• October 24, 2014

Students From Caribbean Med Schools Head for New York, Angering Some Local Programs

The trend angers some medical educators, who say their trainees are being crowded out of clinical rotations

Students From Caribbean Med Schools Hit N.Y., Angering Local Programs 1

Photograph by Yana Paskova for The Chronicle

Todd J. Mekles, from St. George's U., in Grenada, trains at a New York City-area hospital. He believes his clinical experience is as closely supervised as any American program's.

Thousands of students from offshore medical schools flock to teaching hospitals in the United States each year to complete the clinical portion of their education. In New York, the number of students performing third- and fourth-year hospital rotations from these offshore programs now almost equals the number of students from the state's own medical schools.

That is making a number of medical educators in the state angry. They say their students are being crowded out of opportunities, in part because the offshore medical schools are paying hospitals to secure the spots—something they say their budgets prohibit them from doing. Some also say many offshore students have been poorly supervised and are inadequately prepared to practice medicine.

The offshore schools counter that their students are not only qualified but badly needed at a time when the United States faces a looming shortage of doctors.

The New York State Board of Regents is weighing those arguments as it decides whether to tighten requirements for offshore medical-school students to participate in clinical rotations, commonly referred to as clerkships, at the state's teaching hospitals.

Students enrolled in offshore, or "dual campus," medical schools spend the first two years of basic-science study in offshore institutions, mostly for-profit medical schools in the Caribbean. The next two years are spent in clinical training, shadowing doctors in teaching hospitals or clinics in the United States.

Medical training in the United States generally follows a similar model. After graduating from college, students enter medical school, typically spending two years of basic-science study followed by two years of clinical rotations in hospitals or clinics.

Once they graduate from medical school as doctors, they begin several years of residency training, practicing medicine under a doctor's supervision.

The discussions in New York focus primarily on the third- and fourth-year clinical rotations that are part of the training students receive before they become doctors.

Charles R. Modica, chancellor of St. George's University School of Medicine, in Grenada, contends that there are plenty such slots in New York, and that medical deans are using the training issue as an excuse to limit class sizes and deny New Yorkers access to medical education. Many of those students end up on his campus, which he helped found in 1977.

St. George's has nearly 1,000 students in training in New York hospitals, he says. "They could have attended New York medical schools, but the deans rejected them."

Pay to Play

New York hospitals have a financial incentive to accept as many students as possible from offshore schools, which typically pay hospitals $400 to $450 per student per week for clinical training. Since most American medical schools pay little or nothing for clinical placements, "it's practically impossible for the U.S. schools to compete," says Jo Wiederhorn, president of the Associated Medical Schools of New York, an advocacy group representing the state's 10 private and five public medical schools.

In order to match the fees paid by offshore programs, "our schools would have to significantly raise tuitions, which would make them noncompetitive with schools in other parts of the country," she says. "The hospitals in New York are operating on very small margins, and in some respects you can't blame them for wanting to accept the money."

Two years ago, the New York City Health and Hospitals Corporation angered New York medical-school officials by signing a 10-year contract, reportedly worth up to $100-million, to provide clinical training at its 11 public hospitals for students from St. George's.

International medical-school graduates already make up 36 percent of New York state's physician work force, compared with 25 percent nationwide. Many came from one of the 14 dual-campus medical schools approved for training by the state, half of which are in the Caribbean.

While the academic caliber of some offshore schools worries New York educators, so does the sheer number of students streaming in from the Caribbean.

Last year, St. George's graduated 640, and Ross University School of Medicine, in Dominica, graduated 754. That compares with an average class size in New York medical schools of about 120.

New York State, which has one of the nation's largest concentrations of teaching hospitals, is a popular destination for offshore students.

In the 1980s, when medical educators were warning of a glut of doctors, New York medical schools severely restricted class sizes, and parents whose children weren't getting into the highly competitive schools complained to state lawmakers, Ms. Wiederhorn says. Over the next few decades, the state's education department expanded the number of offshore schools from which it accepted third- and fourth-year students, making it easier for students who didn't get into U.S. schools to attend medical school elsewhere and end up back in New York.

Last year the state education department approved an estimated 2,000 third-year students from offshore schools to train in New York hospitals (although some may have ended up spending some of their time in other states). That compares with about 2,220 from New York medical schools in 2008, the most recent year tracked.

