The Saudi exodus from Dalhousie Medical School could be a massive financial hit to the university

The Saudi exodus from Dalhousie Medical School could trigger a chronic multi-million dollar-sized migraine for the institution, possibly starting this fall, as it scrambles to replace a lost revenue stream.

Immediately in question is the collectability of an estimated $5.9 million in Saudi tuition for the current term.

Neither the university nor the Nova Scotia Department of Labour and Advanced Education would discuss the issue directly, although both indicated they were still trying to get a handle on the fallout from the loss of the medical school’s 59 Saudi residents and fellows.

Nova Scotia Department of Labour and Advanced Education spokesperson, Chrissy Matheson, acknowledged Friday in an email statement that the exit “will have impacts on our institutions, especially the Dalhousie Medical School.”

She added, “We are engaged with the med school and other institutions to determine both the short- and long-term impacts and ramifications, and those discussions are ongoing. We do not have that information finalized at this point.”

Indicative perhaps of the issue’s sensitivity, was a deafening silence from the medical school itself. Andrew Warren, the medical school’s associate dean of postgraduate medical education advised through staff, Friday, he was not giving media interviews on the Saudi issue. An emailed request Wednesday from the Halifax Examiner for an interview with David Anderson, the dean of the medical school, has gone unacknowledged as of this writing.

On behalf of the university, Senior Communications Manager Janet Bryson said in an email, “The medical school is working to assess the financial impact on their budget and it’s too soon to speak to the impacts. The priority for the medical school has been continuing to work with its partners in healthcare to support all residents and to look at ways to mitigate impacts to the healthcare system, as the residents from Saudi Arabia return to their country.”

The Dalhousie statement did not address whether the school will be able to collect all, part, or none of the $5.9 million in tuition for its 59 Saudi residents and fellows. Each is charged an annual $100,000 fee under a pan-Canada medical school agreement for Saudi postgraduate medical training in Canada.

The academic year for Canadian postgraduate programs in medical specialties and subspecialties started in July, but it was Aug. 5, barely a month into this year’s training schedule, when the Saudi government abruptly ordered its medical trainees in Canada to return home by Aug.31.  In conjunction with the decree, the scholarships were suspended that cover tuition fees for Saudi physicians taking Canadian post-graduate medical training. It is not clear what effect this will have on billing and payments.

Given the kingdom’s current tensions with Canada, it is also unclear when or if the long-standing Canadian provision of postgraduate medical training to Saudi physicians will be resumed. Even if the program were to be restored, there is no guarantee it would be on the same scale. An estimated 800 Saudi physicians were enrolled in specialty or subspecialty training in Canada at the time of the Saudi edict.

Canada deeply concerned by Saudi Arabia’s expulsion of Canadian ambassador. More information: https://t.co/FCOFR65VbO

— Chrystia Freeland (@cafreeland) August 6, 2018

The directive to return home is part of Saudi retaliatory action in a diplomatic squabble with Canada over Global Affairs Minister Chrystia Freeland’s tweet that called for the immediate release of human rights activists imprisoned in Saudi Arabia.

For Dalhousie Medical School, the potential for a chronic multi-million dollar revenue shortfall is bound to raise alarm. Faced with a $2.5 million government cut to the school’s operating budget in 2010, Tom Marrie, then dean, warned accreditation for the medical school’s undergraduate degree program would be jeopardized unless the funding was restored. After a short-lived public kerfuffle, the school eventually got $1.4 million of it back, enough to ward off a calamity.

Eight years on, the medical school will be looking at much bigger annual losses if the Saudi revenue stream dries up permanently. More government funding or new revenue sources — or some combination of both — will likely be needed for the medical school to maintain current levels of operation.

To appreciate what a cash cow the Saudis have been, compare their $100,000 tuition for postgraduate medical training to the $3,164 fee Dalhousie charges Canadian physicians, according to the university’s posted 2018-2019 schedule. Canadians pay less because their programs are government-subsidized.

In Nova Scotia, Canadian medical residents receive salaries negotiated by the Maritime Resident Doctors. As of June 30 this year, the scale ranges from $62,000 for a first-year resident to $99,000 in the final year of an eight-year residency. In contrast, Saudis physicians are responsible for their own salaries and living expenses.

The way residencies and fellowships are set up, the Royal College of Physicians and Surgeons of Canada regulates all postgraduate medical education with the exception of family medicine, which is governed by the College of Family Physicians of Canada. Programs are delivered through the nation’s medical schools, but actual training takes place in affiliated teaching hospitals and other clinical settings. Most residency programs last two to five years and an MD degree is required for enrolment.

Over time, the Saudi scholarship program has become an unacknowledged subsidy scheme for Canada’s healthcare system, and participating Canadian medical schools like Dalhousie. The Saudi physicians have provided medical service at no cost to hospitals and other facilities where they train, and their scholarships have been a significant and reliable revenue stream for medical schools.