Sir, I am writing regarding the financial difficulties faced by trainees in oral medicine and oral and maxillofacial surgery when reading for their second degree, be that in medicine or dentistry.

Recently there has been a lack of suitable candidates for registrar training posts in both specialities but particularly in my chosen career pathway of oral medicine. One of the main deterrents for prospective candidates is the lack of financial support provided by the NHS during their period of study towards a second degree. A greatly reduced regular income, course fees running into thousands of pounds (tens of thousands for non EU graduates), loss of superannuation payments and an unfair NHS Bursary system all add to the reasons why not to specialise in these disciplines.

I am currently part of the 4th year cohort of the MBChB course at the University of Birmingham Medical School and recently enquired with the NHS Student Bursary Service about receiving an NHS Bursary in my 4th year. Although all medical students can claim a bursary in their final year, only students undertaking a four year 'graduate entry course' are entitled to an additional bursary in their penultimate year. According to the Bursary Service dentists are not considered graduate entry students, hence are not entitled to the assistance. This is despite the fact that generally, dental graduates will be older and more likely to have additional financial responsibilities such as mortgages and children when compared to non dental graduate students.

Another negative aspect of reading towards the second degree is the loss of superannuation payments during the period of study; and the resultant detrimental effect on your NHS pension. I have been told by the NHS Business Services Authority that not surprisingly the NHS pension is inflexible in this respect. Moreover, as of 31 March 2008, the ability to purchase extra years will be replaced with a new 'additional purchase facility' which allows a top up of superannuation payments to provide a maximum of £5,000 pa in extra payment on retirement. I will leave discussion about which is the better deal to the accountants and the financially astute. However, one question remains unanswered, that is will I be forced to work longer than my general practice colleagues in order to attain a full pension?

The British Society of Oral Medicine, although sympathetic and supportive of the cause of prospective registrars, was unable to provide any further assistance. The British Association of Oral and Maxillofacial Surgeons were also sympathetic but suggested that they are working with the Postgraduate Medical Education and Training Board to try and establish the principle that commencement of the second degree in oral and maxillofacial surgery should mark the starting point of specialist training, and as such it should be funded. Any decisions here could cross over to additionally affect oral medicine training. It remains to be seen if any substantial progress will be made towards improving the situation.