Medical training: High tuition fees, low salary after graduation

First-year students of HCM City University of Medicine and Pharmacy enroll in admission. Among State-owned healthcare training institutes, the university charges the highest tuition. Photo thanhnien.vn

HCM CITY The medical field has some of the highest tuition fees and longest training periods in academia, but not all graduates are able to find employment that matches their efforts.

The past few years have seen high numbers of medical staff in public healthcare facilities quit their jobs to move to private healthcare, due mainly to low salaries and benefits in the public sector.

Tuition fees for health science majors at universities and colleges, especially those involved in medicine, are currently extremely high, at nearly VNĐ200 million per year at some institutions.

According to the tuition fee schedule announced for the 2024-2025 school year, non-autonomous (or State-supported) schools can collect a maximum of VNĐ27.6 million per student each school year, which lasts for ten months.

Schools that are able to ensure regular expenditures can collect a maximum of VNĐ55.2 million per student per year, while autonomous schools can collect fee of up to VNĐ69 million per student per year.

Students in accredited programmes must pay higher fees based on their school.

Among State-owned healthcare training institutes, HCM City University of Medicine and Pharmacy charges the highest tuition at VNĐ80 million per academic year.

Hồng Bàng International University has the highest tuition costs among private universities with fees of VNĐ180 million every academic year, followed by Tân Tạo University and Nguyễn Tất Thành University, both of which charge VNĐ150 million.

Current tuition fees for healthcare and pharmaceutical majors are ten times higher than they were ten years ago.

The highest medical tuition costs for the 2014-2015 school year were just VNĐ8 million.

Aside from the high cost of education, medical students also have to go through a long and difficult learning process. But the income offered to young doctors at public health facilities today is not much of an incentive.

After graduating from HCM City University of Medicine and Pharmacy's Faculty of Medicine in 2022, Nguyễn Thu Phương sought a job at a hospital in Thủ Đức City.

She first had to complete a two-month apprenticeship with a monthly assistance stipend of VNĐ1.5 million, followed by a two-month probationary period with wages of over VNĐ3 million. After that, her monthly basic wage of VNĐ3.5 million was paid in full.

Phương's low income prevented her from being able to afford the high cost of living in the city. She was also unable to work part-time in clinics to increase her income, because she lacked a certificate to practise.

Eventually, she was able to secure extra weekend hours at a hospital in the nearby province of Long An after completing a year of study to obtain her credentials.

“During the week I work in HCM City. At the weekend I ride a bike to Long An,” Phương said.

"I have to stay up all night and don't have any days off throughout the week. There were times when I was traveling from HCM City to Long An, and I had to park my bike on the roadside to take a nap to have the energy to continue working," she told Thanh Niên (Young People) newspaper.

Phương's current income -- including salary, allowances and night shift pay at the hospital in HCM City -- is about VNĐ8 million per month, and her part-time job in Long An brings her VNĐ4 million.

"I only have enough to meet the cost of living in HCM City, although I work so hard and without days off. I feel sorry for myself sometimes," she said.

"After six years of study and an additional year to get a certificate, I had a longer learning curve than many of my friends. Even if I work considerably harder, my friends earn two or three times as much as I do.”

"I have to remind myself that I just received my degree and that I still need to get additional knowledge and experience. My income will increase after I become a decent doctor, but that process will likely take a long time," she added.

In spite of long training periods and high tuition fees, many medical graduates get low pay. Photo thanhnien.vn

A young doctor in HCM City who declined to be named told Thanh Niên that he could earn over VNĐ10 million per month including basic salary, night shift allowances and others.

Meanwhile a doctor who works at a private clinic two days per week could earn up to VNĐ6 million per month. A fresh graduate has to go through an apprenticeship for one to three years to be able to earn a living. The average income is around VNĐ6-8 million per month, plus whatever doctors can make from part-time jobs. The total might range from VNĐ12-15 million per month.

This is a low wage, not comparable with the effort they spend working and studying, he said.

A.D., another young doctor in HCM City's District 3, said that from five to ten years after graduation, doctors' incomes are often still not equal to what they spent on tuition.

A number of physicians and other healthcare professionals at public hospitals have recently quit their employment as a direct result of inadequate pay and excessive work pressure.

Up to 166 doctors and healthcare professionals in Bình Dương Province resigned from their positions in the first seven months of 2022 as a result of inadequate pay and benefits, a demanding work environment, hard labour and ongoing exposure to risk factors.

From early 2021 to July 2022, Nghệ An Province also saw 119 physicians and medical staff members leaving their positions in public hospitals. Two-thirds of them went on to work in private hospitals.

The Nghệ An Department of Health claimed that at the time, new graduates at public hospitals were only paid VNĐ5-7 million per month, whereas private institutions were willing to pay VNĐ15-20 million.

A medical resident can earn a salary of up to VNĐ15 million per month at public hospitals, but private hospitals are ready to pay them VNĐ70-100 million per month.

Dr Trương Hữu Khanh, an epidemiologist and former Head of the Department of Infectious Diseases-Neurology at Paediatrics Hospital No 1 in HCM City, said medical workers in the public system face many challenges, including the fact that their pay is not commensurate with their level of knowledge.

Those who continue working in the public system seek a setting in which they can contribute to society and advance their knowledge and skills. People have more options when they are more talented, he said.

“Impoverished patients would ultimately suffer if gifted doctors left the public system,” he said.

"Compared to other professions, the pay in public hospitals is not comparable with the amount of work that medical staff members put in. The 'easiest' time for medical staff to quit their positions because of low pay is the first ten years after graduation,” he said.

Increasing subsidies

The Ministry of Health has proposed a new subsidy rate for medical workers due to increasing base pay.

Surgery and procedure allowances as well as on-duty and meal allowances are also expected to increase.

According to the Government's Decree 81, students pursuing demanding and potentially hazardous careers — such as general practitioners, pharmacists, nurses, midwives and medical testing technicians — will get their tuition costs reduced by 70 per cent.

The Ministry of Health has also suggested that the Government and other organisations adopt a variety of favourable policies for medical and pharmaceutical students.

One proposal is for the state budget to give VNĐ3.63 million in living expenses for pharmaceutical and medical students. VNS