New York Resolution on Carib students/clinical spots

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DocEspana

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So this is fresh off the floor of delegation and debate. The new New York State position on offshore schools is as follow (I admit the wording may be slightly different, i dont have a copy of the final wording, so I'm using my original submitted wording. Its a little tighter worded in reality):

"...medical students from LCME/COCA accredited medical schools should be provided preference in allocation of clinical clerkship opportunities in appropriate, and whenever possible, local hospitals before inviting international students or dual-campus students to serve regardless of other incentives"

Boom goes the dynamite. Now what sort of laws come from this policy? we shall see. For those in NY (NYC especially) this is a *huge* thing. A first step in reclaiming some of the lost clerkship rotations we've been seeing due to the influx of pay-to-play students taking over the clerkship spots in highly desired hospitals.

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So this is fresh off the floor of delegation and debate. The new New York State position on offshore schools is as follow (I admit the wording may be slightly different, i dont have a copy of the final wording, so I'm using my original submitted wording. Its a little tighter worded in reality):

"...medical students from LCME/COCA accredited medical schools should be provided preference in allocation of clinical clerkship opportunities in appropriate, and whenever possible, local hospitals before inviting international students or dual-campus students to serve regardless of other incentives"

Boom goes the dynamite. Now what sort of laws come from this policy? we shall see. For those in NY (NYC especially) this is a *huge* thing. A first step in reclaiming some of the lost clerkship rotations we've been seeing due to the influx of pay-to-play students taking over the clerkship spots in highly desired hospitals.

I always say it's always better to stay in the US in you can, because that way you have legal backup to protect your education and medical license. The american allopathic and osteopathic organizations have very strong lobbying efforts in washington D.C. The DO's have a "DO day on the Hill" every year, where students from pretty much every school meet personally with their congressman/senators.
 
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So this is fresh off the floor of delegation and debate. The new New York State position on offshore schools is as follow (I admit the wording may be slightly different, i dont have a copy of the final wording, so I'm using my original submitted wording. Its a little tighter worded in reality):

"...medical students from LCME/COCA accredited medical schools should be provided preference in allocation of clinical clerkship opportunities in appropriate, and whenever possible, local hospitals before inviting international students or dual-campus students to serve regardless of other incentives"

Boom goes the dynamite. Now what sort of laws come from this policy? we shall see. For those in NY (NYC especially) this is a *huge* thing. A first step in reclaiming some of the lost clerkship rotations we've been seeing due to the influx of pay-to-play students taking over the clerkship spots in highly desired hospitals.

Hey DocSpana, what are your credentials besides a DO student? I mean what is your involvement at the NYS level?

Also, if this is true (would like to see source soon), it isn't policy, it's only a resolution, which means it's practically meaningless.
 
Hey DocSpana, what are your credentials besides a DO student? I mean what is your involvement at the NYS level?

Also, if this is true (would like to see source soon), it isn't policy, it's only a resolution, which means it's practically meaningless.

Yeah, it really doesn't sound like this is anything more than a symbolic victory, until some specific policy is attached

It's kind of like when the Senate passes resolutions like "We stand in support of Japan" or a couple years back, when Congress "recognizes the importance of the symbols and traditions of Christmas," though to be fair the NY resolution could lead to some serious laws, we'll have to wait and see.
 
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I'm not a caribbean student, but i don't even know what this resolution means. and there's nothing in the news about it. so...
 
It's nice to see the major osteopathic organizations take a page out of the AMA's book on how to run a monopoly. Milton Friedman must be rolling in his grave. As a future physician (DO), it is attitudes like this that make me ashamed of our parent organizations.

Let every student, MD, DO, IMG, or FMG, compete on an equal legal playing field. If organizations have a preference for domestic students, so be it. And if organizations have a preference to make more money by training paying international students, so be it. And if our government wants to subsidize domestic students so they can get better clerkships, so be it. But don't legislate against this unless there is a very real and very significant harm being done.

The MDs were passing the same types of legislation against us 40-50 years ago. I hope the DNPs don't try this in another 50.
 
Hey DocSpana, what are your credentials besides a DO student? I mean what is your involvement at the NYS level?

Also, if this is true (would like to see source soon), it isn't policy, it's only a resolution, which means it's practically meaningless.

Agreed. Whats been driving this all along is hospitals wanting the extra $$. Any non binding resolution won't remove that motivation. Until they pass some sort of law that says any hospital taking more then X% of rotators from non US medical schools, will be fined Y$, nothing will change.
 
It's nice to see the major osteopathic organizations take a page out of the AMA's book on how to run a monopoly. Milton Friedman must be rolling in his grave. As a future physician (DO), it is attitudes like this that make me ashamed of our parent organizations.

Let every student, MD, DO, IMG, or FMG, compete on an equal legal playing field. If organizations have a preference for domestic students, so be it. And if organizations have a preference to make more money by training paying international students, so be it. And if our government wants to subsidize domestic students so they can get better clerkships, so be it. But don't legislate against this unless there is a very real and very significant harm being done.

The MDs were passing the same types of legislation against us 40-50 years ago. I hope the DNPs don't try this in another 50.

:thumbup: Exactly. This is a petty move to legislate against FMGs who for years have helped alleviate US physician shortage, specially in a state like New York. It should be said that while OP is a DO student, I don't think (and hope) that he doesn't represent the AOA. Merely passing on his own personal views at the state level, or so he claims.
 
It's nice to see the major osteopathic organizations take a page out of the AMA's book on how to run a monopoly. Milton Friedman must be rolling in his grave. As a future physician (DO), it is attitudes like this that make me ashamed of our parent organizations.

Let every student, MD, DO, IMG, or FMG, compete on an equal legal playing field. If organizations have a preference for domestic students, so be it. And if organizations have a preference to make more money by training paying international students, so be it. And if our government wants to subsidize domestic students so they can get better clerkships, so be it. But don't legislate against this unless there is a very real and very significant harm being done.

