow them on Twitter and consider using this letter template to email you MP. 

Related articles recommended by this writer:

• Student loan system changes: One in four black students could be barred from university

• Students will face £100k bill for degrees and won’t pay off loans until retirement

• The government isn’t just ignoring students – it’s actively making life harder for them