More than 200 medical students have written to the Minister for Further and Higher Education outlining "extreme" concern at the financial barriers to becoming a doctor in Ireland.
Students of the State's Graduate Entry Medicine (GEM) programmes have said the annual fees demanded of them and the fact that they are excluded from any SUSI grant support is placing a colossal burden on students and their families and is "pricing out entire demographics" from the profession.
GEM students are required to pay tuition fees of up to almost €17,800 for each year of the four-year programme.
With accommodation and living costs on top of this, as well as placement fees and other charges, the Irish Medical Organisation says this means those with the ability to draw down loans are graduating with debts the size of mortgages.
Uniquely, students on this kind of postgraduate programme are not eligible for any support under the State's SUSI grant system.
In their letter to Minister Simon Harris, the students say "many of our classmates are unsure how, if even, we will be able to finance the remainder of our education.
"This is a deeply upsetting and frustrating challenge which has become a huge burden to struggle with, in addition to an already intense and challenging degree.
"At a time when we are experiencing one of the worst medical staffing crises in the history of the State, we find the current barriers to accessing medicine to be deeply perplexing and irreconcilable."
Looking for "decisive and creative" Government-led action they say otherwise "we foresee a future in which medicine in Ireland is once again a profession that is reserved only for the select and fortunate few, and many amazing potential doctors are excluded solely as a result of socio-economic factors beyond their control".
The students have requested a meeting with the minister to discuss the issue.
The letter was written by student representatives from the country's four main GEM courses: UCD, the Royal College of Surgeons, UCC and University of Limerick. It has been signed by 242 medical students.
The Irish Medical Organisation has said it supports the students' stance. It says that at a time when almost 1,000 consultant posts in Ireland are vacant due to shortages, and the country has a GP availability crisis, young doctor graduates are being forced to move abroad to countries like Australia so that they can pay off loans that are "crippling".
The cost of GEM also makes entry to the course impossible for anyone who does not come from an affluent background, and this is reflected in Higher Education Authority data which shows that medical students are significantly less likely to come from disadvantaged backgrounds compared to other fields of study.
Graduate entry programmes were introduced 16 years ago to entice older people into medicine. The belief was that this would lead to a more diverse medical profession.
But RTÉ News has spoken to a number of GEM students who are struggling financially, including one who feels he may have to drop out after just one year as a result.
This first year student, who does not want to be identified, told RTÉ News he worked "multiple jobs, concurrently, including evenings and weekends" for two years after graduating from his degree in order to save enough money to cover his first year fees of more than €17,600. But he does not know what he will do next year.
He says his parents "absolutely" cannot afford to give him the level of support that would be required for him to continue.
"I'm not entirely sure where that leaves me," he told RTÉ News. "It is difficult to think about it. None of us is looking for a handout but essentially, socio-economically, this should be feasible but it currently isn't."
Another first year student, Rebecca Byrne, also worked for a year to save money towards her four-year GEM course. The only reason she can afford to do the course is because her parents are able to give her some level of financial support.
"I am in a very privileged position," she told RTÉ News. "This is literally the only option for students, they have made it so elitist."
On top of exorbitant fees students must pay almost €350 to sit a GAMSAT admissions test. It is a difficult test to pass and many students sit it a number of times before they succeed. Some pay fees of €50 per hour for grinds to increase their chance of passing.
Both the IMO and college student unions agree that the current situation is highly inequitable.
"Students have to have access to a six-figure sum to be able to afford this education," says Chair of the IMO’s Non Consultant Hospital Doctors (NCHD) committee, Dr Rachel McNamara.
"So for most people it is just not an option," she says.
The IMO says the supply of doctors is being hugely affected by this. It says over one third of current new entrants to medicine are coming from the GEM programmes.
"Even if they can borrow - and many can't - by the time they come out they are in a really vulnerable situation, with a six-figure debt.
"Then they need to make serious decisions as to whether they can pursue specialist training in order to become the GPs or consultants that we need."
Doctors who train via Graduate Entry Medicine are particularly valuable because of their age, the IMO says.
"They are the ones who want to stay in Ireland. Because they are slightly older, they are more likely to have roots here, they are more likely to be in relationships, to have children in creches.
"But they are also completely financially stuck, and in many cases are being forced to leave so that they can pay back their debts."
Dr McNamara says the IMO is not looking for "handouts".
"There is a GP availability crisis. We need to enable more people to go down this pathway and then be able to stay to work here."
SUSI grants
When it comes to State support for pursuing this kind of graduate entry programme, students are faced with a catch-22 situation. The way the system is structured makes it impossible for them to access SUSI grants.
GEM is a postgraduate programme, because you need to have already completed a Level 8 degree to be eligible for entry. But GEM courses are themselves classified as Level 8 programmes, and SUSI grants are only available to people who are deemed to be progressing from one level to another.
So, the kind of grant support that is available for all other postgraduate courses is not available to these students.
In fact they cannot draw down any grant support at all.
Education Officer with UCD student union, Sarah McGrath, says this makes no sense.
"It just seems like a complete cop-out. Students who are furthering their education, who have to have already completed a degree, and then they have to pay extortionate fees to do another degree.
"The whole point of graduate entry was to diversify medicine, but this system has made it elitist, because there is no financial option at all for most."
Bank of Ireland used to offer a loan tailored to GEM students but this was discontinued last year.
The Minister for Further and Higher Education had no words of comfort for students when asked about this issue recently.
"I accept it is a very large amount of money and it can be prohibitive," Mr Harris told RTÉ News.
"I'm looking at this issue. I am engaging with the Department of Health. I also think it is legitimate to ask the universities about the fee levels they are charging."
