First business, then medicine, then law, and now everyone. The handwriting is on the wall. Tuition at Queen's University is going up again soon, and by a lot. Principal Bill Leggett wrote that deregulation of tuition across our university could be good for us. He claimed that higher tuition has improved medical training, and with a complicated financial analysis, he predicts that further hikes across the entire university need pose no barrier to access.

I disagree and am disappointed with his failure to examine the available evidence, both from the present and from the past. Higher medical tuition has not improved the quality of education, and the students know it. Tuition also seems to be raising the barriers to access, as it already did in the past. Family wealth rather than aptitude will further determine who gets to be educated. In other words, the intellectual gene pool for university admission may be shrinking.

Universities have a difficult job when the province refuses to provide sufficient funds even to cope with inflation. Tuition hikes are an obvious solution to compensate for the difference, and Leggett puts a brave face on a desperate measure. The students occupying his office this week seem to understand that. But before pronouncing on the harm (or lack of harm) in raising fees, we should examine the question with evidence and research. The little information now available warns us to go slowly.

First, we have been here before. In 1853, the government at Toronto decided it was inappropriate to provide public funds for education in the "lucrative professions" of medicine and law; support was stopped. Sound familiar?

The experiment failed. Funding was restored in 1887. The reasons are interesting: the public was deemed to be the beneficiary of good professional training; therefore, the public should invest in that training.

Second, medical school tuition quadrupled over the last five years. But higher tuition has not yet improved the quality of education. As the former elected chair of the Queen's Faculty of Health Sciences, I am aware that class sizes have been growing, rooms are inadequate, sufficient tutors for important small-group teaching are difficult to find. Recent improvements have been the result not of higher tuition but of generous gifts energetically sought. Students see the irony: educational quality slips while they pay more. Our faculty is working hard and well to simply maintain our traditionally high standards. The tuition hikes help to barely meet that minimalist goal.

Third, my research shows that recent increases have returned medical tuition to levels not seen for more than a century — making higher education the purview of an elite few. Since the mid-19th century when the schools were founded, tuition rose steadily in actual dollars. When converted to dollars of equal value, however, it seemed to remain stable until the late 1980s and the 1990s, when it soared exponentially.

The hikes are even more sobering when the fees are compared to a worker's wages across the 150 years. The graph* displays tuition in three Ontario medical schools in terms of "carpenter wages." From a high of 700 hours of labour for one year of medical training in 1860, this indicator declined steadily during much of the history of our country. A low of 83 hours of carpenter labour was reached in the late 1970s, when some of our current leaders were themselves students. And in the last decade, under the direction of those educated most economically at public expense, tuition has soared back beyond 700 hours in terms of carpenter labour — reversing a century and a half of increasing access.

Finally, several other research projects also show that wealth may determine who will go to university and who will become a professional. For example, through careful surveys, medical students from across the country demonstrated that they come from the wealthier segments of the population. Last summer, a consortium of Queen's students and faculty drawn from several sectors of the university began to assess these matters historically and demographically. The results are not encouraging for those who are sanguine about tuition hikes; they imply that the exclusion of lower-income contenders occurs after high school, within universities. We need to know more.

Why should we care? Equality of access is most important, but we should also keep education relevant to our society. A narrowing of the educated will result in a narrowing of their usefulness. Among the most needed practitioners of medicine, law, and education are those who are prepared to serve where demand is greatest — in rural or inner-city areas — knowing that they will never become rich. We also need people who are willing to investigate interventions based on the social determinants of health. We do not know, but we should be prepared to imagine that people with these aptitudes may come themselves from disadvantaged backgrounds. Already, however, they are disproportionately excluded from education.

This demographic narrowing occurred long ago in the United States. How did the high cost of fees at all American schools contribute to that problem? Surprisingly enough, that is unknown. Maybe we should find out before we convince ourselves that undergraduate tuition hikes will do nothing to damage equality in Canada.

Rich professionals should be required to pay for their education. In a society priding itself on equality of access, that payment must be in the form of a reimbursement made when they become rich: stiff taxes appropriately directed to education. The province of Ontario seems to have forgotten that mechanism — a forgetting (if not suppression) that is euphemistically called "facing reality" in a recent Queen's document.

Historians are not obliged to do the same. Certainly, other parts of Canada and the world seem to be able to live in other "realities." Queen's should not rush to embrace and extend the privatization fad, a pedagogical manoeuvre Ontario deemed to be an error long ago. Queen's will not be the first institution bent on repeating the past.

It is high time we abandoned the pretense that tuition deregulation is a boon rather than a stopgap, that tuition hikes are good for society, that the naked emperor is well clothed. As privileged scholars and citizens, let us engage with the real question, which is intellectual, philosophical and political.

Jacalyn Duffin is a hematologist and historian who holds the Hannah Chair of the History of Medicine at Queen's University.

* "What goes around, comes around: a history of medical tuition" — Reprinted from, with permission of the publisher, CMAJ 9 January 2001; 164 (1) 50-6 © 2002 Canadian Medical Association http://www.cma.ca/cmaj/index.asp.

The views expressed are those of the author and not necessarily those of CAUT.