When contacted by OMSBF telemarketers, potential contributors often ask a variety of questions about the Fund and its purpose.
Following are some of the most frequently asked questions, and the responses provided by telemarketing staff:
1. "It was hard when I was a medical student, and I did it without help. How is it different today?"
Since tuition deregulation in 1997, the cost of medical school tuition has soared. Using 1999 dollars, today’s tuition levels are four times higher than in 1977. Government assistance has not increased to keep up with the changes. Clerkship stipends have also been eliminated.
During the 1980s, there was relative comparability in growth among annual tuition, the cost of living (as measured by the Consumer Price Index), and students’ future income expectations (as measured by average gross OHIP billings). Since 1980, medical tuition costs have increased by 880 per cent — twice as fast as the cost of living and three times as fast as students’ expected future earnings.
The way that medical students are trained has also changed. Since the elimination of the rotating internship and the establishment of family medicine as a specialty, all graduates now go directly into a residency program, and can no longer moonlight with their general licences during their residency.
2. "Shouldn’t the responsibility for accessibility to medical school fall under the purview of the provincial government? What is the OMA doing to change government policies?"
We agree that the government must take responsibility. That is why the OMA continues to meet with government officials to try and impress upon them the need to modify public policy to ensure access. Important issues broached with government include: capping tuition levels until the effects on accessibility have been assessed; matching funds for the OMSBF; increasing OSAP limits; and changing the Millennium Fund to make it more valuable to students.
However, the situation is worsening. We cannot wait for changes in government policy — we must act now, and do everything we can as a profession to make sure that any qualified student who wishes to go to medical school will be able to attend, regardless of financial status.
3. "There are so many demands on my financial resources these days — so many worthy charities asking for money. Why would I choose to donate to the Bursary Fund?"
One day, these medical students will join you as your colleagues. It is in the profession’s, and the public’s, best interest that the most qualified students reflect our demographic reality.
Our profession is facing a crisis — as medical students graduate with higher debt-loads, fewer are choosing family medicine as a career. This trend threatens to worsen the family physician shortage faced by many Ontario communities.
The shortage of physicians in rural and northern areas will only get worse if we aren’t able to recruit students from these areas. Numerous studies have demonstrated that students who come from rural and northern areas are much more likely to return to these areas once they complete their education.
4. "Medical students will make a really good income once they finish school. Why are we worried about assisting them financially?"
Our worry is that many qualified students will self-select out of medicine to avoid the significant debt that would be incurred over years of training. Qualified students who must travel to medical school from rural and northern areas, or those who come from lower socioeconomic backgrounds, may not even apply to medical school due to "sticker shock."
We also worry that high debt-loads will dictate to students where and what type of medicine they will practise. Longer training programs, often in disciplines that are already underserviced (such as obstetrics, neurology, anesthesia, and general surgery), may be passed over in favour of specialties that facilitate quicker entry to practice, and hence quicker loan repayment.
Physician supply is already severely constrained in rural and northern practice. High debt-loads may discourage graduating students from seeking the additional training needed for rural practice. Some students may choose to move to the United States, perceiving a greater opportunity for higher remuneration, lower income tax, and the ability to be debt-free in a shorter period of time.
5. "I have heard of a free tuition program offered by the Ontario government. What is it? Why don’t students make use of this? Why do they need the Bursary Fund?"
The Ontario government does offer a financial incentive program for medical students in exchange for return-of-service (ROS). Medical students who participate in this program are reimbursed up to $10,000 in return for a commitment to practise in an underserviced area for a contracted number of years. Students receive $10,000 for each year of undergraduate medical training, to a maximum of $40,000, in tuition grants and location incentives.
Medical students have voiced serious concerns with the program, including the claim that it offers free tuition. In fact, the program is only offered to students in their final year of medical undergraduate studies —students do not see any of this money until they have completed medical school.
The money does not help them at all during their undergraduate training, when they need it the most. Four out of the five medical schools now charge more than $10,000 a year in tuition, so the amount does not even cover tuition costs. Furthermore, the money is taxed, so students actually receive considerably less than the $10,000 offered.
The OMSBF offers funding to students in financial need during the course of their undergraduate training to offset the exorbitant costs they incur while in school.
Students are also concerned that in the face of tuition deregulation and excessive tuition, any return-of- service program implemented in Ontario today may inevitably discriminate against economically disadvantaged medical students. These students may feel obligated to sign ROS contracts as the only means of realizing their dream of a medical education. However, by signing these contracts, they may limit their practice choices based on financial need, not professional interest.
The OMSBF provides financial support to students, regardless of what and where they choose to practise. This may prove especially helpful to those students whose professional interests may not match the conditions outlined in the government’s ROS program.
6. "Who is eligible to receive an OMSBF bursary? How do the universities assess financial need?"
OMSBF bursaries are to be awarded on the basis of economic need only, taking into consideration overall debt-load and government student loan status. Each bursary shall be awarded in a manner that does not take into account any other financial assistance that a student may be accessing.
The universities assess financial need using the same formula employed by the Ontario Student Assistance Program (OSAP) to determine who is eligible for student loans.
A student’s financial need is established by taking into consideration allowable education costs (e.g., tuition fees, other compulsory fees and book and equipment costs, personal and living expenses), and subtracting the financial resources that the student (and his or her family, if applicable) is considered to be able to contribute.
7. "Why did the OMSBF choose a telemarketing campaign instead of using a direct mail campaign to solicit donations?"
The OMSBF decided to use a direct mail campaign, as well as the telemarketing campaign, to solicit donations. It was found that direct mail was not as effective in achieving results as contacting physicians by phone. In general, most direct mail campaigns result in a one per cent response rate, while the response rates for telemarketing are much higher. The telemarketing campaign also affords OMSBF administrators the opportunity to talk directly to physicians and hear their views about the issue.
8. "It’s all well and good that you are contacting physicians, but what about the private sector? Are you soliciting funds from the private sector as well?"
Yes, fund-raising efforts have also been directed toward soliciting private sector funds. To date, the Royal Bank of Canada, KPMG LLP, MDS Inc. and ABELSoft Corporation have been secured as corporate donors.
Discussions are continuing with other corporations and foundations. However, it is critical that we continue to raise funds from within the profession. Our success in attracting corporate donors is related to the number of physicians who donate to the OMSBF. The private sector has told us that they would be more willing to contribute toward the Fund if they see the same commitment from physicians.