Katherine Branson Essay Prize 2023 - Winner


During the Cost-of-living Crisis, how can medical students best manage their money? - Lani Robinson

The cost-of-living crisis presents an immense threat to health and wellbeing, which medical students are not immune to. This question erroneously assumes that (1) there is a one-size-fits-all solution to financial hardship experienced by medical students and (2) economising presents a modifiable way to mitigate the impact of this crisis. This not only unfairly assigns personal responsibility during a national financial crisis but fails to recognise the overly severe financial burden borne by students from deprived backgrounds.

The cost-of-living crisis requires people compromise on necessities fundamental to living a dignified and healthy life. Proposing further cost cutting measures would serve to limit participation in society, thus undermining people’s sense of agency, social life, and self-worth[i]. Professor Michael Marmot contends “it is undignified...to wear two coats indoors against the cold; to plead against eviction because of an inability to pay the rent”1. Yet, this is the reality people are confronting. In 2022, inflation reached a 40-year high[ii], food prices increased by 16.4%[iii] and energy bills increased by 96%[iv]. Consequently, two thirds of homes expected to experience fuel poverty in January 20232, meaning more households grappled with the “heat vs eat” dilemma. Medical students are no exception; a recent BMA survey indicated over 60% of medical students have reduced spending on essentials such as food and heating[v]. Therefore, suggesting people can budget their money more effectively when they cannot afford to heat their homes is irresponsible. This diminishes the scale of the crisis and blames the individual for financial hardship beyond their control.

Furthermore, although everyone has felt the impact of the cost-of-living crisis, those from more deprived backgrounds suffer the most. Research conducted by the Sutton trust found that just under half of university students sought extra financial support from family members[vi]. However, those from more disadvantaged backgrounds were less able to request this additional help and were more likely to skip meals to save money6. This highlights that although all students feeling more pressure, financial crises disproportionately impact deprived students, thus exacerbate pre-existing inequalities. Hence, it is remiss and unproductive to offer identical financial advice to an inherently heterogenous group that face differing financial pressures.

Moreover, assuming medical students come from homogenous financial backgrounds keeps medicine inaccessible and leaves society worse off. This is particularly true for those already at university, as efforts concentrate on improving access to medicine for those applying[vii][viii], but little is done to support medical students from more deprived backgrounds once they are admitted. Medical schools are criticised for failing to address financial barriers[ix][x], with Dr Harvey Bluemel testifying that medical schools believe “that once you’re in, you’re exactly the same as everyone else. And it’s just not the case.”9 Others accuse medical schools of operating on the assumption that students have a “financial safety net”[xi] to support them during their studies. This is clearly demonstrated by summer electives remaining unpaid. During these placements students undertake quality improvement projects or publishable research, which makes their specialty applications more competitive. So, if a student needs to earn money during the summer to support their living expenses, they do so at cost to their future. Indeed, society benefits from a representative medical workforce[xii], yet, as it stands, medicine has one of the lowest enrolments of free-school-meal students[xiii] and sees only 4% of doctors come from working class backgrounds[xiv]. Therefore, offering financial advice to ‘medical students’ perpetuates the belief that this cohort are similarly affected by this crisis, which is detrimental to improving accessibility and support for disadvantaged students.

Additionally, medical students’ finances are already stretched thin. Over half of medical students work during termtime, with most reporting this adversely impacts their studies[xv]. Financial insecurity is further exacerbated in 5th and 6th year, when there is a reduction in maintenance loans due to the NHS bursary[xvi], which then reportedly only covers 30% of living costs15. Therefore, no amount of scrupulous budgeting will help bridge the ever-widening gap of rising costs and inadequate student loans.

In conclusion, this question fails to appreciate the true impact this crisis has on medical students and neglects to consider the disproportionate harm caused to disadvantaged students. Given the call to “drive change and development in medicine” made by Medical Women’s Federation’s spring conference, now is the time to challenge, not promote, the barriers that prevent medicine reaping the rewards of a diverse workforce. Success in medicine should be based on ability, not on financial status. Medical students cannot budget their way out of this crisis and to imply otherwise is at best well-intentioned but ill-conceived. This cost-of-living crisis provides the needed impetus for medical institutions to join the BMA in supporting the #liveableNHSbursary campaign, to prevent financial injustice continuing and safeguard the future workforce of the NHS.

