The Doctor Is In(ternational): Foreign Medical Schools and U.S. Hospitals

Jan 24, 2011

For years, Caribbean medical schools have secured residency training for their graduates at U.S. hospitals. But now New York medical schools are trying to put up road blocks in their state, arguing that this phenomenon results in poorly trained American doctors and unfair competition for dwindling residency slots.

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Fighting Foreign Competition

According to the Association of American Medical Colleges (AAMC), over 42,000 individuals applied to American medical schools in 2010. But only about 18,600 - fewer than 50 percent - matriculated.

With competition so fierce at U.S. institutions, many aspiring physicians have turned to medical schools in the Caribbean. Located on tiny islands such as Grenada and Dominica, these institutions are unable to provide the kind of residency training required to practice in the U.S., where most students hope to eventually return. So the schools, many of which are for-profit institutions, are paying American hospitals to allow their students to complete their medical residencies back in the States.

Because New York trains more medical students and residents than any other state, New York hospitals have received the bulk of this influx of foreign-educated residents. But now the state's 16 medical schools are fighting back, lobbying the State Board of Regents to make it more difficult for foreign schools to offer U.S. residencies in order to reduce competition for their own graduates.

The New York institutions have alleged that many of their foreign competitors are essentially medical diploma-mills, churning out poorly trained graduates for a profit. As a result, the overall quality of residency training at hospitals is being reduced for their U.S.-educated peers. And, if the New York schools are correct, many underprepared doctors are receiving medical licenses.

Representatives of Caribbean medical schools argue that Americans are making spurious claims, motivated by snobbery and a fear of competition. Speaking to The New York Times, the chancellor of St. George's University in Grenada, one of the oldest medical schools in the region, commented that, 'It's basically a situation where the New York State deans just can't hold their noses high enough up in the air, and I think it's disgraceful.'

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Doctor Shortage Solution?

In fact, the Caribbean schools maintain that they're filling a need. Last fall, the AAMC predicted that there will be a shortage of 63,000 physicians in the U.S. by 2015. Since American medical schools turn away so many applicants, the physicians will have to come from somewhere. And graduates of foreign medical schools are more likely to go into primary and family care, rather than specialties like surgery, where there is the greatest need.

But New York state schools contend that they should be the institutions to fill that gap, and competition for residency spots at U.S. hospitals is making it difficult for them to expand. The AAMC estimates that there will have to be at least a 15 percent increase in the number of medical residency slots over the next 10 years to accommodate the number of new doctors we will need. Without those slots, American medical schools will struggle to find places for their own graduates, forcing them to continue to keep class sizes down.

So New York state medical schools are asking the State Board of Regents to adopt the same position as the American Medical Association, which asserts that 'the core clinical curriculum of a foreign medical school should be provided by that school and that U.S. hospitals should not provide substitute core clinical experience.' If the Board of Regents accepts the proposal, foreign schools could still send students for electives in their fourth year, but not core training in their third.

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