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As far as Harvard goes, you are posting last year's tuition rates. Next year tution will be $12,500 for all students whose parents make less than $120,000 per year. There are other schools which are also offering free or low cost tuition, and some schools that have always had tution comparable to or less than Canadian schools. And, FWIW, Ontario medical schools have had spiriling tuition costs over the last few years. Base tution (before fees) is almost $17,000 at the University of Toronto. Base tution is $11,000 at McGill (not $2,000) unless you are a resident of Quebec --then it is $3,700.

Harvard offers discount on med school tuition

Eligible students could save up to $12,500 a year.

Lana Lobachova expects to be more than $100,000 in debt when she graduates from Harvard Medical School two years from now. But that amount should shrink under Harvard's plan to boost its financial aid package for some medical students by as much as $50,000 over four years.

In March, Harvard announced that students whose families earn $120,000 or less a year will get up to $12,500 off the annual $65,000 cost of tuition and living expenses. The program will start with the 2008-09 academic year.

Harvard now offers $24,500 in subsidized federal and institutional loans to students who demonstrate financial need. Students whose families make $120,000 or less must contribute about $12,500 before being considered for an institutional scholarship.

Under the new plan, the Boston school would cover the $12,500 family contribution by increasing its institutional scholarships to $11 million annually. Of the school's 700 students, 235 would be eligible for the funds, to be distributed based on a school formula.

"I haven't worked it out yet, but I hope I will save a large amount," said Lobachova, who qualifies for aid.

Jeffrey Flier, MD, Harvard Medical School dean, said it is important for the school to ease students' debt, which averages $98,000 at Harvard, so graduates will be able to pick a specialty regardless of its income.

The median medical school debt is $140,000, according to the Assn. of American Medical Colleges. Today's graduates pay 9% to 12% of their income toward school loans, a figure that could grow to 25% to 31% of doctors' income by 2033, the AAMC said.

http://www.ama-assn.org/amednews/2008/05/12/prsb0512.htm

With Debt on the Rise, Students and Schools Face an Uphill Battle

Mar.–Apr. 2008

Medical student debt is threatening to become untenable for young physicians. Medical school graduates in 2006 found they owed about $130,000 on average when their educational bills came due. This figure is daunting even for those earning the estimated mean physician income of $216,000, and it can take years for younger doctors to reach that income level. Many primary care physicians may never reach it, as they earn an average of about 30 percent less than the mean.
Indebtedness Rates Growing for Both Public and Private Medical Schools: The Impact of the Physician Workforce Shortage

A 2004 AAMC report on student debt and education costs, updated last fall, indicated that indebtedness rates are growing at an average of 6.9 percent for public medical school graduates and 5.9 percent for their private school counterparts. The 2004 report projected annual growth of owed monies at 8.3 percent and 8.9 percent for public and private schools, respectively. The good news is that these rates were lower than anticipated, but the bad news is that these increases still far outpace the estimated 3 percent annual increase in physician income.

In a worst-case scenario, the 2007 report update estimated that in 2033, physicians who opt for the standard 10-year loan repayment plan would see half of their after-tax earnings going to loan repayment. This could deter promising students from considering medical school, especially those with lower-income backgrounds.

“In the long run, schools will have a hard time filling their classes with good students if graduates can’t repay their debts without undue hardship,” said AAMC Senior Associate Vice President H. Paul Jolly, Ph.D., who led the study. “Right now, people with parental incomes in the top 20 percent of U.S. families are making up 55 percent of medical school students. If present trends continue, this imbalance will only worsen.”

The report found more sobering news for students who hope to gain a financial advantage by matriculating to medical schools in their home state. With public medical school tuition and debt catching up with the private schools, qualified students may no longer benefit from less expensive in-state tuition that these public schools traditionally have offered. According to the AAMC report, if present trends continue, by 2033, the average debt of public and private medical school graduates would be nearly identical.

Many in the academic medical community worry that rising debts will not only discourage students from considering medicine, but will take – or is already taking – a serious toll on the existing physician workforce. As evidenced by Knight, it is increasingly difficult to recruit young physician researchers because the field offers comparatively low income. Projected shortages in the lower paying primary care specialties can have an immediate impact on the nation’s health care system.

“Primary care physicians are the usual first stop for a person with a new illness or minor injury,” Jolly said. “If a shortage of these doctors should develop, the remaining primary care physicians would be stressed, and new patients would have difficulty being seen promptly.”
Medical Schools Develop Expense/Debt Management Strategies for Students

But with all of these threats in mind, some in the medical education community are taking action. Many medical schools are developing expense management strategies for their students, or educating medical students on the essentials of financing their education.