The MDs were passing the same types of legislation against us 40-50 years ago. I hope the DNPs don't try this in another 50.
Give me a break.
 
Hi guys. This is gonna be long. So bear with me.

Hey DocSpana, what are your credentials besides a DO student? I mean what is your involvement at the NYS level?

Also, if this is true (would like to see source soon), it isn't policy, it's only a resolution, which means it's practically meaningless.

I am the chair of legislative awareness for medical students of New York State. This is for both the medical society of New York and the AMA.

And it is policy. Resolution is when its not yet voted for. Policy is when it's been approved to have funds to back its execution. It's policy of the medical society of New York. More on the meaningfulness of this in the next few comments

Yeah, it really doesn't sound like this is anything more than a symbolic victory, until some specific policy is attached

It's kind of like when the Senate passes resolutions like "We stand in support of Japan" or a couple years back, when Congress "recognizes the importance of the symbols and traditions of Christmas," though to be fair the NY resolution could lead to some serious laws, we'll have to wait and see.

Well by the merit of being a new policy alone it means that we can put pressure on Albany to make this become law. It also means that we can put pressure on hospitals to cut it out. It also means we can convince AMSNY, who has been sitting on their hands with this issue, to ally with us on it.

Oh and also: I talked with MSSNY legal council after passing it. They're filing a federal lawsuit against the hospitals in the next month or two, once they gather all the data (of which I supplied a decent portion to start with). The federal lawsuit will state that there is precedent in other organizations that receive state money to perform a public good (I do not know which organization he is referring to, but he knows his stuff so I didnt stop him to ask) where if they receive foreign money to provide the same service, they are welcome to do so, but the funds they receive are subtracted penny for penny from their state funding until either they equal out to a net zero change in income, or the state pays them nothing if the funding exceeds state funding. (which it really never will). All a hospital earns by being paid excessive funds to take these students is bad press. Though I doubt it would stop them from taking some just because there are qualified students to be had, but they wont profit from it.

Yea that was kind of a big deal and was the jaw dropping consequence of this. Yes lawsuits take *ages* to get solved and in the meantime we have at least this on the books and it will be receiving funds to be pushed into albany's plates at the next legislative session.

I'm not a caribbean student, but i don't even know what this resolution means. and there's nothing in the news about it. so...

I can explain later. This comment is gonna be too long as it is. It's not in the news because all of these resolutions are not publicly distributed (Though they can be accessed if you look for them). Its internal documents and suggestions that then become our functional policies in the future if voted to be funded and supported.

This is why med schools are letting in more students too....

There is an effort to get foreign trained docs out of the system.

Yup. Part of the expansion attempts is to properly make the american education net bigger so that the qualified students have enough seats to all go somewhere. Another policy being pushed by other states is to cut down on the carib grads and increase the ease of foreign (Africa, india, europe, asia) doctors to come into the country. Studies repeatedly show that the american trained physician is ~8% better than the non-american caribbean graduate, and ~10% better than the US-born caribbean graduate, just as they show the indian doctor is about 7-8% better than the US doctor. We want more american seats so we get all the good american candidates (and still filter out the poor ones) and we want more true FMGs (aka not from caribbean unless they clean up their educational standards).

It's nice to see the major osteopathic organizations take a page out of the AMA's book on how to run a monopoly. Milton Friedman must be rolling in his grave. As a future physician (DO), it is attitudes like this that make me ashamed of our parent organizations.

Let every student, MD, DO, IMG, or FMG, compete on an equal legal playing field. If organizations have a preference for domestic students, so be it. And if organizations have a preference to make more money by training paying international students, so be it. And if our government wants to subsidize domestic students so they can get better clerkships, so be it. But don't legislate against this unless there is a very real and very significant harm being done.

The MDs were passing the same types of legislation against us 40-50 years ago. I hope the DNPs don't try this in another 50.

Not a osteopathic organization. This is the AMA (or the NY branch of it). So this is overwhelmingly allopathic schools. I just happen to be a DO, but it was my job title that got me to the head of this stuff, not my future degree.

The issue here is that allopathic schools like Columbia and Einstein are losing their affiliations. Forget how kicked around Touro (my school) was in all of this. The angry parties are Columbia, located in harlem, who loses Harlem Hospital, their (now ex) #2 hospital, located just a handful of blocks from them. Entirely gone to St. George's. Pissed off is Einstein, in the bronx, who lost Bronx-Lebanon entirely to Ross as of this upcoming clinical year. Annoyed is NYMC who is sending people all across NJ and CT now because they lost a hospital to a closing, but suddenly found that all their ancillary hospitals are now closed to them despite years and years of affiliation and the students who went to St. Vincent's had no place to go til the school scrambled for random hospitals in other states.

Touro. Hhaha. Well after losing 3 hospitals in a row (Harlem Hospital, Lennox Hill and, this year, bronx-lebanon) we pretty much have moved almost our entire clinical education to north jersey. And this is when the medical commisioner of new york is telling us his #1 priority is keeping New York trained students in NY for residency. Well if you have schools who were going to send 90% of their students to NY hospitals, and now have to send 90% to jersey for 3rd and part of 4th year, you are doing a pretty poor job of keeping New York trained students in NY for residency. BTW: I asked him that and he had no answer except that he'd need to get a commssion together to get all the figures from the offshore schools. ah well. He does have to be diplomatic with his responses.

Agreed. Whats been driving this all along is hospitals wanting the extra $$. Any non binding resolution won't remove that motivation. Until they pass some sort of law that says any hospital taking more then X% of rotators from non US medical schools, will be fined Y$, nothing will change.

