自治医大卒業医師の訴訟問題が友人医師の間でも話題になっています。
僕自身も父親が研究者で、あまり歳の離れていない弟も二人おり、決して裕福な家庭ではなかったので、私大の医学部はありえず、大学には正直なところ選択肢がありました。
医学部受験を真剣に考えたのが医師だった祖父の死を鑑みての大学受験の4ヶ月前だったので、防衛医大や自治医大は選びませんでしたが、最初から医学部を目指していたら、当然進路として考えたと思います。ちなみに僕は、いまだに大学院の授業料については毎月奨学金を返済しています。
医学部は、単なる「大学の一学部」ではありません。卒業し国家試験に合格して初めて、医師という強い職業資格への入口に立てる。
しかも自治医大は、学費負担を大きく抑えながら医師になる道を与えるという、極めて特殊な仕組みです。
だから、自治医大に入学できたということ自体を、僕なら「権利を得た」というより「非常に大きな機会を与えられた」と考えます。
医学部に入りたい人は大勢いる。しかし全員が入れるわけではない。自治医大の場合、その限られた席を一つ使って医師になった以上、「卒業後は地域医療に貢献してください」という条件は、後から突然追加されたものではありません。
ここは一般の奨学金とは少し違うと思います。
たとえば1000万円を借りて大学へ行ったという話なら、返済条件の妥当性を中心に議論すればいい。しかし自治医大の場合、提供されたのはお金だけではない。
医学教育を受ける席そのものです。
その席がなければ医師免許を取得することもできなかった。
そう考えると、途中で「やはり義務は負いたくないので、お金だけ返せばいいでしょう」という発想には、僕も少し違和感があります。返済によって金銭的な帳尻は合わせられても、その人が使った医学部の一席は、後から別の志願者に返すことができないからです。
宝くじという表現もわかります。
もちろん入試に合格した本人の努力はある。しかし、医学部の定員、時代、出身県の枠、試験当日の結果など、人生には本人の努力だけでは説明できない縁もある。
そして大きな縁には、ときに責任が伴う。
僕なら自治医大の制度を、
「無料で医者にしてくれる制度」ではなく、「医師という非常に希少な資格を得る機会と引き換えに、一定期間社会へ返す制度」
と捉えます。
だから制度の細部、たとえば10％の遅延損害金が高すぎないか、病気や家庭事情への例外をどうするか、という議論は当然あっていい。
しかし、それと
「そもそも地域医療に従事する義務を負うこと自体がおかしい」
という議論は別だと思います。
医師免許は、一度取れば基本的に一生使える非常に強い資格です。
その資格を得る入口を社会から与えてもらったのなら、若い時期の数年間を地域医療に返すことは、むしろ制度の筋としてかなり自然ではないでしょうか。
「悪魔のような制度」自治医大・修学資金3766万円“一括返還”巡る訴訟 「約束したんだから返せ」の声に原告医師が反論（弁護士JPニュース） – Yahoo!ニュース
The Lawsuit Involving a Jichi Medical University Graduate
The lawsuit involving a graduate of Jichi Medical University has become a topic of discussion even among some of my physician friends.
My own father was a researcher, and I also have two younger brothers who are not much younger than I am. We were by no means a wealthy family, so attending a private medical school was simply not an option for me. To be honest, I did have choices when it came to which university to attend.
I only began seriously considering medical school about four months before the university entrance exams, following the death of my grandfather, who was a physician. That was why I did not consider institutions such as the National Defense Medical College or Jichi Medical University. But if I had been determined to become a doctor from the beginning, I certainly would have considered them as possible paths.
Incidentally, I am still repaying, month by month, the student loans I took out to cover my graduate-school tuition.
Medical school is not simply another “department within a university.” You can only stand at the entrance to the highly specialized profession of medicine after graduating from medical school and passing the national medical licensing examination.
And Jichi Medical University has an especially distinctive system: it provides a pathway to becoming a physician while substantially reducing the financial burden of medical education.
That is why, if it were me, I would view being admitted to Jichi Medical University not so much as having been “given a right,” but as having been given an extraordinarily valuable opportunity.
There are many people who want to enter medical school. But not everyone can. In the case of Jichi Medical University, once you have used one of those limited places and gone on to become a physician, the condition that you “contribute to community medicine after graduation” was not something suddenly imposed on you later.
It was part of the deal from the very beginning.
I think this is somewhat different from an ordinary student loan.
If someone borrows ¥10 million to attend university, for example, then it makes sense to focus the discussion on whether the repayment terms are reasonable. But in the case of Jichi Medical University, what was provided was not simply money.
It was a place in a medical school.
Without that place, the person would not have been able to obtain a medical license in the first place.
Seen in that light, I also feel somewhat uncomfortable with the idea of saying, midway through the process, “I’ve decided that I don’t want to fulfill the obligation after all. Can’t I just pay the money back?”
Repayment may settle the financial balance, but the place that person occupied in a medical school class cannot be returned afterward to another applicant who wanted to become a doctor.
I can also understand the lottery analogy.
Of course, the person who passed the entrance examination deserves credit for their own hard work. But the course of a life is shaped by factors that cannot be explained by individual effort alone: the number of medical-school places available, the era in which one happens to live, regional admission quotas, the result on the particular day of the examination, and countless other forms of timing and circumstance.
And sometimes, great good fortune comes with a responsibility attached to it.
If I were to describe the Jichi Medical University system in my own words, I would not call it
“a system that gives you a medical degree for free.”
I would describe it as
“a system that gives you an opportunity to obtain an exceptionally valuable professional qualification in exchange for giving a certain number of years back to society.”
Of course, there is room for legitimate debate about the details of the system—for example, whether a 10% late-payment penalty is excessive, or how exceptions should be handled in cases of illness or serious family circumstances.
But I think that is a separate question from saying,
“The very idea that graduates should be required to serve in community medicine is wrong.”
A medical license is an extraordinarily powerful professional qualification that, once obtained, can essentially be used for the rest of one’s life.
If society gives you the opportunity to enter through that door, then spending several years of your early professional life giving something back through community medicine seems, to me, not only reasonable but actually quite natural when viewed in the context of the system itself.
