Graduate debt: Does Norway need more medical study places?

The fact that medical graduates who pursued their studies abroad make up a significant proportion of the country’s ‘highly indebted’ graduates – defined as those with debt of over NOK1 million (US$95,600) – has raised concerns about the number of medical study places available within Norway.

According to figures released in June by the Norwegian State Educational Loan Fund (Statens Lånekasse for utdanning), a public administrative body under the Norwegian Ministry of Education and Research, 106,000 students started repaying their student debt this year.

On average their debt was NOK427,000 (US$40,800), an increase since 2013 of 20% (adjusted for the value of the krone in 2023).

However, figures show the number of highly indebted graduates increased by 400%. Most of these – 71% – studied abroad and 28% specifically studied medicine abroad.

Average debt varies per country

While the average debt of students having graduated abroad varies according to the country in which they studied, in 2023 the average debt for a student who studied abroad was NOK703,000 while those who stayed in Norway to study had an average debt of NOK409,000.

Those having studied in the UK in 2023 had an average debt of NOK790,000 upon graduation, while the debt for Norwegian graduates in the Netherlands and Germany was NOK500,000.

According to figures on medical students abroad supplied by Lånekassen, 600 Norwegian students finished their medical studies abroad in 2023 and have started to pay back their debts. Of these, 300 (50%) have more than NOK1 million in debt.

Medical students in Poland, Slovakia and Hungary, which attract the highest number of Norwegian medical students and where students are required to study for six years, were among those with the highest debt.

According to Lånekassen figures, among 90 medical students graduating in Hungary 76% had debt of more than NOK1 million while that figure was 70% of 200 students graduating in Poland and 45% of 100 students in Slovakia.

According to the Norwegian medical association, there are a total of 1206 medical students in Poland, 520 in Hungary, 468 in Slovakia, 368 in Denmark, 211 in Czech Republic, 144 in Latvia, 37 in Croatia, 27 in Sweden and a smaller number in 18 other countries.

Cuts to grants

Øyvind Bryhn Pettersen, president of the Association of Norwegian Students Abroad, told University World News medicine is and remains the most popular field of study for Norwegian students abroad. He said in the 2023-24 academic year, slightly fewer than 3,000 Norwegians studied medicine abroad.

“These students are returning to Norway with unsustainable, high debt,” he said, particularly in the wake of cuts to student grants in 2023.

“Now, students abroad only get 40% of their tuition fees converted to a grant. ANSA thinks that this grant proportion should increase to 70% to make it possible for more students to get real opportunities to study medicine abroad.

“Graduates from abroad contribute with international perspectives, important competences and language and cultural understanding that are all positive for Norwegian society,” he said.

Passing the bill

As reported by University World News in 2019, Norway was advised by an expert committee to increase the number of medicine study places offered in the country by 69% (from 636 places in 2019 to 1,076 by 2027) in line with World Health Organisation guidelines.

Editor-in-chief of the Journal of the Norwegian Medical Association Are Brean criticised the failure of the state to educate its own doctors.

“I think that it is disgraceful, from a global perspective, that Norway as a rich country is letting other [countries] foot the bill for educating the doctors we need,” he told University World News.

In an article he authored for the journal in August 2022, Brean said that over 45% of Norwegian medical doctors were educated abroad, with Norway being 26th among the 29 OECD countries with regard to the number of doctors it educates per inhabitant.

“While the number of medical doctors educated in Norway from 2013 to 2021 increased by 5%, the number of applicants for medical practice training who were educated abroad increased by 46%,” he wrote.

“Contrary to most other countries, we are sending our students abroad for training to bring them back as graduated doctors later. This is very profitable for Norway where one medical students’ training is estimated to cost NOK885,000 while a student educated abroad is estimated to cost NOK94,500,” he explained.

Brean said against the backdrop of the UN’s Sustainable Development Goal 3, part of which calls for more doctors to be trained to meet global demand, Norway was “wasting” global education capacity by not educating its own doctors.

“This is part of the background for WHO's Global Code for the International Recruitment of Health Personnel, which was adopted in 2010. By joining this, Norway undertook to work to fulfil its health personnel needs with its own resources.

“On the contrary, the proportion of Norwegian medical students abroad has increased steadily in all the years since. From 2008 to 2017, the growth in the number of foreign students was 33%, compared to an increase of 1% in Norway,” said Brean.

Brean said even with increases in the number of study places since 2018, current educational capacity covers only 54% of the estimated need for doctors.

New study places

Professor Hilde Grimstad of the faculty of medicine and health sciences at the Norwegian University of Science and Technology (NTNU) who in 2019 chaired the expert committee investigating how to expand medical education in Norway told University World News that the committee recommended that 440 new study places be allocated to meet the 2027 target.

“We also recommended a plan for the increase, whereby 235 new study places should be established by 2024. The government has established 185 study places by 2024, 50 less than we recommended, and I do not know if there are any plans for further increases,” said Grimstad.

She said 80 of the new study places were given to decentralised medical education in line with the government’s investments in decentralised education whereby students are taught for the last 3-4 years outside the cities of the faculties of medicine.

“Some medical schools in eastern Europe finance some of their activities through the tuition fees from foreign medical students, and it seems as if they set the tuition fee close to the limits from what Lånekassen will offer the students.

“In addition, the Norwegian krone has weakened and living costs have increased for the students. On one side, the students themselves choose to study abroad, and can calculate the costs although it can change during six years, and on the other side, Norway is dependent on some young people choosing to study medicine abroad and letting the students carry the extra costs.

“It is a special opportunity for Norwegian students that they can choose to use Lånekassen’s loans and scholarships for a whole study programme abroad. That is not the case, for example, in Denmark.

“But still, Norway has to make a plan to educate its own doctors as we have supported in the WHO Global Code of Practice on the International Recruitment of Health Personnel,” Grimstad said.

‘Ready to expand’

Professor Bjørn Stensaker, vice-rector for education at the University of Oslo, said the university was “ready” to expand the number of medical students if it receives the necessary funding.

“The decentralised study model we have developed in the last couple of years has been really successful, so we are confident that we are able to further expand the number of students in medicine without compromising the quality of the study programme,” he explained”.

Kjetil Moen, CEO at Lånekassen, told University World News the organisation had seen the number of students with more than NOK1 million in student debts increasing, but said the growth had abated from 2022 to 2023.

“We are monitoring the development of our customers’ debt closely,” said Moen. “Most of our customers are managing to pay their invoice every month. For customers that are having trouble paying their invoice, we have several schemes that could help.

“For instance, those paying their debt can defer repayment of their invoice up to 36 times. And if you are on a low income, you can have your interest deleted. Some can have their debt deleted, for instance, people who become disabled,” he added.