Non-binding resolutions wont. You're right. For that matter states can't prevent them from doing it either. All they can do is make punitive measures (you do x, we tax you/dont pay you y). But federal courts can actually stop it. They can also make some crazy punitive meauses. Which is why the legal counsellor at MSSNY wanted to pick this up and run with it immediately. This let us work on this independantly of the health commisioner, who has to try to protect the hospitals. I get that. But his priority should be to protect the students and still find some way for the hospitals to pull in some profit from this at lower levels. It's the spirit of the resolution (and the spirit does matter, even if only the wording become policy, because the debate is recorded for the purpose of identifying what the 'spirit' was if the wording is unclear).
 
Oh also: exact link is prob coming tuesday or wednesday. Debate on the remaining issues/resolutions doesn't close til tomorrow. Then I figure it'll take a day or two for them to post the new policies officially on the website, but I'll link it when I see it.
 
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It's nice to see the major osteopathic organizations take a page out of the AMA's book on how to run a monopoly. Milton Friedman must be rolling in his grave. As a future physician (DO), it is attitudes like this that make me ashamed of our parent organizations.

Let every student, MD, DO, IMG, or FMG, compete on an equal legal playing field. If organizations have a preference for domestic students, so be it. And if organizations have a preference to make more money by training paying international students, so be it. And if our government wants to subsidize domestic students so they can get better clerkships, so be it. But don't legislate against this unless there is a very real and very significant harm being done.

The MDs were passing the same types of legislation against us 40-50 years ago. I hope the DNPs don't try this in another 50.
Why? Why shouldn't AMGs (whether MD or DO) get first shot at clerkships/residencies? Just curious.
 
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:thumbup: Exactly. This is a petty move to legislate against FMGs who for years have helped alleviate US physician shortage, specially in a state like New York. It should be said that while OP is a DO student, I don't think (and hope) that he doesn't represent the AOA. Merely passing on his own personal views at the state level, or so he claims.

This is ACTUALLY a move MORE against the Carib grads.
IMGs (the foreign-born grads), will ALWAYS have a niche if they have great credentials. Plus, there's a crap ton of FMG PDs out there who LOVE taking their own.
 
Why? Why shouldn't AMGs (whether MD or DO) get first shot at clerkships/residencies?

Not residencies. Rotations/clerkships. AKA 3rd and 4th year. (just being redundant now). I see you get me and are, seemingly, in agreement. But for anyone who doesn't... here is a rant:

It's that the "adults" of MSSNY feel that students come to NY for pre-clinicals and flee the state sometime between the end of 2nd year and the match. It's clear that NY is a great place to get educated and bring your education back to your home town and/or city of desire. But the problem is that the lack of "undergraduate education to graduate education" overlap has been rapidly worsening with every year just in the last 10 years. Coincidentally coinciding with Ross and SGU moving into the area with rapidly increasing class sizes and, since 2008, the systematic takeover of tons of the NYC, Long Island, and "NYC suburb" hospitals. It has begun taking NYC students who are, generally, the cream of the crop of american students (Feel free to disagree any other city) and forcing them to no longer be able to rotate in highly desired hospitals that are historically associated with the school.

Harlem Hospital was where all the surgeons from Columbia would go. Now they cant. For those who don't know, Columbia-Presbyterian is a level III trauma center, so they dont see surgical emergencies much worse than paper cuts. (yes thats hyperbole, but Harlem Hospital is level I. Thats where future surgeons want to be, not the celebrity hospital). Einstein still has jacoby but lost Bronx-Lebanon, which was literally taking a bit under half of their students just a few years ago. now its (about to be) zero as no new american students will be going there for cores. Every single NYC school (Except NYU who is entirely untouched because the doctors at bellevue threw a fit when the contract was about to be signed, and lucking out with thier other sites) has these stories. There are no exceptions. Even though it is a NYC-and-long-island-centered issue, the upstate schools have said they've seen it to lesser degrees as well.

Their experience with it, and the more modest number of students was part of the guide of the original wording (which did originally request that students from offshore schools be unable to enroll at such a rate as to preclude american students, but that was felt to be too unclear and the doctors wanted one clear and strong stance rather than a few nuanced stances)
 
This is ACTUALLY a move MORE against the Carib grads.
IMGs (the foreign-born grads), will ALWAYS have a niche if they have great credentials. Plus, there's a crap ton of FMG PDs out there who LOVE taking their own.

A fellow student member sat through the IMG caucus on this resolution. They seemed nervous about this and how it would be intepreted and some were against it... but apparently equal numbers were for it as they felt caribbeans do give them a bad name and that this wouldn't touch their niche and may actually expand it.

I was suprised they weren't against it because, although the spirit and set-up of the resolution clearly showed a lot of respect for the FMGs and their well documented excellence, the final wording isnt crystal clear that it doesn't include them too. But... it won't include them because 1) its pretty well understood it targets carib specifically and 2) FMGs don't really rotate in the US the way American medical students and caribbean students do. They're generally doctors already so they rotate more to get their faces seen, rather than a requirement, and I imagine most forgo that and simply apply straight into the match.
 
Why? Why shouldn't AMGs (whether MD or DO) get first shot at clerkships/residencies? Just curious.

Just to clarify, I am only talking about clerkships. With residencies, as I'm sure you're well aware, hundreds of thousands of dollars of taxpayer money is used to train each resident, so I understand the desire to give AMGs first shot.

With clerkships though, no subsidized money is exchanging hands (as far as I know... someone correct me if I'm wrong). So unless there is a real and significant harm towards AMGs, why enact an anti-competitive law? There has to be some justification for restricting who is legally able to rotate at a private hospital.

By my reading of the situation, the major harm towards AMGs is schools are forced to pay for clerkships or AMGs are forced to rotate at less desirable locations. Is this a significant harm, worth restricting non AMGs from rotating in NY? I don't think so. The NY schools could pony up some more cash, or the proposal could just as easily make it illegal to pay for rotation sites, or to pay more than a certain token amount, but instead, it tries to ban non-AMGs from rotating altogether. I'd much rather this country be able to recruit those Island gunners, at a small cost to AMGs, than guarantee every AMG superb rotations, at the cost of not recruiting the best and the brightest foreign grads. But that is my opinion and I'm sure many people disagree with it.
 
