As nearly a million university students start term this month, UK medical schools face a perfect storm of financial problems that could dramatically affect student education, according to a special report by The BMJ today.
They include closures, cuts to charity income, fear amongst international students, and a botched A-level algorithm that has thrown medical school into chaos and severely cut funding.
What's more, new covid-19 rules are dramatically altering the curriculum. Just when we need them most, the next generation of doctors is facing a perfect storm of challenges, reports journalist Stephen Armstrong.
Letters seen by The BMJ show medical schools asking staff to consider voluntary pay reductions, early retirement, redundancy, or changes to clinical academic contracts to cope with budget constraints.
These moves are causing significant concern about the effects on student education.
In July, the Institute for Fiscal Studies warned that the covid-19 crisis posed a considerable financial threat to universities, with estimated losses of around £11bn (€12bn; $14.2bn), more than 25% of the sector's annual income.
Figures compiled by the Times also show that the sector's debts have risen over the past year to £10.8bn, making them particularly vulnerable to financial problems.
This means that less prestigious and financially weaker institutions face insolvency, the institute says, with some 13 unnamed universities needing a government bailout to survive.
Medical schools should be in a strong position to weather this storm because their funding comes from three pillars: student fees, the government/NHS, and research grants.
And yet, fees and grants are severely threatened after covid-19, while recent pay rises for NHS staff mean that clinical academic consultants and senior academic GPs are paid at least 2.8% less than equivalent NHS posts, attracting senior academic clinicians away from teaching, explains Armstrong.
Alongside this, charity funded research at universities is expected to fall by 41% for the financial year 2020-21, resulting in a projected reduction in medical research investment of £252m-£368m and further threatening jobs.
Two senior academics at two city based medical schools, who wished to remain anonymous, have told The BMJ of their "significant concerns" about the effects of financial pressure on the quality of student education.
David Strain, senior clinical lecturer at the University of Exeter Medical School and co-chair of the BMA's Medical Academic Staff Committee, says that, after the A level fiasco and the subsequent huge increase in medical school places, making academics redundant now would seriously damage teaching.
The University and College Union warns that cuts could not have come at a worse time, with clinical academics treating patients during lockdown and medical researchers leading the fight against the virus.
The BMA is also concerned about the decline in senior clinical academics.
Strain says, "We've lost too many senior clinical academics over recent years, and we cannot afford to lose any more: to do so would be disastrous for the extent of medical research in the UK and the quality of learning in our medical schools, to the detriment of the NHS workforce of tomorrow."
But medical students describe a sense of solidarity with staff.
Chris Smith, a final year medical student at Southampton University and co-chair of the BMA's Medical Students Committee, says: "We've heard stories up and down the country of medical school staff leaving and not being replaced. We stand shoulder to shoulder with the academics: we don't want to see anyone forced into taking a pay cut, and, if we lose academics, medical students will be the ones that lose out."
Peer reviewed? No
Evidence type: Investigation
Subjects: UK medical schools