Sarah Batkin is just two years away from graduating to become a doctor but instead of feeling relieved at getting closer to finishing, she’s facing a financial dilemma.
Her eligibility for a student loan is about to run out so she is having to pay for her fees and living costs for the next two years out of her own pocket.
“I’m working a retail job and a nannying job at the moment and then I’m also doing a summer job at a GP practice just helping to organise the patient notes,” the 30-year-old medical student says.
Batkin says she’s lucky she can pay $18,000 towards her fees next year but it means using her life savings as she has no help from her parents.
She is also working multiple jobs, alongside her full-time studies and practical placement at Middlemore hospital so she can save up enough money to pay for the following year’s expenses.
The reason she is having to do this is because the government student loan system - StudyLink - won’t fund her studies from next year because she has reached a cut off point.
Students are eligible to receive StudyLink loans for tuition fees and living costs for about seven years.
If they go beyond that then they’re able to apply for an extension to cover about 10 years worth of study.
But because Batkin took up medicine as a post-graduate, after completing a Bachelor of Arts, mastering in linguistics, she’s reached the limit and she’s not alone.
She’s heard stories of people who had to “crowdfund” to get money to finish their medical degrees.
“That’s why I am working so much during the holidays because it’s really my only window of opportunity to make as much money as possible to then use that money to pay for food and rent the following year,” she said.
Batkin says it’s this kind of extra stress on top of what is an already stressful study programme that can really “tip you over”.
“It’s like, oh my gosh, I'm not coping because I've got so much uni work to do. Plus, I have to deal with this other stuff going on,” she says.
Indira Fernando, president of the New Zealand Medical Students’ Association (NZMSA) says they couldn’t agree more.
Fernando says 60 percent of medical students surveyed by NZMSA say financial stress has led them to forego food and GP appointments.
They’ve even heard of medical students living out of their cars because they can’t afford rent close to the hospital where their placement is.
“We have people like that coming to us and saying ‘I’m actually considering dropping out because I just can’t afford to do this anymore’ and we have to recognise this for what it is: a disaster waiting to happen,” they say.
“They're supposed to be our locally grown doctors who are supposed to prop up this system that we can all recognise is struggling. And yet, they can't even be supported to finish a degree.”
(Sarah Batkin, Medical student at University of Auckland)
How the system works
The student loan system in New Zealand funds what’s called Equivalent Full-time students (EFTS) for the first seven years. If their studies go beyond that then they can apply for an extension up to 10 years.
But if like Batkin, their studies go for longer, then they have to find the money themselves.
Fernando says this is a growing problem because the medical profession is attracting more post-graduate students.
Some are deciding to do medicine after already completing honours, masters and even PHDs.
“As we see more students of that calibre entering into medicine, we are very happy to have them because their experience from previous degrees and their extensive knowledge makes them better medical students and subsequently better doctors, but these students run the risk of running out of EFTs,” Fernando says.
(Indira Fernando, president of the New Zealand Medical Students’ Association)
Then there is the issue of the Trainee Intern Grant (TIG) stipend
For the last year of a medical degree, students are eligible for what’s called a Trainee Intern Grant (TIG) stipend. This is $26,756 a year paid to medical students and means they’re unable to get a student loan to cover living costs.
For many students, the TIG is a lifeline but it has stayed the same since 2006 and has not been adjusted for inflation or cost-of-living.
“The Ministry of Education has repeatedly been asked by us and individual students to please increase the TIG and they’ve repeatedly told us they will not do that,” Fernando says.
“Despite the fact that is about $26,000 and if it had been adjusted to inflation alone it would be over $39,000. They won’t do it. But if they don’t then it is future doctors who are paying the price.”
The Ministry of Education told Re: News in a statement that successive governments have worked on managing the costs of the student support system.
“While the trainee intern grant (TIG) is a fixed stipend, other support such as student loan living costs are annually increased by inflation,” says Katrina Sutich, group manager for policy at the Ministry of Education.
Sutich said removing the student loan limit and increasing the TIG stipend “would need to be considered alongside other spending priorities for tertiary education and across all of its portfolios”.
“The student loan lifetime limit is designed to encourage students to consider their study decisions so that they can achieve their goals sooner and keep the costs of study down.”
The tipping point
Both Batkin and Fernando say it’s no surprise a new study found a third of the medical students or health science post-graduate students it surveyed are suffering clinical symptoms of depression, anxiety and stress.
The report surveyed 140 post-graduate and medical students at the University of Otago’s Christchurch campus after researchers heard stories about how stressed and burnt out some of the students in the medical school were.
One of the lead researchers, Dr Katherine Donovan said “the context was really important to this study”.
“We were hearing directly from students in the medical school at the Christchurch campus and hearing directly from post-graduate student reps, that people were reporting high levels of distress”.
This particular study focused on students in Christchurch, living in a city that has been through a series of traumatic events like the earthquakes and 2019 Terror attacks.
But Donovan says that didn’t show up as a factor causing stress, anxiety, depression or burn-out.
The University of Auckland says these trends are reflected in another study, where medical students across 12 countries showed concerning rates of mental health problems, burnout and substance abuse.
New Zealand ranked seventh out of the 12 nations and the University of Auckland has introduced a well-being curriculum as medical students are especially vulnerable.
“Our curriculum enables students to learn skills which will be relevant for their patients and for themselves,” says Dr Fiona Muir, Pastoral Care chair and well-being lead for the Medical Programme.
Batkin says she’s grateful for the extra focus on wellbeing in the curriculum because when she was trying to get into the medical programme, she pushed herself to her “absolute limits”.
“Like I got insomnia, I started having to take sleeping pills which I had never taken in my life,” Batkin says.
“It definitely took me a couple of years to be like ‘oh okay, the world isn’t going to collapse if I don’t get an A plus for this test’ which sounds ridiculous.
“But when you are preparing to apply for the programme you get into this mindset of like ‘I have to be perfect’ or as close to perfect as possible or otherwise I won’t get in and that’s pretty true.”
Fernando says overall New Zealand’s future doctors need more support.
“They need to be able to focus on their studies and focus on their wellbeing so they can graduate from an extremely stressful and time consuming degree with the capacity to then go into an even more stressful, demanding and burdensome job - which is what we’ve all signed up to do”.
Batkin says despite the challenges, she is completely committed to her future profession.
“I wouldn't have put myself through this whole rigmarole if I thought ‘oh, like, maybe I could be something else’... this is only it. It’s just a bit grim.”
“This is genuinely the only job that I want to do.”
*This article has been amended to show the TIG is available for students in their final year, not the final two years of their studies.
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