Kevin, are you soon to enter Carib school?
If so, don't go.
Go DO if need be. You potentially get 2 shots at matching.

Foreign born grads do observerships and that's it.

Caribs students often times get OUTSTANDING core rotation experiences (i.e. Sinai, Columbia, etc.). It kinda made me sick.
I had to set up 4th year rotations at good programs. Also, do my own inpatient months. If not, I'd be stuck in BFE doing community medicine 3rd and 4th year.
 
Just to clarify, I am only talking about clerkships. With residencies, as I'm sure you're well aware, hundreds of thousands of dollars of taxpayer money is used to train each resident, so I understand the desire to give AMGs first shot.

With clerkships though, no subsidized money is exchanging hands (as far as I know... someone correct me if I'm wrong). So unless there is a real and significant harm towards AMGs, why enact an anti-competitive law? There has to be some justification for restricting who is legally able to rotate at a private hospital.

By my reading of the situation, the major harm towards AMGs is schools are forced to pay for clerkships or AMGs are forced to rotate at less desirable locations. Is this a significant harm, worth restricting non AMGs from rotating in NY? I don't think so. The NY schools could pony up some more cash, or the proposal could just as easily make it illegal to pay for rotation sites, or to pay more than a certain token amount, but instead, it tries to ban non-AMGs from rotating altogether. I'd much rather this country be able to recruit those Island gunners, at a small cost to AMGs, than guarantee every AMG superb rotations, at the cost of not recruiting the best and the brightest foreign grads. But that is my opinion and I'm sure many people disagree with it.

NYU estimated that the cost for their students (and my dean confirmed his estimate was only 1-1.25 thousand lower) was an additional 13,500 PER YEAR increase in tuition to be able to match the offshore school bids. If you want your tuition to increase by that much per year, go right ahead and say that there is no harm in the competition. I think the cost of medical school is heinous enough.

The average medical school debt is 153,000. The average in NY state is 208,000. I dont want to add 70,000 more dollars onto that.
 
NYU estimated that the cost for their students (and my dean confirmed his estimate was only 1-1.25 thousand lower) was an additional 13,500 PER YEAR increase in tuition to be able to match the offshore school bids. If you want your tuition to increase by that much per year, go right ahead and say that there is no harm in the competition. I think the cost of medical school is heinous enough.

The average medical school debt is 153,000. The average in NY state is 208,000. I dont want to add 70,000 more dollars onto that.

NYU's current tuition is $47,476.00, which is comparable to almost any private MD school, especially when you consider it is in an expensive area of Manhattan where overhead costs are high.

I guess my question is, how could tuition only have been 34,000 per year for a prime location in a prime city? Especially when you consider that lots of MD schools have tuitions at 45-50,000 in less desirable locations, and without any caribbean schools competing for rotations
 
Just to clarify, I am only talking about clerkships. With residencies, as I'm sure you're well aware, hundreds of thousands of dollars of taxpayer money is used to train each resident, so I understand the desire to give AMGs first shot.

With clerkships though, no subsidized money is exchanging hands (as far as I know... someone correct me if I'm wrong). So unless there is a real and significant harm towards AMGs, why enact an anti-competitive law? There has to be some justification for restricting who is legally able to rotate at a private hospital.

By my reading of the situation, the major harm towards AMGs is schools are forced to pay for clerkships or AMGs are forced to rotate at less desirable locations. Is this a significant harm, worth restricting non AMGs from rotating in NY? I don't think so. The NY schools could pony up some more cash, or the proposal could just as easily make it illegal to pay for rotation sites, or to pay more than a certain token amount, but instead, it tries to ban non-AMGs from rotating altogether. I'd much rather this country be able to recruit those Island gunners, at a small cost to AMGs, than guarantee every AMG superb rotations, at the cost of not recruiting the best and the brightest foreign grads. But that is my opinion and I'm sure many people disagree with it.

I did not previously address all of your issues. (sorry. I was celebrating this becoming policy)

With every clerkship money is exchanging hands. This is unversal across the board. Allopathics tend to pay a few thousand dollars per student per year (sorry I dont have the exact figures. It has always been sufficient to say its been small) and osteopathic schools pay about twice this much per student mostly because they dont really have 'affiliated hospitals' in the same way allopathics do. But still... this is a matter of $2,500 per student (made up number, but prob very accurate) vs $5,000 per student (again. made up. prob accurate though). St. George's pays $400 per student per week. Ross pays even more at between $450 and $500 per student per week. That means that they (sgu) hit the allopathic pay rate around the first month. They hit the osteopathic pay rate around the second month. So they pay 12x the amount allopathic students pay and 6x the amount osteopathic students pay.

Technically american students have their school simply pay a "kick back" where the hospitals get paid a flat rate for supporting the school students and the rate is based on rough "ranges" of how many students they take. Despite this, every bit of data I've seen has suggested this number is <$5,000. Osteopathic schools have paid more as 1) they are nearly all private and 2) Only one has a university hospital, so they all do have to pay. Their numbers have mostly been cited ~$5,000 per student when average for the most common student enrollment size. Even then, this is *nothing* compared to the massive amount of money the offshore schools are offering.

This hospitals are hurting for money. This is *easy* money. The resolution did take stronger language (because that was supported and we saw an opportunity to solidfy it) but the original language was to simply limit and spread offshore student so that they did not kick out columbia, einstein, mt. sinai, cornell, NYCM, Hofstra, Downstate, and Touro students (prob Stony Brook, NYCOM, Buffalo, Rochester, Upstate, Sophie Davis, and Albany students as well). As stated before, the original intention was not to cripple the hospital so as to deprive them of this money, but we *do* feel that they should not be profiting as strongly from this and that if their need to profit from the acceptance of out of country students harms the in-state students (Who the commissioner of medicine says is his second biggest concern behind tort reform) the hospitals should either pay for going against the second greatest command of the governor on the issue, or should be forced to defend this position in court as other organizations have made it clear that the state has the right to garnish or entirely cut funding to organizations who use state funding to provide services to out of country recipients, as that pay is meant to serve the people of the state, and their medical students (in this example).