Some are even reviewing their payment mechanisms to help bring down expenses. The University of Minnesota Medical School, the Mayo Clinic College of Medicine, and Washington University in St. Louis School of Medicine have instituted policies through which tuition for new students does not rise during their medical school tenure. The policy helped Minnesota end its reign as the public medical school with the nation’s highest average tuition.

“We implemented this policy because at that time our school had the highest tuition,” said Deborah E. Powell, M.D., medical school dean at Minnesota. “We wanted to see if we could change that. Students like the predictable nature of this policy. It allows them to plan better.”

The program, which began four years ago, now allows students up to six years to graduate at the frozen tuition cost, on the provision that they are using any time away from school to participate in activities related to medical education. Since this policy was started, Powell said she has seen Minnesota’s ranking fall from the most expensive to second-most expensive public medical school, and hopes this modest trend continues.

Robert McCormack, assistant dean of student affairs and director of financial aid at Washington University’s medical school, said that his institution’s fixed tuition policy “enables our students to budget for their entire education. That was the genesis behind it, and we think it’s a great asset for students.” McCormack estimated that the freeze has kept average medical student debts at about $98,000, or more than $30,000 under the national mean.

Yale University School of Medicine’s Director of Financial Aid Pamela Nyiri said her school has purposely established a low threshold for their students’ base loan, which is the basis upon which loan payments are set.

“We are very committed to keeping the base loan as low as possible, so that debts are as low as possible and we can free students not to make career decisions based on money,” Nyiri said.

The lender community discourages over-borrowing, but said that being somewhat in the red is not always reason to panic.

“Our view is that students should borrow only what they need, and that a certain amount of debt is not a bad thing, especially on a very, very good investment like medical school,” said Timothy M. Fitzgibbon, vice president of debt management services at the National Council of Higher Education Loan Programs, a national organization that represents guaranty agencies, secondary markets, lenders, and other related groups.

The AAMC is unveiling a new educational program to help financial aid officers and students navigate the complexities of medical school debt and understand repayment options. With the association unlinking itself from any direct engagement with a commercial lender (i.e., ending its long-term engagement with Sallie Mae in the AAMC MEDLOANS program), AAMC officials said the association is well positioned to offer constituents a comprehensive tool to educate students on debt management.

The first phase, scheduled to launch May 1, will provide the program’s logistical groundwork. Future phases will include highly interactive tools and resources that will assist financial aid administrators and students in evaluating individual loan programs and help the latter group develop good consumer practices, financial literacy, and responsible repayment behavior.

“The idea is to provide unbiased information, resources, and tools to support the efforts of our financial aid constituency and help students make informed decisions,” said Julie Fresne, director of student financial services at the AAMC. “We envision a comprehensive program that includes, among other things, an online mechanism that can compare and evaluate loan terms and conditions.”

Of course, there is no magic bullet to solve the student debt equation. “Debt is a multifaceted issue, and we need to focus our energy and best efforts into addressing it,” Fresne said.

Source: AAMC Reporter: January 2008 — By Elissa Fuchs


http://www.nejmjobs.org/rpt/Medical_School_Debt_Rising.aspx

Stipend
Money paid to a graduate student from a grant for the student to work on their thesis research which is part of the research program of the professor's grant. This is an amount of money paid annually to the student. This source of money is treated as a scholarship for income tax purposes, i.e. currently exempt from Québec income tax and allowing either a complete or partial exemption from federal income tax. For federal income tax purposes, registered students and postdocs who receive a T2202 or T2202A are eligible for the education amount and thus completely exempt from income tax on their scholarship income, while those without a T2202 or T2202A receive a partial exemption only. A stipend can be paid to international students as well as Canadian nationals. In Quebec, postdocs are considered supervised research trainees, not salaried employees. The federal and Quebec granting councils allow postdocs to be paid in the form of a stipend from research grants, which is treated as a scholarship for income tax , i.e. currently exempt from Québec income tax and either totally or partially from federal income tax (since the 2006 federal budget,
scholarship income is totally exempt from federal income tax if the awardees is entitled to the education amount, as evidenced by a T2202 or T2202A). Where allowed by a granting agency, postdocs should be paid in the form of a stipend. Only in cases where an agency only allows payment in the form of a salary should this form of payment be used. Foreign postdocs paid in the form of a salary may be entitled to a partial deduction for Quebec income tax purposes, if they meet the requirements for the “Certificat d’admissibilité” issued by the Quebec Government

(see http://upload.mcgill.ca/gps/pdinfo.pdf for details and links).

