State law contained “no geographic requirements or restrictions” that pre- vented THECB from granting or deny- ing a certificate of authority to a foreign medical school “that otherwise satisfies the statutory and regulatory criteria for issuance of such a certificate.” Lawmakers disagreed with that in-
terpretation, which led them to take up the issue during this year’s legislative session.
Meanwhile, THECB in January re- leased the results of a survey of the state’s medical schools that received mixed interpretations. According to the board, because “the number of students at a particular clerkship site is fluid … it is difficult to adequately assess the clini- cal capacity within a particular clerkship site.”
But Dr. Wright says the survey was quite clear in that medical schools unan- imously agreed the clinical training sites they work with could not accommodate more students. At Brackenridge, he has about 35 medical students from UT. For the past four years, the school asked him to accept additional students and for the past four years he turned them down be- cause “I don’t have the capacity, faculty, or resources.” Meanwhile, struggling hospitals have had to downsize, and many students have to travel across the state to find clerkships. Kenneth I. Shine, MD, then-executive vice chancellor for health affairs of the UT System, testified on behalf of the state’s medical schools that they, too, are scrambling to find enough third- and fourth-year clerkships to keep pace with an Association of American Medical Col- leges recommendation to increase en- rollments 30 percent by 2015. That was before two new medical schools were approved in Texas. Even though THECB’s plan pertained only to a single foreign school, it could open the door to others, he warned. “The fact is there are 35 English-speaking medical schools with thousands of stu- dents in the Caribbean alone,” he told the Senate Higher Education Committee in April. Even if they were barred from clerkships, however, qualified foreign medical school students could apply for electives and residencies in Texas.
Medical schools also spend consider- able effort developing clinical rotation sites, extensive faculty training, and in- frastructure for libraries and simulation centers, for example, Don Peska, DO, dean of the Texas College of Osteopath- ic Medicine, told the Senate committee. Offshore schools do not bear those ex- penses, he noted.
Warning shots from New York While the issues TMA and the medical schools raised were not realized in Tex- as, they were not unfounded, Dr. Wright says. All lawmakers had to do was look east to see that the stakes were high. Five years ago, New York City Health and Hospitals Corporation signed a 10-year, $10 million exclusive contract with the Caribbean offshore school St. Georges’ Medical School. The for-profit school pays $400 per student per week for training slots under that agreement. Initially, the move did not drastically impact medical schools’ relationships with teaching hospitals, says Jo Wieder- horn, president and chief executive offi- cer of the Associated Medical Schools of
New York. Then, several other offshore schools followed suit. “All of a sudden it became much more of an issue,” she said. In 2009, the state education de- partment reported that about half of the 4,000 medical students doing third- and fourth-year rotations in New York State were from offshore medical schools. “It is displacing our students,” as hos-
pital use the funds paid by off shore medical schools to supplant low Medic- aid payment rates, she said.
The diminution of the quality of stu- dents’ education also is bearing out. On one hospital rotation, 25 stu-
dents from an offshore school replaced five New York students. Because Liai- son Committee on Medical Education (LCME) accreditation standards require all students from a medical school to re- ceive an equivalent education, regardless of where in the state they train, some New York schools pulled out of certain hospitals with relationships with foreign medical schools. They feared jeopar- dizing their accreditation because they could not guarantee an equivalent edu- cational experience for their students.
International medical graduates on the rise
Medical school enrollments continue to grow at a faster rate than entry-level residency positions in the United States. Mean- while, of all applicant groups* to the U.S. National Resident Matching Program, U.S.-born international medical school stu- dents and graduates showed the largest increase at 19 percent in 2013. The 5,095 U.S. citizen international medical graduates were 50 percent more than in 2009. About half of U.S.-born students who went to foreign medical schools matched into U.S. residency programs in 2013, compared with 94 percent of U.S. allopathic seniors who matched.
*Applicant groups with more than 100 applicants October 2013 TEXAS MEDICINE 51
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