"Offshore schools have increased exponentially the number of students they're accepting, and we're beginning to see a wave of students coming in," says Michael J. Reichgott, a professor of medicine at the Albert Einstein College of Medicine. Dr. Reichgott, who is also chair of the education committee of the Associated Medical Schools of New York, says he is unaware of any students being unable to land a clerkship but adds that New York schools have had to reach out to hospitals they hadn't considered before.

"Einstein had to take students out of a couple of sites because of the number of offshore students there," he says.

Squeezed Out

Two years ago, New York Methodist Hospital told officials at the State University of New York's Downstate College of Medicine that the hospital could no longer accept students into its small internal-medicine rotation because of the number of offshore students training there, says Ian L. Taylor, the New York medical school's dean.

"Our university hospital only has about 325 beds, so we're very dependent on affiliates taking our students," he says. "Given the massive expansion of Caribbean schools, our worry is that when the big wave hits—maybe next year and the year following—the problem may be more significant."

Critics argue that offshore students, many of whom hope to practice in New York, are poorly supervised during their clinical training. The few doctors appointed to oversee them are thousands of miles from the schools' Caribbean base, and many have had only a cursory training in how to structure and oversee clinical assignments, they say.

Accreditation requirements for U.S. medical schools dictate that clerkships expose students to a sufficient number of patients with diverse conditions, maintain a certain faculty-to-student ratio, and meet set educational objectives. Offshore schools generally don't dictate the same standards.

"We're just seeing the tip of the iceberg of what's going to be a huge quality-of-care issue," Dr. Taylor contends.

Nancy Perri, chief academic officer at Ross University, says such concerns don't apply to the Dominican institution, which hires clinical-faculty members to teach and supervise its students in New York.

She adds that more than 98 percent of Ross's students are American citizens, many of them New Yorkers who want to practice in the state. "We recognize that both U.S. and international schools like Ross are needed to fill the shortage of physicians needed in the U.S.," she wrote in an e-mail message.

A Successful Business Model

Touro College of Osteopathic Medicine, which opened in Harlem in 2007, seeks to increase the pool of minority physicians and those committed to working in underserved areas. Largely because of competition from offshore medical schools, which pay to place their students, it has been shut out of nearby hospitals, including Harlem Hospital Center, just 10 blocks away, says Joseph R. Maldonado Jr., assistant clinical dean. Instead, its 225 or so third- and fourth-year students train in New Jersey or Queens.

"We recruit students from underserved neighborhood schools, but when it comes time for training, we have to send them away. It's ironic," he says.

Meanwhile, the State University of New York at Stony Brook's medical school has kept its class size constant for the past three years, in part because of the difficulty of placing some students in clerkships at hospitals that have contracts with offshore schools, SUNY administrators say. Among those schools, the American University of the Caribbean School of Medicine signed a contract in 2008 with Nassau University Medical Center, a Stony Brook teaching affiliate.

The Association of American Medical Colleges has called on medical schools in the United States to raise their first-year enrollments by 30 percent over 2002 levels by 2015 to help prevent a projected physician shortage.

But state budget cuts and competition for clinical placements are making it hard for New York medical schools to expand, Ms. Wiederhorn says.

A New York-based lobbyist for American University of the Caribbean, in St. Martin, which has about 250 students training in New York hospitals, says domestic schools feel threatened by the success offshore schools have had in placing students, in part by paying for clerkship positions.

"The Caribbean schools have developed a business model that works for them and works for the hospitals, and domestic schools historically haven't had to do that," says the lobbyist, Lisa H. Reid.

Rather than squeeze domestic students out of clerkships, offshore schools have created new clinical positions and filled slots that many American trainees would not be interested in, she says.

Hysterical Deans?

Mr. Modica, the St. George's chancellor, says that so far this year, his medical school has paid New York hospitals more than $23-million for clerkships. Those costs are covered by tuition, which is comparable to that at many private schools.

As for the argument that offshore students are crowding out onshore students, "these are ridiculous assertions of a group of hysterical medical-school deans who should be ashamed that they didn't accept these students years ago," he says.

"These same deans have for years kept the enrollment of their own institutions down to a bare minimum using the excuse of quality."

Todd J. Mekles, a fourth-year student at St. George's, was rejected by all 15 medical schools he applied to in the United States. He says he had a grade-point average of 3.93 from Emory University and a 30 on his Medical College Admission Test—just below the 31 average for entering medical-school students in the United States this year.

