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Saturday, August 9th 2008

Carribbean Medical School Pays For Clinical Rotations

During the third and fourth years of U.S. allopathic medical education, the medical students are in clinics and hospitals getting hands on experience with patients. The affiliation between the medical student’s school and the hospitals in which students rotate is typically not a financial one but often involves health care facilities with a mandate and mission for education on top of their primary one to provide care.

In New York City that is about to change. A for profit Caribbean medical school, St. George’s University, has essentially bought spots for its medical students to rotate in New York City public hospitals. Those public hospitals are run by the New York City Health and Hospital Corporation who recently signed a potentially $100 million dollar deal with the Caribbean medical school, which plays host largely to U.S. citizens who did not get into American allopathic medical schools.

New York City’s Health and Hospitals Corporation has signed a 10-year, $100 million contract with a profit-making medical school in the Caribbean to provide clinical training for hundreds of students at the city’s 11 public hospitals.

The unusual deal, proposed by a member of the corporation’s board who has long worked for the Caribbean school, has been met by an outcry from New York medical schools fearing that clerkship slots will grow scarcer and that they might have to increase tuitions to compete.

Under the contract, which was signed last year but never publicly announced, St. George’s pays the hospitals $400 to $425 per student per week — St. George’s charges students about $1,000 a week in tuition — on top of an annual fee of $50,000 for hospitals that take 24 or more St. George’s students.

“If that $400 per week per student algorithm were applied to the New York schools, I think it’s not affordable and it would certainly be a problem,” said Dr. Brotman, estimating that it would cost N.Y.U. $2.8 million per year. “I don’t come at this from a quality point of view. I come at this from a volume and logistics point of view.”


“This changes the whole dynamic from an academic relationship to a dollar-based relationship,” said Dr. Michael J. Reichgott, associate dean for clinical affairs and graduate medical education at Albert Einstein College of Medicine in the Bronx.

As above, one of the major concerns is the implications of this for allopathic medical students in New York City. Many public hospitals are primary teaching affiliates of medical schools within the city. Those schools include Albert Einstein, Mount Sinai, New Your University, Cornell, and Columbia.

On top of that, the deal is a major grab for St. George’s in the highly competitive world of for profit medical education. U.S. clinical rotations are a near necessity for these Caribbean medical schools, as most students there are Americans and aspire to come back and do a residency in the U.S. Caribbean medical schools have affiliations with hospitals all over the U.S. but having such a large number of rotator positions in one city and at such diverse and well experienced hospitals as Bellevue and others means that St. George’s has really staged a bit of a coup. And they intend to keep it that way,

The contract also bans the hospitals from providing clerkships to other Caribbean medical schools — a critical provision to St. George’s, which has faced heightened competition in recent years, particularly from Ross University on the island of Dominica, part of DeVry Inc., a publicly traded educational company, since 2003.

The member of the Board of the NYC Health and Hospital Corporation who brought the deal forward to be considered was a graduate of St. George’s and serving in the school’s Dean’s Office. Although he recused himself from discussion on the deal, he has since resigned from the Board of the Health and Hospital Corporation.

The board member, Dr. Daniel D. Ricciardi, submitted a brief letter of resignation to the president of the corporation, Alan D. Aviles.

Dr. Ricciardi had come under fire from officials of New York-based medical schools for his role in securing the contract for the city’s 11 public hospitals to provide clinical training to students from St. George’s University School of Medicine in Grenada.


He was promoted to dean of clinical studies at St. George’s, overseeing the clinical clerkships, just before the contract was signed a year ago.

Okay, my tone might’ve implied differently above, but I actually don’t have a problem with this. Why shouldn’t these rotation spots be up for bidding? Especially considering this is an infusion of revenue into a financially troubled public hospital system. It can do nothing but improve the health of the populace of New York City. The more prestigious schools within the city limit should be eager and willing to face the challenges of competition, even from ‘for-profit’ medical schools. As if the title ‘for-profit’ somehow diminishes the medical schools goals or the education they give their students.

As for Dr. Ricciardi, we can’t know his influence in the matter sitting on the other end of a NYT story. However, it appears, per everyone’s word, that he recused himself and did not participate in the debate. He seems a very….outspoken gentleman…and his comments and actions after the accusations started flying towards him might have as much to do with his resignation as any impropriety in the whole deal between SGU and the NYC HHC. Still, just based on what is at stake an investigation is probably in order. Hopefully the HHC won’t cow to the weight of the medical schools in the city, unless they actually find something wrong in the methodology of the deal they reached with St. George’s.

But that’s just another two cents into this whole debate.