Govt. subsidy/student debt in European programs?

[lilycat]

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Hey all -- I'm trying to write a letter to the editor regarding medical costs, and I was hoping to verify some info. regarding higher education in Germany, France, etc. My impression is that the public schools are completely subsidized by the government (for residents of that country), and that students only pay nominal fees. I've tried a couple of Google searches with some luck, but not exactly what I was hoping to find. If anyone has info. to confirm or deny this, I'd really appreciate it. Thanks!

 

[El Duderino]

I can tell you about the Swedish system, where school is 'free' outside of a nominal charge each semester (40 bucks or so). You get financial support to the tune of apx 350 dollars a month, and they'll typically let you loan another 600 (apx) or so.

Counting living expenses etc, the typical Swedish medical graduate leaves medical school about $30,000 in debt, which typically is paid off over a period of 25 years or so.

 

[neilc]

the czech language program is "free" also, to all those that qualify. there are nominal fees, but i don't think they even hit $100 a year...and, they have super cheap rent in the dorms, the student cafeteria feeds them for about $1-2 a meal, etc...

 

[Miklos]

Hey all -- I'm trying to write a letter to the editor regarding medical costs, and I was hoping to verify some info. regarding higher education in Germany, France, etc. My impression is that the public schools are completely subsidized by the government (for residents of that country), and that students only pay nominal fees. I've tried a couple of Google searches with some luck, but not exactly what I was hoping to find. If anyone has info. to confirm or deny this, I'd really appreciate it. Thanks!

The Hungarian system is similar to the Czech one for Hungarian languages programs. There are two categories of admission: fully state-sponsored and self-supported.

If one gets enough points on the admissions exam (it is a straight up competition) one gains state sponsorship. Once those spots are gone, the remainder that still qualify for admission must pay. Though, it is much less than the tuition charged to the English program, it is still a significant burden to students and their families.

Regarding the German and French systems, do a search on this forum. It has been covered before.

 

[f_w]

> My impression is that the public schools are completely subsidized
> by the government (for residents of that country), and that students
> only pay nominal fees.

That impression is correct, at least for the two countries you mentioned.

But:
If you talk about the lack of public funding for medical education in the US, please keep one thing in mind: While your goverment doesn't really help you out with the expenses for medical school (except for the guaranteed loans), it heavily subsidizes residency training later on. All the goodies like formal teaching and guaranteed curricula that make US residencies great are grace of the 80-120k/resident/year the feds pump into the hospital for that purpose.
In most european countries (with some exception in the UK), residents are regular employees of the hospital. You are expected to WORK first, education is often an afterthought. And as much as we bitch about workload and scut here, without the federal cash it would be far worse.

> I've tried a couple of Google searches with some luck

Unless you have the search terms in the correct languages, you won't have too much luck with google.

PM me, I might be able to give you some pointers.

 

[Miklos]

If you talk about the lack of public funding for medical education in the US, please keep one thing in mind: While your goverment doesn't really help you out with the expenses for medical school (except for the guaranteed loans), it heavily subsidizes residency training later on. All the goodies like formal teaching and guaranteed curricula that make US residencies great are grace of the 80-120k/resident/year the feds pump into the hospital for that purpose.

I'm assuming that those numbers represent both indirect and direct reimbursement. Direct reimbursement, is to my knowledge, a fraction of that.

In most european countries (with some exception in the UK), residents are regular employees of the hospital. You are expected to WORK first, education is often an afterthought. And as much as we bitch about workload and scut here, without the federal cash it would be far worse.

True enough.

 

[tlew12778]

Do you want to know about Italy as well? It's not free here. There is a tuition scale based on family income. I think it ranges from about 200 euro to about 2500 euro per year. That's just for the course. Books and living expenses are not included and you don't get funding for them. You can apply for scholarships and/or private loans, but the government does not automatically off you these.

 

[f_w]

> I'm assuming that those numbers represent both indirect and direct
> reimbursement. Direct reimbursement, is to my knowledge, a fraction
> of that.

That would be DGME+IME payments. DGME is pretty much fixed at about 20k IME is variable depending on the proportion of medicare admissions to the total and some other harder to understand factors. The numbers are somewhat variable and trend down at this time, but even if a hospital only grosses 70k from the goverment they get the resident essentially for free.

correction
Just looked up the numbers for our state. DGME is $49.000/FTE, total GME payment is $113.000 / FTE. (Some hospitals get way more, some way less depending on the ethics and testicular volume of their administrators) Considering the meager salary they pay me they make quite a good cut on this deal.

AAMC has a little brochure on this outlining the system in broad terms:

https://services.aamc.org/Publications/showfile.cfm?file=version19.pdf&prd_id=88&prv_id=110

 

[brightblueeyes]

...In most european countries (with some exception in the UK), residents are regular employees of the hospital. You are expected to WORK first, education is often an afterthought. And as much as we bitch about workload and scut here, without the federal cash it would be far worse...

