Cross-cultural communication （97）　

97) Student Loans for American Medical Students
As I wrote in the article Cross-cultural communication (76), the majority of American university students pay their own tuition fees. To do this, they often work for several years to save up the money before entering university. However, tuition fees at private universities in the US (in the US, private universities are generally considered to be better than public universities) are usually several million yen per year, so it is impossible to raise the funds just by working for a few years, and most students have to take out an education loan. When it comes to medical school, tuition fees are even higher. They are around 3 to 8 million yen per year. In the US, you enter medical school after graduating from a four-year university, and then study for another four years. For example, if you attend a four-year university with annual tuition fees of 3 million yen, and then go on to a medical school with annual tuition fees of 5 million yen for four years, the total amount comes to 32 million yen. Add to that the cost of living, and the financial burden on American medical students is no small matter. Currently, the average amount of student loan repayments upon graduation from a four-year university in the US is over 10 million yen. For medical students, it is double that, over 20 million yen.

According to the article “Disruption: Beyond Disruption, Part 9: The Great Digital Financial Earthquake” in the December 11, 2019 morning edition of the Nikkei, a certain start-up company in the US conducted a more detailed survey of graduates with large education loans, and as a result of this, when they lowered the interest rate from the 6% range to the 4% range and lent money, many borrowers gathered. The key question in the survey was the number of times the university graduate had defaulted on their debt over the previous 35 years. I imagine that the next target for this shrewd company will be medical graduates. It's likely that they've already started. In the US, the only cases of defaulting on debt after becoming a doctor are cases such as becoming a casino addict or becoming ill, including from illegal drugs. If you're just practicing medicine normally, you can probably pay off that kind of debt within 10 years. However, it is only natural that you want to get out of debt as quickly as possible. So, it is not an exaggeration to say that, over the past 20 years or so, the reason why American medical students choose their specialty after graduation is often the amount of money they can earn in that field. Specifically, specialties with high annual incomes, such as neurosurgery, orthopedics, ophthalmology, cardiology, and gastroenterology, are popular, while specialties that provide primary care (general medical care, or the current Japanese department of general medicine) such as family medicine, general internal medicine, pediatrics, and obstetrics and gynecology, do not attract people because of their low annual incomes. This may be a somewhat extreme way of putting it, but while the American medical/healthcare world demands a level of morality and professionalism that seems excessive in the field of medicine/healthcare, the choice of specialty at the entrance to the field is determined by money.

Turning to Japan, what about the situation there? Leaving aside the question of whether the current situation is good or bad, the majority of medical students in Japan rely on their parents to pay their tuition fees. Therefore, very few of them have any loans to pay off when they graduate. Also, there is almost no difference in annual income depending on the specialty after graduation. Most young doctors in Japan are salaried doctors working in hospitals, so if they are the same age, their annual income is more or less the same regardless of their specialty. In fact, if they leave their specialty and open their own general practice, their income will actually increase. As a result, when you look at the overall number of active doctors, the ratio of super-specialists to general practitioners is fairly well balanced, at least compared to the US. The WHO has previously acknowledged that the overall quality of medical care in Japan is superior to that in the United States. However, it is also true that if you are not concerned about the cost of medical care, the level of super-specialized medical care in the United States is several levels above that in Japan. Having been involved in various forms of medical care in Japan, the United States and France as a doctor for over 40 years, I now more than ever believe that it is extremely difficult to create an ideal medical system for a country.

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