In light of the controversy surrounding
this recent article by the New York Times, I thought it appropriate to take the time to write a response as a student who will be attending a Caribbean medical school in 1 week and as someone who plans to do most, if not all, her core rotations in New York City hospitals.
First off, there is a looming shortage of doctors that's projected to hit 90,000 by 2020 (that's only 9 years people) and of the 42,000 people applying to US medical schools today, only 18,600 get spots. And what of the other 23,400? A percentage of them end up going to Caribbean medical schools. What's particularly infuriating about the discussion stemming from this article's publication is the number of people commenting that they would never go to a doctor trained in the Caribbean because they weren't "good enough" for the US... I'm sorry, but do people just ignore all the stats found in the very beginning of the article? It's quite obvious that there is no way medical schools can accept all the good candidates applying because there are SO FEW SPOTS AVAILABLE.
As a consequence of this exclusivity, there is a spill-over effect of good medical applicants going to the Caribbean. My stats are average I'll fully admit, but at AUC I know of students who scored 40s on their MCATs and I know others who have GPAs of 3.5 and higher. I'm not saying by any means there aren't bad students who go to the Caribbean, of course there are. Many students who start in the Caribbean will inevitably drop-out for a number of reasons, but those who do finish and graduate are just as capable and knowledgeable as any US medical graduate. In the end, *ALL* medical school students who wish to practice in the US have to pass the *SAME* exact test, which is the USMLE. As it stands now, the average first time pass rate for US med students taking Step 1 is
92% and guess what? AUC's first time pass rate for Step 1 is a
94%. That's right, a CARIBBEAN school has a HIGHER pass rate than some American schools. And who can one ignore the fact that 1/3 of the last AUC class who sat for the exam scored a 99?! (Please note, if given a chance any Caribbean med student would go to an American school at a moment's notice. It sure beats all the stigma and false preconceived notions)
After reading the article, I could not help but think the claims of the 16 New York med school deans were ridiculous and laughable. Let's look at some of their arguments as stated by the journalist.
1. The deans are looking to expand their enrollment to their own schools, but are impeded by competition with Caribbean schools for clinical training slots in NY hospitals.
2. Caribbean schools turn out poorly trained students who undercut the quality of training for their New York peers learning alongside that at the same hospital.
3. Caribbean medical schools are profit-making institutions that are "bribing" New York hospitals by paying them millions of dollars to take their students. American schools traditionally pay nothing, because hospitals like the prestige of being associated with universities.
4. City hospital officials have defended their contracts with Caribbean schools as a way of getting students into hospitals in poor neighborhoods that have been
shunned by New York medical schools.
5. These very same students, after completing their clinical training, often return as residents and then full-fledged attending physicians at these poor, city hospitals.
Is it just me or does there seem to be some gaping inconsistencies in this report? I think it's first important to highlight the fact that no matter how many more students medical schools are willing to accept, nothing is going to fix the shortage problem if more residency spots aren't available. A medical school graduate cannot become a practicing physician until they have completed residency and the positions available have remained stagnant for YEARS. It's simply impossible to solve the impending crisis by increasing medical school enrollment without a corresponding increase in residency programs. You only increase the competition levels for the same few residencies, leaving even more people out in the dark defaulting on $200,000 loans. So the deans' claim that they want to increase their class sizes have no real bearing presently. Furthermore, these deans are pushing to suspend Caribbean medical students as soon as possible from New York hospitals, when they themselves don't even have the students to fill these clerkships. Absurd if you ask me.
Secondly, after reading the response of the hospital officials, it seems that the clinical sites available to Caribbean students aren't places that the American students even associate with. So why this anger? Why do these deans want to stop Caribbean students from rotating at the hospitals that their own students don't even go to? I'm not going to pretend to know the answer because no one can know this answer but the deans themselves, however, for speculative purpose... I feel this is one part territorialism with a dash of snobbery, but at the end of the day, isn't everything always about money? Caribbean medical schools are paying millions of dollars to have their students rotate at hospitals all across the country, not just New York. I think the NY medical board members realize that they may eventually have to start compensating hospitals, but they don't want to pay any money themselves. To them, it should be free and it's a privilege for the hospitals to be associated with THEM (Again, I'm only musing here on the alterior motives of these rabble-rousers). Never mind the fact that many of these hospitals would be bankrupt if not for the influx of Caribbean money, and that they would close down like so many in their stead, further depriving millions of their access to some semblance of quality healthcare. And most of the attendings and physicians working in these hospitals are foreign trained, from the Caribbean! Let's face it, if you are a US med school student, you're not trying to get a general residency in a poor city hospital.
I think I'm done with the diatribe for now. I was thankful to read at the end of the article many positive comments in support of the good work done by Caribbean-trained doctors. I liked the fact that people remember to judge doctors by their merit, compassion, and professionalism and not just where they went to school. Hope that's the majority out there. If not, well maybe one day they can read this blog and think otherwise. I hope to be an example to prove all the nay-sayers wrong.