"I was upset that I had to leave my country, but Charles Modica is my hero for giving people like me, who deserve to be doctors, a chance," Mr. Mekles says. Having worked with students from Weill-Cornell Medical College at New York Methodist, he believes his clinical experience is as closely supervised as any American program's.

"Students from St. George's can run with the kids from Cornell or Einstein," he says. "They have the utmost respect for us and don't treat us any differently."

Lumped Together

While many educators are less critical of established schools like St. George's and Ross, critics often paint all offshore schools in an unflattering light. They point out that students from offshore schools tend to have lower grade-point averages and MCAT scores, if those scores are required at all.

The proliferation of medical schools in the Caribbean in recent years—now up to 55—has created headaches for schools like St. George's. "They want to lump us all together, and I'm not going to let them do it," Mr. Modica says. He welcomes the recent push to require a uniform accreditation process for foreign medical schools that train students in the United States.

Among the recommendations the New York State Board of Regents is considering is that it hold offshore schools to standards comparable to those set by the Liaison Committee on Medical Education, the main accreditor of American medical schools.

Schools that wanted to place their students in New York hospitals would have to be able to prove that they met clearly articulated standards.

 


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Comments

1. interface - December 15, 2010 at 05:14 pm

I sometimes wonder if "high entrance standards" is a euphemism for "being completely unwilling to lose the elite status we leverage for our personal advantage." It's like Harvard, with the resources of a small nation, educating so few undergrads every year. I'm not sure who these practices benefit, but I'm pretty sure it's not a whole lot of people, nor the system as a whole.

2. duleepd - December 15, 2010 at 10:54 pm

Free Market economics! To state schools.... you can charge students like crazy but you want the hospitals to give it to you for free.... I say reduce medical faculty salaries by 20% and those savings pay for their student rotations!
Grow up... AMA and all u folks!

3. ddubs - December 16, 2010 at 01:50 pm

These are the same deans who openly discriminate against caucasians in the admission process, and admit students from outside New York State and even this country, now complaining about propriety and fairness.

4. mdstudent - December 16, 2010 at 02:21 pm

As a 2nd year St. George's University medical student, I take particular umbrage at the assertion that I will be any less qualified to practice medicine than a colleague who attended a U.S. based medical school. If Dr. Reichgott and his cohorts choose to rest their "quality-of-care" argument on the joint laurels of "better college GPA and MCAT score", then I will rest mine on St. George's 95% USMLE pass rate. Put another way, do the results of the test your doctor took before medical school matter nearly as much to you as those of the one he took after?

There are a variety of reasons why each of the 75% of medical school applicants who are rejected each year are turned down for those positions, and indeed among them may be reasons such as uncompetitive grades and MCAT scores. But just as likely are what one Washington-area medical school dean in an email to me euphemestically referred to as "some weighting factors", which include metrics such as race, gender, and socioeconomic background in which a bimodal distribution is preferred (the very wealthy who provide donations and the very poor who provide diversity).

Best-selling author, physician, and Stanford University School of Medicine professor Dr. Abraham Verghese has repeatedly bemoaned the elitism exhibited by certain U.S. medical schools toward their foreign counterparts as both unscientific and ultimately deleterious to the quality of medical care in this country. While Dr. Reichgott's sudden interest in quality of care standards among graduates of foreign medical schools that practice in NY is laudable, it is equally suspect for its transparently self-serving nature. His crusade against my colleagues and me is doing himself and his cause no favors, and is in fact a stain on the otherwise good name of Albert Einstein College of Medicine.

5. equality - December 16, 2010 at 02:34 pm

The graduates of some of the Caribbean medical schools provide the highest quality of health care services to the American people. This I believe, is Mr. Reichoff'es main concern regarding the Caribbean medical schools. The high quality of education of some of the Caribbean medical schools proves the insufficiency of the admissions criteria set by many of the New York medical schools.