Are you sure about this? I won't know first hand for several years, but I checked several descriptions for post-graduate medical training here in France and they all seem to focus on the education requirements. Basically, the three components are your thesis, your theoretical courses, and your stages (I know during med school they would be called rotations but I'm not sure what they should be called during a residency). The only time during post grad training when it looks like the primary focus might not be education seems like it would be during the stages. But even these look fairly structured and focused on learning goals (with the possible exception of one of the stages for Family Medicine).

I also noticed on one description that trainees are still considered full time students during these stages.

I may be wrong, but I thought one of the attractive things about doing post-graduate training here was that trainees wouldn't be working really long hours at a stretch and could focus more on their training.

I'm from Canada but a major reason for my coming to France was that I'd heard their clinical training was supposed to be excellent--at least as good, I was led to believe, as back home.

 

[f_w]

I am not that familiar with the situation in france, the folks who went to do their training there never came back 🙂)

Next to Switzerland, France is probably the best place in europe to be a physician. It is not like they drown in money, but once they have reached the 'hospital practicioner' status, they seem to have quite a decent lifestyle.

 

[brightblueeyes]

Hey all -- I'm trying to write a letter to the editor regarding medical costs, and I was hoping to verify some info. regarding higher education in Germany, France, etc. My impression is that the public schools are completely subsidized by the government (for residents of that country), and that students only pay nominal fees. I've tried a couple of Google searches with some luck, but not exactly what I was hoping to find. If anyone has info. to confirm or deny this, I'd really appreciate it. Thanks!

You're right about France. There are fees but they are mostly for social insurance (which is quite good here). Once you take away this, the actual tuition fee is about 150 euros per year (i.e. < $200). In fact, during the last three years of med school we get an allowance that comes to roughly 1,500, then 2,800 and finally 3,200 euros per year.

Germany's in the process of changing. Studies used to be free but some universities have begun charging modest tuition (something like 1,500 euros) for students who've already spent more than a certain number of years in post-secondary studies. I think it might vary from Land to Land (i.e. state to state) and maybe even from university to university.

Belgian and Swiss med schools are also very inexpensive. I think it's about 1,500 euros for one of the Belgian schools I know about and about 2000 euros (I think) for one of the Swiss schools. Dutch med schools may cost a little more but are still very inexpensive by North American standards.

 

[tlew12778]

Are you sure about this? I won't know first hand for several years, but I checked several descriptions for post-graduate medical training here in France and they all seem to focus on the education requirements. Basically, the three components are your thesis, your theoretical courses, and your stages (I know during med school they would be called rotations but I'm not sure what they should be called during a residency). The only time during post grad training when it looks like the primary focus might not be education seems like it would be during the stages. But even these look fairly structured and focused on learning goals (with the possible exception of one of the stages for Family Medicine).

I also noticed on one description that trainees are still considered full time students during these stages.

I may be wrong, but I thought one of the attractive things about doing post-graduate training here was that trainees wouldn't be working really long hours at a stretch and could focus more on their training.

I'm from Canada but a major reason for my coming to France was that I'd heard their clinical training was supposed to be excellent--at least as good, I was led to believe, as back home.

I think this is getting a little OT since the OP seems to be referring to actual medical school training and not residency training, but in Italy residents are still considered students (just to add to the mix). In fact, the 800-900 euro/month "salary" is actually a "scholarship" and is taxed likewise (you pay 8% tax as opposed to ~30%). However, that doesn't mean that the hospital or your professors will necessarily treat you as a student. I know many residents who are forced to slave away like FT employees with little concentration on the actual training they get. I know others who are learning new skills everyday. It really depends on the hospital IMO. There is a test that all residents are required to take every year though.

So in France, you do your clinicals and your thesis after you graduate? That's interesting.

 

[brightblueeyes]

...So in France, you do your clinicals and your thesis after you graduate? That's interesting.

I think most people use the word "clinicals" to refer to clinical rotations. And these are done during med school just like anywhere else. (But I wasn't sure of the word to use for practical training conducted during a residency so I just used the French word stage which is also the word used for rotations--hence the confusion.)

But you're right about our theses being defended during post-graduate training. I think France might be the only country that does this. (And, as you can imagine, I have mixed feelings about this.)

Basically, after we finish med school, we receive Medical degrees of deuxième cycle, i.e. at the level of a Master's. But after successfully defending our theses during specialist training, we receive doctorats which are supposed to be of troisième cycle.

BTW, I'm curious about what medical studies are like in Italy. France has various rituals and traditions (and vocabulary) associated with the whole sub-culture of studying Medicine (some very interesting and some just plain silly). Given its history, I think Italy is the country most likely to have developed a similar set of traditions. Did you notice anything like this during your studies?