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Sunday, June 17th 2012

International & For Profit

For profit medical schools outside of the United States which tailor to U.S. citizens have become an increasingly important part of the pipeline of American physicians. But these schools, most prominently in the Caribbean, draw their share of opposition. Beyond their for profit status, which as the broader debate on for profit education has drawn considerable ire from opponents, the graduates of these offshore (not regional) schools, largely American citizens who traveled abroad for their education, tend to do worse on a whole range of standardized tests that lead to things like licensure and board certification as compared to graduates of American schools.

Increasingly though these medical schools are drawing complaints from established American medical education institutions over the issue of third and fourth year clinical rotations for students. Many of these Caribbean medical schools in particular are multi-campus affairs; students do their first two years of medical school in the Caribbean and then come back to the United States to do clinical rotations at hospitals throughout the country.

By far the most clerkship spots for foreign based medical students to rotate are in New York and yet for the past two years there has been an intermittent struggle to cut the flow of Caribbean based students training in the state.

New York State’s 16 medical schools are attacking their foreign competitors. They have begun an aggressive campaign to persuade the State Board of Regents to make it harder, if not impossible, for foreign schools to use New York hospitals as extensions of their own campuses.

The changes, if approved, could put at least some of the Caribbean schools in jeopardy, their deans said, because their small islands lack the hospitals to provide the hands-on training that a doctor needs to be licensed in the United States.

The dispute also has far-reaching implications for medical education and the licensing of physicians across the country. More than 42,000 students apply to medical schools in the United States every year, and only about 18,600 matriculate, leaving some of those who are rejected to look to foreign schools. Graduates of foreign medical schools in the Caribbean and elsewhere constitute more than a quarter of the residents in United States hospitals.

Similar struggles are taking place in other states where international medical schools are trying to expand or establish their presence. In Texas currently no hospitals train Caribbean based medical students but that could soon change.

The American University of the Caribbean, a for-profit medical school owned by DeVry Inc., has requested authorization from the coordinating board to allow its students — and in particular those from Texas — to have the opportunity to spend years three and four of medical school in Texas hospitals, clerking or taking clinical electives.

Amongst opposition from organized medicine, leaders at public medical schools in Texas and the legislature the THEC has postponed a decision on AUC’s application.

In March, leaders from the state’s public medical schools sent a letter to Texas Higher Education Commissioner Raymund Paredes, who has recommended that the board grant AUC approval. The school leaders argued that allowing students from foreign schools into Texas clerkships would “displace Texas medical students in already limited clinical training settings at hospitals in our state.”

It doesn’t seem the fight over stateside clerkship spots for international based medical students is close to being finished.