A recent article suggested that there is a good way to help medical students alleviate their crushing debt and at the same time assist outlying communities to solve their chronic shortage of doctors (“Solving the primary care crisis,” BCMJ 2009;51[1]:12-13 [9]). The two eager students feel this is a classic “win-win,” and on the surface of it they seem to be right, but they need to look a bit further back than their references went to see that this has been tried and failed.

When I was a house surgeon in New Zealand in 1976, it came to my attention that just such a scheme was being employed by the Australian government to entice students to make a commitment to the Flying Doctor Service (FDS)—2 years and your education is free. To start with this was fairly successful, until a few students found that their enchantment with the FDS was very limited. Some started to go to banks with their degree as collateral and arrange loans to pay off the government, get out into private practice, and repay the bank loan in less than a year.

Any system set up here would have to plug such a loophole (human rights?) or be so advantageous to the student that it would be a bad financial deal for the province. I think the principle of the proposed scheme is good, but it is a good deal more complicated to implement than it seems at first blush. Human nature and the real world always seem to get in the way.

—Mike Marshall, MD
North Vancouver