Tuition fees
Tuition fees paid during medical school or a residency program are not deductible but may be eligible for the "tuition tax credit". Obtain Form T2202A from your university to determine allowable tuition costs. Keep in mind that fees paid for admission, application, use of library or laboratory facilities, examinations (including re-reading) and diplomas, as well as mandatory computer service fees and certain academic fees qualify as eligible tuition fees. Other tuition fees (i.e., for ATLS courses, certain LMCC preparation courses) may also qualify for the tax credit. Contact the course administrators for further details and be sure to obtain appropriate documentation for these courses from them.
In addition to the tuition tax credit, students may also claim an education tax credit. Although full-time medical students can generally claim a Federal education tax credit of $400 per month ($120 per month for part-time students), this benefit has not always been available for residents who were considered to be pursuing post-secondary education in relation to their current employment. The March 23, 2004 federal Budget removed this employment restriction, so those residents in an otherwise qualifying educational program may be eligible for the education tax credit for the 2004
and subsequent taxation years, provided that no part of the education cost is borne by or reimbursed by their employer. Consult your provincial house organization (e.g., PAR-A, PARI-MP, PAR-O, etc.) or tax advisor for more details.

Should a medical student not be required to use their entire tuition/education credit to reduce their tax to nil, these remaining credits may be transferred to an eligible person (e.g., spouse or common-law partner or, under certain restrictions, a parent or grandparent) up to a maximum of $5,000. For 2007, this translates to a $750 federal tax credit. To make this designation, the student must complete and sign Form T2202A. A copy of the signed form should be kept by the designated person and, if applicable, by the student to support the amount claimed. The form does not need to be filed with the
return but must be available if requested by the CRA. Students are entitled to carry forward indefinitely unused tuition and education tax credits. This will
enable students to utilize the credit when they have sufficient income (i.e., during residency). Any amount not used in the current year by the student and not transferred to an eligible person will be automatically available to carry forward. However, once income is sufficient to utilize the unused taxcredits, they must be applied to reduce taxes payable.

www.mcgill.ca/gps/postdoc/einfo/tax/

Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care, The Commonwealth Fund, May 2007, by K. Davis, C. Schoen, S. C. Schoenbaum, M. M. Doty, A. L. Holmgren, J. L. Kriss, and K. K. Shea: Overview Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report—an update to two earlier editions—includes data from surveys of patients, as well as information from primary care physicians about their medical practices and views of their countries' health systems. Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill.

Executive Summary
The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance. This report, which includes information from primary care physicians about their medical practices and views of their countries' health systems, confirms the patient survey findings discussed in previous editions of Mirror, Mirror. It also includes information on health care outcomes that were featured in the U.S. health system scorecard issued by the Commonwealth Fund Commission on a High Performance Health System.

Among the six nations studied—Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2006 and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last on dimensions of access, patient safety, efficiency, and equity. The 2007 edition includes data from the six countries and incorporates patients' and physicians' survey results on care experiences and ratings on various dimensions of care.

Key Findings

Quality: The indicators of quality were grouped into four categories: right (or effective) care, safe care, coordinated care, and patient-centered care. Compared with the other five countries, the U.S. fares best on provision and receipt of preventive care, a dimension of "right care." However, its low scores on chronic care management and safe, coordinated, and patient-centered care pull its overall quality score down. Other countries are further along than the U.S. in using information technology and a team approach to manage chronic conditions and coordinate care. Information systems in countries like Germany, New Zealand, and the U.K. enhance the ability of physicians to identify and monitor patients with chronic conditions. Such systems also make it easy for physicians to print out medication lists, including those prescribed by other physicians. Nurses help patients manage their chronic diseases, with those services financed by governmental programs.

Access: Not surprising—given the absence of universal coverage—people in the U.S. go without needed health care because of cost more often than people do in the other countries. Americans were the most likely to say they had access problems related to cost, but if insured, patients in the U.S. have rapid access to specialized health care services. In other countries, like the U.K and Canada, patients have little to no financial burden, but experience long wait times for such specialized services. The U.S. and Canada rank lowest on the prompt accessibility of appointments with physicians, with patients more likely to report waiting six or more days for an appointment when needing care. Germany scores well on patients' perceptions of access to care on nights and weekends and on the ability of primary care practices to make arrangements for patients to receive care when the office is closed. Overall, Germany ranks first on access.