Also of note, offshore schools rotate in grenada/dominca/saba/Dutch Antilles. The idea that the "next step" in rotations is Columbia Presbetyrian, Bronx-Lebanon, Jacoby, Mamionedes, Suny Downstate Health Center, Harlem Hospital, Lennox Hill, and other elite hospitals is ridiculous. These schools (yes each and every one) has connections across the country and within *other NY schools*, yet they refuse to send less than the maximum to NYC. The big unusual fact is that SGU paid $100,000,000 to send 600 students into manhattan under an additional clause that all Ross/AUC/Saba students be immediatly kicked out. Firstly: HHC is made up of 80 facilities and 11 large hospitals. SGU paid to simply place 600 students, and HHC chose to place them all (prob under pressure, but I cant be sure) in 6 of the 7 most desired of the 11 hospitals. Also none of the non-hospital locations tha tmake up the additional 69 facilities. This was literally a purchase of every major hospital in NYC except bellevue (thus the 6 out of 7) without a single admission that there were TONS of open spots they declined because they felt they paid for only the elite hospitals.

This people are *not* US trained students/[physicians. Plain and simply they are (in majority) people who could not make a US school. Simply put: if you were to go to columbia presbyterian would you want the "cream of the crop student" to spend the most time with you, or the person who couldn't qualify for an allopathic school, or for a second-chance redemption school (which is what DO schools are for many, but not nearly all, students) but was willing to pay his way into a third chance because mommy and daddy were rich.

Every major organization agrees that the medical student spends the most time examining and knowing the patient. Do you want one of the most qualified students in america working at bronx-lebanon or do you want people who paid their way into a third-chance opportunity. (this is not to degrade or dismiss the ability of individuals from the carib to be impressive, this is simply making hyperbole about the current situation).
 
I did not previously address all of your issues. (sorry. I was celebrating this becoming policy)

This people are *not* US trained students/[physicians. Plain and simply they are (in majority) people who could not make a US school. Simply put: if you were to go to columbia presbyterian would you want the "cream of the crop student" to spend the most time with you, or the person who couldn't qualify for an allopathic school, or for a second-chance redemption school (which is what DO schools are for many, but not nearly all, students) but was willing to pay his way into a third chance because mommy and daddy were rich.

Every major organization agrees that the medical student spends the most time examining and knowing the patient. Do you want one of the most qualified students in america working at bronx-lebanon or do you want people who paid their way into a third-chance opportunity. (this is not to degrade or dismiss the ability of individuals from the carib to be impressive, this is simply making hyperbole about the current situation).

SGU, a Caribbean medical school, has higher average GPA and MCAT admission averages than most DO schools. By your logic, SGU students should be given priority over DO students in rotations. Most who choose the Caribbean over DO, don't do it because they couldn't get into DO, they do it because they chose MD over DO.

And no, DO students are not more qualified than IMGs who studied their basic sciences outside of the country, the USMLE step 1 sets the bar. SGU students have higher USMLE Step 1 pass rates than osteopathic students, does that mean they should be given preference?

"These people are *not* US trained".. give me a break. You're definitely a politician and not a very good one at that. I'd take a foreign trained politician over you any day.

Your logic is childish and it's embarrassing that someone with your narrow and discriminatory views is even allowed to have a say in these matters. I would want the most qualified, caring and competent medstudents at Columbia Presbyterian and that doesn't mean a DO simply because they read their basic science text books within certain geographical borders. America has long been built upon the backs of its immigrants and that will not change. Which is why you and your little resolutions will go away.
 
Find me a school that is as restrictive in its licensing examinations as the Caribbean with as skewed statistics. What is your beef with the US students over the Carribean students?
 
NYU's current tuition is $47,476.00, which is comparable to almost any private MD school, especially when you consider it is in an expensive area of Manhattan where overhead costs are high.

I guess my question is, how could tuition only have been 34,000 per year for a prime location in a prime city? Especially when you consider that lots of MD schools have tuitions at 45-50,000 in less desirable locations, and without any caribbean schools competing for rotations
NYU's tuiton may be 47,476 but if then add all the fees and living expenses, COA is ~$75,000....
 
SGU, a Caribbean medical school, has higher average GPA and MCAT admission averages than most DO schools. By your logic, SGU students should be given priority over DO students in rotations. Most who choose the Caribbean over DO, don't do it because they couldn't get into DO, they do it because they chose MD over DO.

And no, DO students are not more qualified than IMGs who studied their basic sciences outside of the country, the USMLE step 1 sets the bar. SGU students have higher USMLE Step 1 pass rates than osteopathic students, does that mean they should be given preference?

"These people are *not* US trained".. give me a break. You're definitely a politician and not a very good one at that. I'd take a foreign trained politician over you any day.

Your logic is childish and it's embarrassing that someone with your narrow and discriminatory views is even allowed to have a say in these matters. I would want the most qualified, caring and competent medstudents at Columbia Presbyterian and that doesn't mean a DO simply because they read their basic science text books within certain geographical borders. America has long been built upon the backs of its immigrants and that will not change. Which is why you and your little resolutions will go away.

MD student here. Your argument's crap. Most DO schools now have average MCATs in the 27+ range and GPAs in the 3.5 + range. Your figure about USMLEs, doesn't take into account that Caribbean schools don't allow just anyone to take the USMLE. They only allow their best and brightest who've demonstrated success on practice tests to sit for the real thing. That's also not taking into account that DOs take the COMLEX and the pass rate is comparable to US MD's and the USMLE. That's because the curriculum at DO schools is geared toward COMLEX, which is a more clinical exam without emphasis on certain subjects, like Biochem for instance.

