Top up fees and medicine

Editor—The introduction of top up fees is highly emotive.¹ The selection of medical students has a markedly skewed socioeconomic distribution: seven out of 10 medical students come from a professional or managerial background. This does not reflect the make up of society as a whole.

The medical course is unique by virtue of its length, unavoidable expenditures, and the lack of opportunity for students to supplement their income with part time work. The government's proposals do not take into account the unique circumstances that medical students find themselves in. In fact, the student income and expenditure figures on which the government has based its reforms exclude medical students.

One of the major determinants of application to university is debt aversion; this is more marked in families who come from lower socioeconomic groups. The new proposals will increase the levels of debt for all medical students and cannot, therefore, be seen to encourage participation from all socioeconomic groups.

I am concerned that the government's reforms of student support will lead to a system where the willingness to commit to unknown debt will take precedence over ability.