“Our Texas medical students should be prioritized, and we must ensure they have access to those clinical rotations without doing anything to jeopardize that.”
Avoiding a bidding war THECB was ready to allow AUC to buy a limited number of core clerkship spots in Texas training facilities. Before the pro- posal was finalized, however, TMA and Texas’ medical schools intervened to put the brakes on the decision over fear it would displace Texas medical students. Adding foreign medical students
MD, chair of TMA’s Council on Medical Education. Yet that’s what one Caribbean medical school tried to do in Texas. The Ameri- can University of the Caribbean (AUC) — a for-profit medical school owned by DeVry, Inc. on the island of St. Maarten
— pitched the move to lawmakers to bring more physicians to Texas. That’s because like many offshore schools, it lacks the facilities to offer the clinical training on site. According to its website, the school offers core clerkships through hospitals in six U.S. states. But Dr. Wright said the proposal came “at a time when Texas medical schools are just so overwhelmed right now try- ing to keep their heads above water, to take on anything additional would cause them to go under and drown.” He said the legislation ensures that “all of our students who need certain clinical expe- riences get them, and not just get them, but have good quality experiences.” The threat to that education was im-
minent: Following a 2011 recommenda- tion by its Strategic Planning and Policy Committee, the Texas Higher Education
50 TEXAS MEDICINE October 2013
Coordinating Board (THECB) was poised to grant a certificate of authority to AUC. It would have allowed the school to of- fer courses leading to a medical degree in Texas and to contract with Texas hos- pitals and other health care facilities for clinical training spots. A November 2012 opinion by the state attorney general’s office reinforced the board’s authority to grant such certification. “It’s important to recognize that this almost happened,” said Sen. Judith Zaf- firini (D-Laredo). She and fellow Senate Higher Education Committee member Sen. Robert Duncan (R-Lubbock) origi- nally coauthored the prohibition as Sen- ate Bill 301, which later passed as an amendment offered by Rep. John Zer- was, MD (R-Simonton), to Senate Bill 215. “I believe strongly we precluded a problem from happening. Our Texas medical students should be prioritized, and we must ensure they have access to those clinical rotations without doing anything to jeopardize that. They are our investment. [The state] invests in medi- cal education, and we have to protect that investment.”
while Texas enrollments continue to grow could exacerbate the shortage of clinical training space and spark a bid- ding war for the spots, which publicly funded medical schools could not com- pete with, wrote then-TMA Council on Medical Education Chair Cynthia Jump- er, MD, to THECB in 2012. The amount of money the state invests in Texas medi- cal students far outweighs any bid for- eign schools’ could offer, she added. In addition to voicing their opposi- tion to the AUC plan to the coordinating board, TMA let key lawmakers Sens. Zaf- firini and Duncan know what it would do to all of the state’s medical schools. “And all of that impact was more or less going to be a negative impact,” said Dr. Wright, director of The University of Texas Medical Branch’s family medicine clerkship program at Austin’s University Medical Center Brackenridge Hospital. “Of all four years [in medical school], the third is the most critical because that’s when students gain clinical exposure” in various specialties: psychiatry, fam- ily medicine, internal medicine, surgery, pediatrics, and obstetrics/gynecology. “That’s how they are going to learn medi- cine,” he said, adding that overcrowding those clinical rotations would dilute the quality of students’ education.
Legislature steps in
Meanwhile, unconvinced of THECB’s au- thority to allow foreign medical schools to operate in Texas, Senator Zaffirini asked the board to seek an opinion from the state attorney general and to further study the capacity issue. “What we asked for was time to investigate the issue.” In his legal opinion, however, Texas
Attorney General Greg Abbott said state law at the time gave THECB the discre- tion to decide whether foreign-based in- stitutions may offer courses leading to a medical degree in the Lone Star State.
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