The match rates speak for themselves. DOs do much better in the MD match than Caribbean students. There's a reason for that.
 
Also don't forget that Caribbean students are given a huge amount of time to study and prep for the Step 1 exam, while many US medical students are only give 4-6 weeks.
 
SGU, a Caribbean medical school, has higher average GPA and MCAT admission averages than most DO schools. By your logic, SGU students should be given priority over DO students in rotations. Most who choose the Caribbean over DO, don't do it because they couldn't get into DO, they do it because they chose MD over DO.

And no, DO students are not more qualified than IMGs who studied their basic sciences outside of the country, the USMLE step 1 sets the bar. SGU students have higher USMLE Step 1 pass rates than osteopathic students, does that mean they should be given preference?

"These people are *not* US trained".. give me a break. You're definitely a politician and not a very good one at that. I'd take a foreign trained politician over you any day.

Your logic is childish and it's embarrassing that someone with your narrow and discriminatory views is even allowed to have a say in these matters. I would want the most qualified, caring and competent medstudents at Columbia Presbyterian and that doesn't mean a DO simply because they read their basic science text books within certain geographical borders. America has long been built upon the backs of its immigrants and that will not change. Which is why you and your little resolutions will go away.

... no.... nobody knows what SGUs numbers are for GPA or MCAT. The health commissioner of NY stated pretty clearly in his town hall meeting a month back he is aware that the numbers they give are cooked as there have been cases of number inconsistency throughout their website. He also said that the students they put out are of quality (i dont disagree) and that he will need to form a committee to blah blah blah. In short he wants SGU to finally actually release the data because their current self-reporting has led to someone from one dept claiming the average is 28 and someone from another claiming is 26 for the same class and both were just counting US enrollees. I wish I had the data so I could know.... but this is *not* about academics. I don't look down on the students who go there. This is about finances.

SGU pre-screens who can take the USMLE. They are well known to decellerate or force people to repeat. but again... this is not about academics. But don't cite a test which is voluntary and a fraction of people take in DO schools against a subset of people who have to take the test and are pre-screened for who can take it. It's comparing apples to armadillos. Totally different worlds. But so you know, the USMLE is not the bar of competence. Its the quantitative marker for residency. The bar for qualitative evaluation of education is resident and attending outcome results. In the last few years multiple studies have been published showing that there are, as a trend, inferior outcomes from US-IMGs. but again. This *might* be about care quality and treatment outcomes, but its more of an ancillary thing. It's still primarily finances.

Well... i mean... they are not US trained. Thats just pointing out something thats just true. I don't get why that got extracted out.

Your comment falsely implies that there are DO students training at C-P for cores. We don't. DOs have been, in a way, much less effected than allopathic students. Touro had to scramble tons because we tried to ally ourselves with classically MD-elite hospitals and then SGU/Ross came in and booted everyone (DO and MD). Touro just went to UMDNJ, PCOM and NYCOM and asked them where they go, and went there now. The issue here is that Columbia is finding their ability to rotate at C-P shrinking despite it being the hospital they are taught their classes right in. The issue here is that Cornell has (almost) no spots at C-P any more because it was their spots that were bought. The issue here is that Einstein no longer has any rotations in its second biggest hospital. The issue here is that we are over $200,000 in debt for going to a NYC school. The estimated cost of competing with SGU and Ross's payments are an additional $17,500 per year in tuition.

This is that the elite MD schools are being kicked out of their classic rotation spots by people who are paying out the ass to do so. The MD schools feel this is unfair practice by a foreign organization to commandeer a state-funded organization (hospitals) that are paid american tax dollars to teach american students. This stuff with HHC is actually able to be stopped in a few easy to imagine ways, legally. Their issue with the private hospitals is harder to enforce as the hospitals are private, but the medical society feels that it remains a predatory practice and decided to officially take a stance against them too.
 
NYU's current tuition is $47,476.00, which is comparable to almost any private MD school, especially when you consider it is in an expensive area of Manhattan where overhead costs are high.

I guess my question is, how could tuition only have been 34,000 per year for a prime location in a prime city? Especially when you consider that lots of MD schools have tuitions at 45-50,000 in less desirable locations, and without any caribbean schools competing for rotations

not sure if I understand what you're saying so I'll restate what I think you missed. the 17,500 figure was an *increase* in tuition that would be needed to generate enough funds to match the offshore student bid. So it would go from ~47,500 to $65,000 in tuition a year. Then add in cost of living.
 
I did not previously address all of your issues. (sorry. I was celebrating this becoming policy)

With every clerkship money is exchanging hands. This is unversal across the board. Allopathics tend to pay a few thousand dollars per student per year (sorry I dont have the exact figures. It has always been sufficient to say its been small) and osteopathic schools pay about twice this much per student mostly because they dont really have 'affiliated hospitals' in the same way allopathics do. But still... this is a matter of $2,500 per student (made up number, but prob very accurate) vs $5,000 per student (again. made up. prob accurate though). St. George's pays $400 per student per week. Ross pays even more at between $450 and $500 per student per week. That means that they (sgu) hit the allopathic pay rate around the first month. They hit the osteopathic pay rate around the second month. So they pay 12x the amount allopathic students pay and 6x the amount osteopathic students pay.

Technically american students have their school simply pay a "kick back" where the hospitals get paid a flat rate for supporting the school students and the rate is based on rough "ranges" of how many students they take. Despite this, every bit of data I've seen has suggested this number is <$5,000. Osteopathic schools have paid more as 1) they are nearly all private and 2) Only one has a university hospital, so they all do have to pay. Their numbers have mostly been cited ~$5,000 per student when average for the most common student enrollment size. Even then, this is *nothing* compared to the massive amount of money the offshore schools are offering.

