By Oleg Pavlov, Ph.D. and Vladimir Gotlieb, MD, MBA
In the face of offshore competition, local medical schools are campaigning with the State Board of Regents, which oversees all educational activities in New York, for stricter restrictions on offshore medical students’ use of state teaching hospitals for trainee lawyers.
There is some evidence that doctors trained abroad are competent and beneficial for government health care. According to a research report by the New York Primary Care Workforce of the New York Center for Health Workforce Studies, 40 percent of the 87,000 physicians admitted to New York attended a foreign medical school.
The Association of American Medical Colleges reports that there were 43,919 unique applicants to U.S. medical schools in 2011, 56 percent of whom were rejected. Many of them choose to attend accredited nonprofit medical schools in the Caribbean that offer curricula that match their American counterparts.
According to a 2010 study by John Norcini and other studies published in Health Affairs, the rigorous clinical training and US approval process ensure no differences in clinical outcomes between overseas and US graduates. After graduation, both US and foreign medical students must complete several years of intensive postgraduate medical training – usually referred to as a residency – in a US teaching hospital. Both groups are also required to take a three-tier US entrance exam (USMLE). Caribbean graduates score high on these exams.
It’s worth noting that while a quarter of U.S. graduates go into primary care, family practice, and pediatrics, the majority of overseas physicians choose these areas. US graduates tend to select specialties that have more prestige and higher wages. With state and federal reforms likely to increase the demand for basic services, offshore students are well positioned to meet the expected surge in demand. More than 90 percent of the students at Ross University, St. George University, American University, Caribbean School of Medicine, and Saba University School of Medicine – all among the top schools – are American and therefore have no difficulty getting on to relate their American patients. which leads to high patient satisfaction rates.
The Association of American Medical Colleges recommended increasing the number of medical students by 30 percent through 2015 to meet demand. Eight new US medical schools recently opened and 20 more are under development. Even so, even after all new domestic medical schools have opened, enrollment is not expected to increase more than 20 percent. The slow increase is due to the high cost of adding medical school capacity in the United States. Aside from much of their US counterparts spending, Caribbean medical universities have healthy profit margins of up to 20 percent that allow them to quickly adjust capacity to demand.
Hospital economics must also be taken into account. Following a recent review, the Brooklyn Health Systems Redesign Work Group concluded that Brooklyn’s 15 hospitals – in a 2.5 million-strong neighborhood – are in dire financial straits and desperately need private investment. The group concluded that six of these hospitals are particularly at risk. Caribbean medical schools pay hospitals around $ 450 per student per week and invest millions of dollars in financially troubled New York hospitals. St. George’s alone donated $ 100 million to public hospitals in New York in 2008 when it signed a 10-year contract with New York City Health and Hospitals Corp. Signed over 11 New York hospitals to educate students at St. George’s. Student income from teaching hospitals is likely to become more critical as federal and state funding for hospitals is cut as part of efforts to reduce the deficit.
The bottom line is that New York needs students from Caribbean medical universities. It would be a mistake to restrict access to New York hospitals. Many of the students will remain in New York as doctors. As many studies have shown, overseas-trained physicians are knowledgeable and willing to work in specialties and geographic areas that U.S. graduates avoid. It’s also important to remember that the revenue offshore trainees bring in for medical purposes helps keep New York hospitals afloat.
Oleg V. Pavlov, Ph.D., is an associate professor of economics in the Healthcare Delivery Institute of the Worcester Polytechnic Institute. His expertise lies in cross-sectoral computer analysis that takes into account feedback and resistance to changes that often occur in complex systems.
Vladimir Gotlieb, MD, MBA, Vladimir Gotlieb is the Chief Medical Officer of Hematology and Oncology and Scholarship Director at Nassau University Medical Center. He is also an Assistant Professor of Medicine at Weill Cornell Medical College and an Associate Clinical Professor of Medicine at New York College of Osteopathic Medicine.