NYC Hospitals Train Caribbean Grads for Profit

12 August 2008 in medical education, news | No comments

The New York Times recently ran an article on the controversy surrounding the NYC public hospitals’ decision to train Caribbean medical students for profit. US medical students spend two years doing clinical clerkships in various fields of medicine; these clerkships last anywhere from a few weeks to a few months and are designed to both inform students’ career choices and provide a broad foundation in clinical medicine. Traditionally, hospitals either provided this training gratis or charged a nominal fee. The recent uproar is over the NYC Health and Hospitals Corporation’s decision to sign a contract with St. George’s University School of Medicine (located on the Caribbean island of Grenada) to train hundreds of medical students in exchange for fees many times the usual rates. Obviously, the physicians in these hospitals can only support a certain number of medical students without compromising the quality of the teaching provided; just as obviously, this contract is likely to increase the price of the remaining slots, potentially making it difficult for local medical schools to place their own students. But throughout the article and the comments, the real outcry is over the perception that the city is legitimizing (and even encouraging) the import of inferior medical students who will eventually become inferior physicians.

But why are institutions like St. George’s flourishing in the first place? An education at St. George’s is just as expensive as training at the most expensive private medical schools in the US, and the school offers less financial aid and fewer scholarships. The school has large classes and little clinical training in the first two years, virtually no active research on-site, and (until the recent contract) clinical clerkships scattered across the country with little faculty coordination. Nevertheless, its graduates generally pass the US licensing exams and often become fantastic physicians. Consider the following:

There aren’t enough primary care physicians or specialists in most non-urban areas of the US.
The quantity of available physicians is directly linked to the number of medical school graduates produced each year.
The number of medical schools in the US, and the number of students they can train, is regulated by a centralized professional organization.
Admission to a US medical school is difficult to get, and increased demand for spots has raised admissions standards over the past few decades.
Of the students who fail to gain admission to US schools, a significant proportion go to medical school abroad, pass the US licensing exams, and practice in the US.

There seems to be an obvious disconnect here - even though we need more doctors (at least in a number of areas), we deny admission to a number of applicants only to re-admit them to the profession after they complete their schooling abroad. The immediate solution, then, is to lower admissions standards to US medical schools and increase the number of available positions to meet the demand for physicians. Or is it?

The crux of the problem is the public perception (and the perception of most US physicians) that doctors must be both budding scientists and well-educated humanists by the time they’re in their early twenties. This is, quite simply, an impossible expectation - there simply aren’t enough qualified undergraduates to meet our need. Just as we’re comfortable relegating certain tiers of care to nurses, therapists of one stripe or another, and nurse practitioners, we should also accustom ourselves to the notion that not all physicians need to have da Vinci’s breadth of expertise. Not every physician needs to be interested in research, the latest advances in medical science, or the details of medical policy. For at least a portion of our physicians, it should be enough that they are attracted by a life of service and that they meet our licensing standards.

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