This hospitals are hurting for money. This is *easy* money. The resolution did take stronger language (because that was supported and we saw an opportunity to solidfy it) but the original language was to simply limit and spread offshore student so that they did not kick out columbia, einstein, mt. sinai, cornell, NYCM, Hofstra, Downstate, and Touro students (prob Stony Brook, NYCOM, Buffalo, Rochester, Upstate, Sophie Davis, and Albany students as well). As stated before, the original intention was not to cripple the hospital so as to deprive them of this money, but we *do* feel that they should not be profiting as strongly from this and that if their need to profit from the acceptance of out of country students harms the in-state students (Who the commissioner of medicine says is his second biggest concern behind tort reform) the hospitals should either pay for going against the second greatest command of the governor on the issue, or should be forced to defend this position in court as other organizations have made it clear that the state has the right to garnish or entirely cut funding to organizations who use state funding to provide services to out of country recipients, as that pay is meant to serve the people of the state, and their medical students (in this example).

Also of note, offshore schools rotate in grenada/dominca/saba/Dutch Antilles. The idea that the "next step" in rotations is Columbia Presbetyrian, Bronx-Lebanon, Jacoby, Mamionedes, Suny Downstate Health Center, Harlem Hospital, Lennox Hill, and other elite hospitals is ridiculous. These schools (yes each and every one) has connections across the country and within *other NY schools*, yet they refuse to send less than the maximum to NYC. The big unusual fact is that SGU paid $100,000,000 to send 600 students into manhattan under an additional clause that all Ross/AUC/Saba students be immediatly kicked out. Firstly: HHC is made up of 80 facilities and 11 large hospitals. SGU paid to simply place 600 students, and HHC chose to place them all (prob under pressure, but I cant be sure) in 6 of the 7 most desired of the 11 hospitals. Also none of the non-hospital locations tha tmake up the additional 69 facilities. This was literally a purchase of every major hospital in NYC except bellevue (thus the 6 out of 7) without a single admission that there were TONS of open spots they declined because they felt they paid for only the elite hospitals.

This people are *not* US trained students/[physicians. Plain and simply they are (in majority) people who could not make a US school. Simply put: if you were to go to columbia presbyterian would you want the "cream of the crop student" to spend the most time with you, or the person who couldn't qualify for an allopathic school, or for a second-chance redemption school (which is what DO schools are for many, but not nearly all, students) but was willing to pay his way into a third chance because mommy and daddy were rich.

Every major organization agrees that the medical student spends the most time examining and knowing the patient. Do you want one of the most qualified students in america working at bronx-lebanon or do you want people who paid their way into a third-chance opportunity. (this is not to degrade or dismiss the ability of individuals from the carib to be impressive, this is simply making hyperbole about the current situation).

Thanks for typing this all out. As evidenced above (Gavanshir), too often people that take the time to have a spirited debate get called names for simply having a differing opinion.

That anecdote on how much MD/DO/Carib schools pay to hospitals is very interesting. I wonder how reflective, at all, it is of any degree bias. I always thought hospitals take on students for the 'prestige' factor, but I guess I was wrong. As an aside, I see those numbers ($100 mil for 600 SGU students) and think what an opportunity we have to subsidize AMG students. Let a few Carib students rotate in exchange for 4 years worth of tuition (I assume funded by the pyramid scheme setup of the Carib). The hospital gets paid and can lower these costs for AMGs. I still don't think that 2.5,5,or 13,500 number you quoted justifies the language in the proposal, but I see how this can be interpreted as such.

To address your last two paragraphs, which I understand are a bit of hyperbole, the only thing I want to add is many of these Caribbean students are our fellow college peers. Many didn't want to, or couldn't, waste an application year applying MD/DO or padding their stats with the red queenish MA/MS/SMP/postbac/MPH combo taken by so many american students that couldn't or didn't get accepted into med school right after college. It is just as unfair to typecast our Caribbean peers by their medical school or MCAT/GPA combo, or ability to finance the debt, as it is for MDs to do to us. I sincerely believe the Carib is set up like a pyramid scheme, but if a fellow citizen can make it through those first two years with all of those hurdles, I don't see why he/she should be legally banned from rotating here (edit: assuming equivalent cognitive factors/academic stats and clinical skills)
 
Don't think it is going to be easy to remove Carib spots from these hospitals. Caribbean schools are supplying these hospitals with MILLIONS of dollars just to train 3rd/4th years. Don't be surprised if the Hospitals side with the Caribbean on this. And it doesn't matter if they force people to become stronger to take the boards or if they have a longer time to study for them. The fact is that the M3 students passed the boards who are taking these clerkships.

There might be some inconsistencies in incoming class stats because they take 2 incoming classes a year.
 
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Thanks for typing this all out. As evidenced above (Gavanshir), too often people that take the time to have a spirited debate get called names for simply having a differing opinion.

That anecdote on how much MD/DO/Carib schools pay to hospitals is very interesting. I wonder how reflective, at all, it is of any degree bias. I always thought hospitals take on students for the 'prestige' factor, but I guess I was wrong. As an aside, I see those numbers ($100 mil for 600 SGU students) and think what an opportunity we have to subsidize AMG students. Let a few Carib students rotate in exchange for 4 years worth of tuition (I assume funded by the pyramid scheme setup of the Carib). The hospital gets paid and can lower these costs for AMGs. I still don't think that 2.5,5,or 13,500 number you quoted justifies the language in the proposal, but I see how this can be interpreted as such.

