CONTRADICTORY CLAIMS ON how much it costs the state to train a doctor have been cited online, often in discussions focusing on how to get qualified doctors to remain in ireland.
The premise of many of these arguments seems to be that the State provides training to doctors at great expense, only for some of them to move abroad where they no longer contribute to Ireland’s health service.
However, different figures are often cited for how big a drain this is on the economy and health service, largely based on how much it costs to train a doctor, and how much of that training is paid by the State.
Public estimates
Some figures suggest the cost to the State of training a doctor is high as €300,000, though the source of this figure is old and appears to have included the costs of doctors training “in the community”.
This is probably a misleading figure, because doctors themselves are paid while they work as part of their studies – like any other employee – and likely contribute some of what they’re paid to their own studies.
Typically, doctors in Ireland spend the first 5-6 years of their training studying an undergraduate medical degree programme. Upon graduating, they then spend a year working in a hospital as an intern.
Doctors then go on to select a speciality, such as anaesthesia or surgery.
Though they are still technically training during all this time, from the stage of intern onwards, they are working and receiving a salary, between €38,572- €85,520 depending on their grade, the HSE told The Journal by email.
As such, categorising these health workers as studying completely at the largesse of the State is misleading, though they can claim up to €1,250 a year for exams, courses and conferences as part of a training support scheme, as well as some refunds for exam costs.
Because of this, one should focus on how much the State contributes over the course of an undergraduate degree.
Figures cited by Minister Simon Harris in the Dáil in April of this year seem to indicate that the figure is as little as €12,500 a year per student, or about €62,500-€75,000 over the span of a degree, falling far short of €300,000 as had been suggested.
Another estimate can be made using public information by comparing the costs paid by Irish medical students, who receive state support, and their non-EU counterparts.
At The Royal College of Surgeons in Ireland (RCSI), tuition fees are charged annually at between €475 (for students who qualify for free fees and the SUSI Grant) and €15,755 (for mature entry applicants who don’t qualify for free fees), excluding one-off fees in the first year.
For non-EU applicants, the same course is €57,000 a year.
While this would suggest that those who qualify for free fees are subsidised and that the actual cost is far higher number than the figure cited by Harris, there is a considerable range.
It is unclear how much of each student’s course fees covers the expense of tuition and how much is taken by higher education institutions (HEIs) as profit.
A similar course for non-EU applicants costs around €4,000 less per year in The University of Limerick, and in NUI Galway, where the annual fee is almost €7,000 less than the RCSI again, the website notes that “discounts are available to students entering through recognised student recruitment agents”.
These variances show that one cannot infer how much it costs the State to train a doctor from university fees alone.
As such, calculating the precise cost to the State from training medical students is difficult using such publicly available information.
However, the government did provide The Journal with its own date figures about how much it costs.
Official figures
Medical degrees are funded by the State through a number of different mechanisms, which can be confusing.
A response from the Department of Further and Higher Education, Research, Innovation and Science (DFHERIS) said it was estimated that Higher Education institutions (HEIs) paid €25,000-€30,000 per student per annum.
This is higher than the average cost per student across all disciplines, which is estimated at around €9,000-€10,000.
However, the department also clarified that the relevant costs varied between HEIs and would not necessarily be paid in full by the State. Instead, they could also be met by grants, fees or income made by the HEI.
The department said that, as of an agreement made in July, 2022, the State would fund HEIs by €25,000 a year for “direct entry undergraduate places” as well as paying the “student contribution” fee, which is generally €3,000 a year.
The State also pays €14,500 a year for graduate entries, but any fees above that figure must be paid by the student themselves, the department told The Journal.
The department also shared figures with The Journal, showing Higher Education Authority (HEA) enrollment figures in medicine courses. Of the 1,304 students who graduated from in 2021, about a third were from graduate entry courses (417).
The department also said that they projected the intake of first year students will increase every year, amounting to an additional 200 students studying medicine per year from 2026 onward.
The different figures cited by Minister Simon Harris in the Dáil referred to the situation prior to the July agreement, and are no longer applicable, the department said.
Based on these estimates, it costs the state around €140,000 to €168,000 per medical student over the course of an undergraduate degree, which lasts five to six years if they are a direct entry student.
If the student is already a graduate, which about a third of students are, the cost is €72,500-€87,000 per medical student over the course of their training.
As such, there is no specific figure for how much it costs the State to train one doctor over the course of their degrees: the figures vary depending on each doctor’s situation, but current estimates fall between the ranges outlined above.
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