6. mdstudent2009 - December 16, 2010 at 09:10 pm

The main problem Mr. Reichgott, is that your schools have continously failed to expand their entering classes year after year after year. Fact of the matter is that these teaching hospitals can support a larger student number than the ones that US schools are supplying to them, therefore carribbean schools have been allowed to prosper.
If the US medical schools opened up their class ranks to the neighborhood of 300-400, then there would be no need for Carribbean medical schools and there would also be no shortage of doctors. Mr. Reichgott attempts to hold on to his eliteist attitude and deny medical education has a necessity and hold onto it as a commodity.
I agree with Mr. Modica in that the US should be an export of medical doctors, not an importer. Medicine is becoming an outsourced field just like every other american business and it is people like Mr. Reichgott that are responsible. We need schools like St. George's University to accept qualified students that should have been accepted into US Schools. Mr. Reichgott should be ashamed of himself; students that are willing to pack up and leave their homes, their lives, and their families for medicine are among the most motivated and dedicated practitioners this country has. He needs to ask himself how many of his students are willing to sacrifice even half as much as these students have for their medical education.

7. greidus - December 21, 2010 at 04:07 am

Interesting comment from Todd Mekles: "people like me, who deserve to be doctors". I am not sure what to make of such a sense of entitlement. Perhaps it says more about our society than his ego.

8. dcadm07 - December 21, 2010 at 09:24 am

Having formerly worked in M.D. admissions, I can say that there are usually pretty significant reasons that students at Carribean medical schools AREN'T getting into U.S. allopathic schools. Their undergraduate performances and MCAT scores fall considerably below the usual averages at most U.S. schools, and some Carribean schools make the MCAT optional. It's scary to think that the medical students that we're letting into our NY hospitals are ones that were purposely left out of U.S. medical schools in the first place because they didn't academically qualify. I'm sure there are plenty of great doctors coming from abroad, but it's a shame that the students who actually made it into the NY and other U.S. schools aren't getting the opportunities they have earned.

9. a_voice - December 21, 2010 at 09:56 am

I hear: I can't compete. Protect me, protect me. I am clueless here...

10. davi2665 - December 21, 2010 at 11:08 am

As a former dean and a long-standing participant in medical education, I have first hand knowledge and experience with several of the caribbean medical schools. As a generalization, the caribbean students are outstanding, highly motivated, and usually better prepared in their basic sciences than comparable US medical students. Many of the caribbean students did NOT get into US medical schools because of an organic chemistry grade, or a less than diligent semester or two from more immature phases of their undergraduate experience. For many of them, once they grow up, find their motivation and really apply themselves, they are excellent students. In one US medical school, I was able to convince the admissions committee to allow a transfer of ONE student- a first for that school, accompanied by great ballyhooing about how terrible these students were. She graduated at the top of her class and was recruited to their "elite" faculty.

For some of the more established caribbean schools, such as St. George's, the first time USMLE pass rate is at the same level as the top elite US medical schools- quite a feat given the fact that the US schools pride themselves on being superselective and only taking the truly elite from the "upper of the upper." Grades and MCATs can offer predictions, but they cannot take the place of motivation, maturity, and desire to succeed. The main question to ask about med school admissions is "does this student have the academically ability to succeed or not?" If the answer is "yes", then subtle gradations in grades and MCAT scores are virtually useless, and motivation, maturity, and desire to succeed take over. When I was responsible for overseeing university-affiliated hospital medical education programs, I welcomed caribbean medical students, and thought they generally were better students than their US counterparts- this from first hand experience and observations, not from ridiculous preconceived notions and biases.

Did you ever wonder why it is that caribbean schools can offer compensation to hospitals for their students' clerkships, while US schools do not- all based on virtually the same tuition levels? The US medical schools have endlessly bloated faculties and administrative also-rans eating up huge budgets. The US medical school faculties may have 50 or more individuals in a single basic sciences department, mainly doing research and occasionally giving walk-on lectures, often deadly and uninspired, done because they have to justify their existence as a researcher in a medical school. In the caribbean schools, the faculty generally are excellent educators, there because they love to teach and are very good at it. Often, they are senior educators who are the authors of major texts, recipients of past multiple teaching awards, and totally fed up with the "generate all of your salary from NIH grants all of the time" mentality that is pervasive in the US medical schools. These caribbean faculty members actually are available to work with their students. To my thinking, it is time for the US medical schools to separate out their "we are an NIH subsidiary" mentality, where the ONLY thing that counts is NIH grants, and get back to the lost value of actually teaching medical students with diligence and excellence. For most medical schools, the faculty receive little or no reward for excellent teaching, and are penalized in promotion, tenure, and salary if they do not have mega-grants from NIH and endless esoteric peer-reviewed publications. Receiving a teaching award is almost a kiss of death for such faculty members.