[i]Marmot M. Studying health inequalities has been my life's work. what's about to happen in the UK is unprecedented [Internet]. The Guardian. Guardian News and Media; 2022 [cited 2023 Feb 10]. Available from: https://www.theguardian.com/commentisfree/2022/apr/08/health-inequalities-uk-poverty-life-death

[ii] Alice Lee, Ian Sinha, Tammy Boyce, Jessica Allen, Peter Goldblatt (2022) Fuel poverty, cold homes and health inequalities. London: Institute of Health Equity.

[iii] Lewis A. How is the rising cost of living affecting students? [Internet]. House of Commons library. UK parliament; 2022 [cited 2023 Feb 10]. Available from: https://commonslibrary.parliament.uk/how-is-the-rising-cost-of-living-affecting-students/

[iv] Bolton P, Stewart I. Domestic Energy Prices - House of Commons Library [Internet]. House of Commons Library. UK parliament; 2023 [cited 2023 Feb 10]. Available from: https://commonslibrary.parliament.uk/research-briefings/cbp-9491/

[v] Student finance is 'broken' and in urgent need of reform, says BMA, as 6 out of 10 medical students are forced to cut spending on essentials [Internet]. BMA. The British Medical Association; 2022 [cited 2023 Feb 10]. Available from: https://www.bma.org.uk/bma-media-centre/student-finance-is-broken-and-in-urgent-need-of-reform-says-bma-as-six-out-of-10-medical-students-say-they-are-forced-to-cut-spending-on-food-and-heating

[vi] Cost of living and university students [Internet]. Sutton Trust. 2023 [cited 2023 Feb 10]. Available from: https://www.suttontrust.com/our-research/cost-of-living-and-university-students-2023/

[vii] The Scottish Government. Widening access to medical schools [Internet]. Scottish Government. The Scottish Government; 2017 [cited 2023 Feb 10]. Available from: https://www.gov.scot/news/widening-access-to-medical-schools/

[viii] MSC summer schools annual report [Internet]. Medical Schools Council. Health Education England; 2020 [cited 2023 Feb 10]. Available from: https://www.medschools.ac.uk/media/2806/msc-summer-schools-annual-report.pdf

[ix] Abdul G. 'exhausted' medical students in England struggle to qualify amid financial woes [Internet]. The Guardian. Guardian News and Media; 2022 [cited 2023 Feb 10]. Available from: https://www.theguardian.com/business/2022/may/30/exhausted-medical-students-in-england-struggle-to-qualify-amid-financial-woes

[x] Nunez-Mulder L. Medical students consider abandoning degree because of financial pressures, survey finds. BMJ. 2018;

[xi] Harvey A. Disadvantages faced by poorer medical students must be challenged [Internet]. The BMJ. 2019 [cited 2023Feb10]. Available from: https://blogs.bmj.com/bmj/2019/11/14/disadvantages-faced-by-poorer-medical-students-must-be-challenged/

[xii] Steven K, Dowell J, Jackson C, Guthrie B. Fair access to medicine? retrospective analysis of UK Medical Schools Application Data 2009-2012 using three measures of socioeconomic status. BMC Medical Education. 2016;16(1).

[xiii] Britton J, Drayton E, Erve Lvd. Which university degrees are best for intergenerational mobility? . Institute for Fiscal Studies; 2021.

[xiv] White C. Just 4% of UK doctors come from working class backgrounds. BMJ. 2016;355:i6330.

[xv] Murray A. Medical students across the UK are feeling the financial heat. BMA. 2022 [cited 2023 Feb 10]. Available from: https://www.bma.org.uk/news-and-opinion/medical-students-across-the-uk-are-feeling-the-financial-heat.

[xvi] Sucharitkul PPJ, Shorrock E, Lawson-Smith E. The NHS bursary: what am I entitled to? BMJ. 2022;376:o561.

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