Efficiency: On indicators of efficiency, the U.S. ranks last among the six countries, with the U.K. and New Zealand ranking first and second, respectively. The U.S. has poor performance on measures of national health expenditures and administrative costs as well as on measures of the use of information technology and multidisciplinary teams. Also, of sicker respondents who visited the emergency room, those in Germany and New Zealand are less likely to have done so for a condition that could have been treated by a regular doctor, had one been available.

Equity: The U.S. ranks a clear last on all measures of equity. Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick, not getting a recommended test, treatment or follow-up care, not filling a prescription, or not seeing a dentist when needed because of costs. On each of these indicators, more than two-fifths of lower-income adults in the U.S. said they went without needed care because of costs in the past year.

Healthy lives: The U.S. ranks last overall with poor scores on all three indicators of healthy lives. The U.S. and U.K. had much higher death rates in 1998 from conditions amenable to medical care—with rates 25 to 50 percent higher than Canada and Australia. Overall, Australia ranks highest on healthy lives, scoring first or second on all of the indicators.

Summary and Implications
Findings in this report confirm many of the findings from the earlier two editions of Mirror, Mirror. The U.S. ranks last of six nations overall. As in the earlier editions, the U.S. ranks last on indicators of patient safety, efficiency, and equity. New Zealand, Australia, and the U.K. continue to demonstrate superior performance, with Germany joining their ranks of top performers. The U.S. is first on preventive care, and second only to Germany on waiting times for specialist care and non-emergency surgical care, but weak on access to needed services and ability to obtain prompt attention from physicians.

While many U.S. hospitals and health systems are dedicated to improving the process of care to achieve better safety and quality, the U.S. can also learn from innovations in other countries—including public reporting of quality data, payment systems that reward high-quality care, and a team approach to management of chronic conditions. Based on these patient and physician reports, the U.S. could improve the delivery, coordination, and equity of the health care system by drawing from best practices both within the U.S. and around the world.


http://economistsview.typepad.com/economistsview/2007/05/an_internationa.html

In March, Harvard announced that students whose families earn $120,000 or less a year will get up to $12,500 off the annual $65,000 cost of tuition and living expenses. The program will start with the 2008-09 academic year.

^ ^ ^ ^ ^ Same amount as we actively recruit from Canada -- zero.

Higher incomes, newer equipment and more opportunities - for some Canadian physicians, the United States seems to have it all. i Some critics have long alleged that because of the “exploitative nature of medicare,” Canadian doctors cannot resist heading south. ii More recently, some argue that this brain drain is a “major contributor to physician shortages in Canada,” iii prompting physician associations and ministries of health to launch campaigns to lure expatriate, Canadian-trained physicians back home. iv Fears of physician losses are further fuelled by reports that the U.S. - renowned for luring more physicians than any other country v - could be short 85,000 doctors by 2020. vi

There’s no doubt that Canada - like other wealthy nations - is losing some of its physicians, particularly to the U.S., vii - that this emigration represents a loss for Canadians. However, when it comes to the brain drain, it’s nowhere near a mass exodus. At worst, it’s more a trickle than a flood.
Entry and exit

Physicians enter and leave the country for a number of reasons. For instance, some Canadian doctors go overseas for medical training, then return home to practise. Foreign medical school graduates may arrive with temporary work visas or as landed immigrants, practise in Canada for awhile, leave, and even decide to return eventually. viii

The Canadian Institute for Health Information charts migration patterns for practising physicians. The data exclude interns, residents and doctors who leave Canada right after graduation without ever working here, but they still provide important information on trends. According to the Institute’s data, the gross number of doctors leaving the country hit two peaks in the last 35 years: one in the late 1970s, when we lost between 500 to 600 doctors a year, and another in the mid-1990s, when we lost around 600 to 700 a year. When assessing the brain drain, it’s important to consider not only the number of doctors who are leaving, but also the number returning to Canada. This number has been holding fairly steady since 1980, with around 250 to 350 returning per year. Thus, our net loss of physicians is fairly small - since 1980, our annual net loss has never been more than one percent (and averages closer to one quarter of a percent) of all practising physicians. ix, x

In recent years, not only has the brain drain trend slowed, it has actually reversed. In 2004, there was a net brain gain of 85 doctors. Although this gain has decreased as of late - a net gain of 61 doctors in 2005 and 31 in 2006 ix, x - the data still counter popular perceptions that Canadian doctors are leaving in droves.