It would be a travesty if the US medical schools are able to bludgeon NY state into restricting caribbean medical schools from having their students do clinical rotations in NY hospitals. It certainly would have nothing to do with quality, and everything to do with political powerbrokering for restriction of trade. It would be highly instructive for the decision makers to actually visit some of these caribbean medical schools and view their educational model firsthand. If we are truly interested in producing a greater supply of dedicated and excellent physicians for future US needs, the caribbean schools represent a rich resource of high quality students.

11. ljakiel - December 21, 2010 at 11:11 am

What about D.O. programs? I thought that was a path taken by some U.S. students who did not get into M.D. programs? Some of the D.O. programs seem to have good reputations. I am most familiar with Lake Erie College of Osteopathic Medicine in PA. http://www.lecom.edu/

Thoughts on D.O. programs in the U.S. versus M.D.'s in the Caribbean?

12. rdittben - December 21, 2010 at 11:56 am

The assumption by medical school deans is that their processes are the only valid indicators of proficiency as a doctor. It is the same kind of elitism that infects other segments of education in which faculty and deans, having passed through the academic gauntlet laid down by others believe that it is the only way to prepare for the art and science of medicine. I am reminded of the case of David Cronin, the pilot of United Airlines 811 who steered a crippled 747 back to Honolulu with only one engine after a chunk of the Business Class section was blown out to sea. He was, by his telling, near the bottom of his flight school class having barely made it in to flight school in the first place. But, he wanted to be a pilot. Several hundred people owe their being here today because of his drive and determination. He did not fly the disabled jet back to Hawaii by following the book and doing what those before him would have advised. He improvised and what he did is now part of 747 pilot training worldwide. The question needs to be asked, so what if a doctor elsewhere does not meet the self-anointed “standards” of the arbiters of medical education in the US. If they are qualified to practice according to the state in which they are to practice, that is good enough for me. I would rather have an experienced “David Cronin” kind of medical doctor operating on me than a top of the class surgeon who can only do things by the book.

13. elvis1955 - December 21, 2010 at 02:17 pm

There is another persepective to this issue that has not been addressed. There are students at some of these offshore who are put in the position of having to organize and find their own placements! Why not interview students from schools such as the medical school in Antigua where students routinely have to find their own placements, have to go without because their financial aid is too little to support living in NYC, or where many students find themselves unable to afford the fees associated with taking the USMLE exam. If Antigua is paying all this money out to the hospitals why aren't they able to provide quality advisement and financial support to their students? It is not ALL the Caribean schools, but Antigua has a whole host of students who are dissatisfied and just trying their best to finish and get on with their lives. These are the students the NYS AMS folks should be talking to.

And the crack about caucasians being discrimminated against went without comment! Does anyone really believe that we need more Caucasians in medical school than other populations?! Or that other races are taking up so many spots white folks can't catch a break?! Here are some numbers--there are currently 537 African-American students enrolled in NYS medical schools (across all four years) compared with 4416 white students! If there is so much discrimmination then why haven't these numbers changed over the last 20 years?! Below is the AAMC website with FACTS regarding the number of non-whites in US allopathic medical schools across the country.
https://www.aamc.org/download/160146/data/table31-new-enrll-raceeth-sch-2010-web.pdf.pdf

Now about DO schools. Osteopathic schools are doing a much better job of increasing the number of qualified students from ALL races into medical school. Yet they are constantly challenged and treated, in some cases, as inferior to their allopathic colleagues. Their training is excellent, and they are AMERICAN institutions.

14. jsntyme - December 21, 2010 at 09:49 pm

As a pre-med advisor at one of the top public research universities in the country, I advise hundreds of students each year. Less than half of them will be admitted to U.S. medical schools, but I believe some of those who are rejected would make excellent physicians. I asked the medical school admissions office on our campus about MCAT scores, since these can be an impediment to admission. He told me that there isn't a statistically significant difference in performance on the USMLE between a student with a score of 24 and one with a 34 on the MCAT upon admission . He said they take the students with the higher MCAT scores because they can get them. Though this may add to the prestige of the medical school, in my dealings with undergraduate pre-meds I sometimes see a lack of ability to make a human connection in those with the highest grades and scores.

After visiting one of the more highly regarded off-shore schools I have begun broaching this alternative to disappointed students. I found the faculty to be very impressive transplants from prestigious, but cold northern U.S. medical schools as well as from Great Britain, Australia, New Zealand, etc. I was particularly taken with their enthusiasm for teaching. The students I talked to seemed happy with their education, although stressed by the long distance from family and home. Off-shore medical schools are unpalatable to the vast majority of the students at my school, due to the stigma that is attached. However, I feel that the best of these schools offer a viable alternative for those who are looking for an opportunity to prove themselves worthy of becoming physicians.

15. farmboy - December 22, 2010 at 07:34 am

Shame On The American Medical School Establishment in New York !!!!

First They Exclude Very Capable Students from medical School admission . Now they are Crying because these off shore schools are getting better training sites. My Doctor is a Graduate of an Off-Shore medical school and he has saved my life through his great medical Care....

16. ganttdg - December 22, 2010 at 01:54 pm

Having taught at several American Medical School and at two Caribbean Medical School and associated with several others, my concerns are 1)student academic accountability; 2) excessive teaching load on the faculty; and 3) the lack of faculty involvement in student acceptance. Faculty are often not allowed to see incoming student records or only have a rubber stamp approval.

Student fees and a year round teaching teaching supported by a overworked and/or incompetent staff and faculty does not provide an adequate teaching model for both students and faculty but a "healthy" paycheck for the Caribbean Medical Schools. Making it possible for offshore schools like St. George's medical school to pay $23-million for clerkships to New York hospitals.

The major problem with all the Caribbean Schools is the lack of accountability. The driving force is not education but "money". Of all the students attending offshore medical school what % really become practicing US physicians?

All offshore medicals schools MUST be held to standards comparable to those set by the Liaison Committee on Medical Education (LCME), the main accreditor of American medical schools.

Now about DO schools? Osteopathic schools have "jumped" into the gap not filled by typical stated funded MD schools. They have also adopted a teaching model similar to that of the Caribbean Medical Schools because most are private institutions, with their own accreditation system (COCA) that provide for less vigorous standards as dose the LCME.

The bottom line is that explosion in both offshore and DO medical schools is driven exclusively by their ability to obtain more student income without full and strict accountability!

17. msmaridge - December 22, 2010 at 03:18 pm

So - do we move to the Carribean???>?

18. stev0 - December 23, 2010 at 12:44 am

Offer clinical training in the Caribbean to the students based in New York? Haha, I'm sure they wouldn't mind.

Regards,
Steve M
http://www.smcmedia.ca
http://www.concretecuttingcalgary.ca

19. downtoearth - December 23, 2010 at 11:14 am

My daughter played Sax and went to a local charter school focusing on the Performing Arts. During this period she realized that she did not want to become a professional musician. Upon her graduation, I advised her to spend her four years in college trying out new courses and allowing herself some time to participate in new experiences. Since the age of 7 she wanted to be a doctor, but I didn't want her to get focused on a particular career choice before she had a greater sense of what her place in the world could be. She was still thinking about medicine so she took a college level chemistry class. Given she had no Chemistry or Physics classes in high school, chemistry did not go well so she ended up majoring in international relations. Upon graduation, it took about a month for her to realize that medicine was what she truly wanted. She then took two years getting her science classes at Harvard's continuing education medical careers program. Unfortunately, we were out of money so she had to work full time while studying for the MCATS and was only able to score in the average range (30). Given her chemistry grade in college her GPA was ar 3.4. However, she had straight A's in her college major and a 3.5 as a science GPA at Harvard, inc an A in organic chemistry. Because of her character and dedication she had wonderful letters of rec. I have never seen someone work as hard or as conscientiously during those years. Her focus is global health, particularly to underserved populations. She was rejected by all 15 of the med schools where she applied. A friend who serves on an admissions committee opined that when the recession hit the number of apps to med schools increased significantly and that schools will take the students with the higher stats for the prestige factor. Apparently, many science, math or physics majors were changing plans because of the poor job outlook. (The prior year, two of my daughter's classmates were accepted with a 29 and a 30?! with no significant differences in GPA, etc.)_When I asked my friend why med schools aren't expanding, given the shortage of doctors, he had no answers. Our state school, a state in which we have lived for generations, had a 3-1 ratio at her interview of Asians to caucasians. Many spoke barely intelligible English. So my conclusion is that american med schools are scooping up anyone with great statistics. I'm not sure what that means for the quality of care issue. I do know that my daughter would have made a phenomenal, caring and conscientious doctor.