The data also disprove claims that the brain drain is responsible for Canada’s doctor shortage. In 2006, there were 62,307 active physicians in Canada - the highest number ever, largely attributable to a more than five percent increase in Canadian-trained physicians over the last five years. ix The 2006 data also show a five percent increase in physicians between 2002 and 2006, which is just over parity with population growth over the same time. ix

An important issue in all of this is where our doctors are coming from. In 2006, of the 238 returning physicians, about 190 had received training in Canada, while the rest were trained mostly in the UK and Ireland, but also South Africa, India and elsewhere. ix In the same year, international medical graduates accounted for 22 percent (13,715 doctors) of the total physician supply in Canada. ix If this means Canada is “poaching” doctors from countries that have a much more limited ability to train physicians and handle internal crises in population health, then this is a serious public policy problem. xi
Destination U.S.

Of the doctors who are leaving Canada, more than half choose to go to the U.S. ix The Canadian Institute for Health Information has been tracking doctors’ destinations only since 1992. Since then, between 60 and 70 percent of physicians who emigrate have headed south of the border. In the mid-1990s, the number leaving for the U.S. spiked at about 400 to 500 a year. However, in recent years, this number has declined, with only 169 physicians leaving for the States in 2003; 138 in 2004; and 122 in each of 2005 and 2006. These numbers represent less than half a percent of all doctors working in Canada.

Popular culture’s obsession with the "mass exodus" of Canadian-trained physicians to the U.S. has meant little attention is given to the movement of physicians from one Canadian jurisdiction to another. In particular, physicians appear to be moving “from less prosperous to more prosperous provinces and from rural to urban areas,” xii which likely exacerbates real shortages in rural, remote and economically disadvantaged areas.
Conclusion

Over time, annual losses of physicians can add up - if we lose even a handful of physicians each year, in 25 years we will have lost a stock of Canadian-trained doctors. This point merits our attention, for educating our physicians is a costly, time-intensive investment - it costs about $1.5 million to train a doctor, much of which is paid for through taxes. xiii There is also the real concern of physician retention in rural and remote areas. vii To address these problems and ensure Canadian taxpayers are able to benefit from their investment, provincial and federal policy makers should focus on co-ordinated national recruitment and retention strategies to retain and sustain our physician supply in all regions of the country.

http://www.chsrf.ca/mythbusters/html/myth29_e.php

About CHSRF

The Canadian Health Services Research Foundation promotes and funds management and policy research in health services and nursing to increase the quality, relevance and usefulness of this research for health-system policy makers and managers. In addition, the Foundation works with these health-system decision makers to support and enhance their use of research evidence when addressing health management and policy challenges. Any Foundation project, process or activity always involves both researchers, and managers, policy makers from academia and Canada's health system.

The Foundation is an independent, not-for-profit corporation, established with endowed funds from the federal government and its agencies.

http://www.chsrf.ca/about/index_e.php

2008
March Myth: Canadian doctors are leaving for the United States in droves

2007
December Myth: Canada's system of healthcare financing is unsustainable

September Myth: Direct-to-consumer advertising is educational for patients

June Myth: Generic drugs are lower-quality and less safe than brand-name drugs

March Myth: We can improve quality one doctor at a time

2006
December Myth: The risks of immunizing children often outweigh the benefits

September Myth: People use health system report cards to make decisions about their healthcare

June Myth: Early detection is good for everyone

March Myth: Medical malpractice lawsuits plague Canada

2005
December Myth: Managed care = mangled care

September Myth: Canadian doctors are leaving for the United States in droves

June Myth: Canada has a communist-style healthcare system

March Myth: A parallel private system would reduce waiting times in the public system

2004
September Myth: We can eliminate errors in healthcare by getting rid of the "bad apples"

March Myth: For-profit ownership of facilities would lead to a more efficient healthcare system

2003
September Myth: Doctors do it for Money

June Myth: The cost of dying is an increasing strain on the healthcare system

March Myth: An ounce of prevention buys a pound of cure

2002
November Myth: Seeing a nurse practitioner instead of a doctor is second-class care

September Myth: Bigger is always better when it comes to hospital mergers

January Myth: The aging population will overwhelm the healthcare system

2001
September Myth: User fees would stop waste and ensure better use of the healthcare system

2000
December Myth: More Money Would Put an End to Emergency Room Crunches

http://www.chsrf.ca/mythbusters/index_e.php