20. ham99 - December 23, 2010 at 07:15 pm

As a surgeon who has helped train family practice residents in my subspecialty for over 15 years,I read this article (and the one in the N.Y. Times) with great interest. I would like to address several issues.

The overall quality of students: Some of the worst students I've ever trained were from Caribbean medical schools. The same goes for American medical schools! And the same for other foreign medical schools. Conversely, some of the best were from Caribbean schools, as well as American, as well as other foreign schools! If a medical student can pass the required and assorted licensing exams, it is then the qualities of the student physician and his or her residency program which ultimately determines the overall performance as a practicing physician.

The highest quality college students are accepted to American medical schools: Too many variables make this untrue. For instance: more competitive colleges often grade more harshly, one bad class or semester can torpedo one's chances, high geographic concentrations of top students often eliminate many highly qualified prospects, etc.

The N.Y medical schools are very concerned about the quality of Caribbean medical schools: Their concern is not without some foundation. But for decades and now, they have demonstrated little interest in the training of foreigners from foreign medical
schools; some of which are nothing short of terrible, i.e. career diploma mills, others as outstanding as our best American schools.
As long as they provided staffing for our secondary hospitals, that often provide the care for the indigent populations, and at the same time provided a conduit for "cases" to the main university hospital, they were perfectly happy.

N.Y medical schools are concerned that their own students may not have adequate access to clinical experience: Thirty years ago this may have been a more real concern, but today, much of the exposure to clinical medicine takes place in an outpatient setting. And another thing. The N.Y. medical schools have a long history of seeking out the best students in the country, without tight restraints on geographic origin. Some of this is admirable in the strictest sense, some of it also a numbers game (of course, a fact of life). To my knowledge many other states have had stricter geographic controls, partly to insure their own supply of physicians, partly because they are more sensitive than N.Y to their own constituents, because, in their view, state money helps support both their public and private institutions.

Holding all institutions, American and foreign to the same standards: I would say, in a perfect world, go ahead. But the realities of politics, with the various powerful interest groups in play, make a fair and equitable set of standards applied, make this very unlikely.

American medical academia despite its history of towering achievements in the last 100 years, often behaves like a "spoiled
child". As long as "cheap labor" manned their city hospitals, they were satisfied. When hospital systems today set up medical schools in the U.S., some no better and some worse than foreign schools, they turn a blind eye.

So Caribbean students: Study hard. Work hard. You are first class medical students who can develop into outstanding physicians and surgeons.

21. richardtaborgreene - December 23, 2010 at 09:41 pm

The "high standards of admissions" of top ten medical schools have, for decades included "not a trace of interest in helping anyone except myself via a huge salary" as deans of the top ten schools privately admit in lunch conversations (most lamenting that courses about patient care get scheduled in closets because no one comes and courses about personal wealth management require football fields to handle the overflow).

Those "high standards of care" infest NIH funding and funders--with the US researching obvious shallow mythic causes of all our most profitable (to physician) diseases where Canada, France, and the UK even, with national care systems surpassing us, find themselves able to research actual causes of profitable diseases, because profits of physicians do not drive the entire system. So, for example, 22 years ago, the UK published 10 fake diseases, kept around just for profit, that each have more than ten causes, more than ten courses of treatment, and more than ten outcomes--like RA rheumatoid arthritis. A new boat or house walks in the door whenever some woman can be SOLD that diagnosis in the US whereas in the UK now research is showing blood flow blockages---23 of them--when eliminated, wipe out symptoms completely. Meanwhile the NIH in the US researchers female hormone causes, driven by statistically invalid stratification of causal knots--the longer the "disease" stays around, the more money people can make off of those women sold the diagnosis.

Of course, Americans, being American, never admit this---no no, they are global, they visit Paris and Tahiti, Bora Bora enlightens physicians otherwise venal---the beaches, the sand, the celebrities at cafes.

22. vigilante - December 23, 2010 at 11:34 pm

WONDERFUL COMMENTS!

Just wanted to say, as a son of a doctor, there are some highly intelligent and articulate comments here. The situation here is virtually identical to Canada where there are - read this correctly - even tougher standards for Medical School.

I think the great thing about these off-shore medical schools, is that they have stronger reputations than what they could be - purley money-making machines, such as the case with some local third-tier Teachers Colleges coming up north.

23. texas2step - January 03, 2011 at 07:20 am

Be wary when graduates of US medical schools tell you that graduates of non-US medcial schools do not measure up. This is self interest speaking, not facts.

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