To address your last two paragraphs, which I understand are a bit of hyperbole, the only thing I want to add is many of these Caribbean students are our fellow college peers. Many didn't want to, or couldn't, waste an application year applying MD/DO or padding their stats with the red queenish MA/MS/SMP/postbac/MPH combo taken by so many american students that couldn't or didn't get accepted into med school right after college. It is just as unfair to typecast our Caribbean peers by their medical school or MCAT/GPA combo, or ability to finance the debt, as it is for MDs to do to us. I sincerely believe the Carib is set up like a pyramid scheme, but if a fellow citizen can make it through those first two years with all of those hurdles, I don't see why he/she should be legally banned from rotating here (edit: assuming equivalent cognitive factors/academic stats and clinical skills)

I totally agree with your last stuff. They shouldn't be banned from rotating here because the ones who make it through *ARE* the successful ones who could cut it. There is some evidence that they still are not at peer with AMGs, but its a difference that should be in the context of "theyre still both successful physicians who arent being chased out for malpractice... its simply a trend of some difference still existing". but what I will say slightly deferring from you is that there are thousands of hospitals they could be rotating at.... The issue here is them focusing in on a few (and they have other great affiliated hospitals in other cities that they dont do this to) hospitals. They focus in on such a level that established US schools no longer have rotation spots. This isnt "we dont want to see the IMGs" its "they literally purchased our entire hospital that is ATTACHED to our school". The original wording was very much for not kicking out offshore students, since they do bring in money, but forcing them to spread out so at to not block US students from being able to use the hospitals they'be used forever.

e.g.: SGU pays HHC $100 mil whether the students are all in manhattan or spread across the 5 boroughs. If they were spread there would still be a lot of students at each hospital, but there would be room for some of these manhattan schools to still send people to the hospitals they have all their staff in, and the hospitals they (in some cases) effectively built the reputation of. We truly do respect the USIMGs who make it back to america. We do. We just dont particularly like what we feel is school poaching. Touro was new on the block and went to columbia and cornell and sinai and asked for spots in their hospitals. We got them. Everyone was cool, they made room by shfting a few people around. SGU came in and literally bought the spots that current students are in and had the hospitals send out letter that the decades long affiliation with these manhattan schools have been absolved overnight and that they need to find a new hospital for next year to send x% of their students.

and because its the famous hospitals, "x" usually is quite a decent percentage of the class.
 
... no.... nobody knows what SGUs numbers are for GPA or MCAT. The health commissioner of NY stated pretty clearly in his town hall meeting a month back he is aware that the numbers they give are cooked as there have been cases of number inconsistency throughout their website. He also said that the students they put out are of quality (i dont disagree) and that he will need to form a committee to blah blah blah. In short he wants SGU to finally actually release the data because their current self-reporting has led to someone from one dept claiming the average is 28 and someone from another claiming is 26 for the same class and both were just counting US enrollees. I wish I had the data so I could know.... but this is *not* about academics. I don't look down on the students who go there. This is about finances.

SGU pre-screens who can take the USMLE. They are well known to decellerate or force people to repeat. but again... this is not about academics. But don't cite a test which is voluntary and a fraction of people take in DO schools against a subset of people who have to take the test and are pre-screened for who can take it. It's comparing apples to armadillos. Totally different worlds. But so you know, the USMLE is not the bar of competence. Its the quantitative marker for residency. The bar for qualitative evaluation of education is resident and attending outcome results. In the last few years multiple studies have been published showing that there are, as a trend, inferior outcomes from US-IMGs. but again. This *might* be about care quality and treatment outcomes, but its more of an ancillary thing. It's still primarily finances.

Well... i mean... they are not US trained. Thats just pointing out something thats just true. I don't get why that got extracted out.

Your comment falsely implies that there are DO students training at C-P for cores. We don't. DOs have been, in a way, much less effected than allopathic students. Touro had to scramble tons because we tried to ally ourselves with classically MD-elite hospitals and then SGU/Ross came in and booted everyone (DO and MD). Touro just went to UMDNJ, PCOM and NYCOM and asked them where they go, and went there now. The issue here is that Columbia is finding their ability to rotate at C-P shrinking despite it being the hospital they are taught their classes right in. The issue here is that Cornell has (almost) no spots at C-P any more because it was their spots that were bought. The issue here is that Einstein no longer has any rotations in its second biggest hospital. The issue here is that we are over $200,000 in debt for going to a NYC school. The estimated cost of competing with SGU and Ross's payments are an additional $17,500 per year in tuition.

This is that the elite MD schools are being kicked out of their classic rotation spots by people who are paying out the ass to do so. The MD schools feel this is unfair practice by a foreign organization to commandeer a state-funded organization (hospitals) that are paid american tax dollars to teach american students. This stuff with HHC is actually able to be stopped in a few easy to imagine ways, legally. Their issue with the private hospitals is harder to enforce as the hospitals are private, but the medical society feels that it remains a predatory practice and decided to officially take a stance against them too.

I won't refute your arguments but just a few things I want to point out:

- The figure of $100 million isn't just for 600 students, it is a 10 year agreement to have our rotations at those hospitals.

- We do not rotate at Columbia Presbyterian, and I don't think Ross does either, which Caribbean medschool rotates there?

- And yes I believe if we are doing our rotations and residencies in the US, then we should be considered US trained physicians. There is a difference between the FMG who has been practicing in his own country for many years who applies for a US residency and an American citizen who has done his basic sciences abroad and returned to complete the rest of his career in his own country. To discriminate against him or her, who just a few years ago was your own classmate is simply cruel and represents a very cut-throat attitude which I frankly don't think should have any place in medicine (it unfortunately does).

- Someone pointed out that Caribbean students have a lot more time to study for the USMLE, this is not true. Only the minority of students who start in the January term have a few extra months, and this should not matter much as all FMGs who apply for US residencies have potentially been studying for the exam for years. This is perhaps one reason why they are discriminated against by PDs. Either way I don't think those few months will make a big difference in terms of performance.

- Many US medical schools have also do not promote their students to the next MS year unless they perform well enough on their own standardized end of term exams. Many US medical schools also have tracks for those who opt to finish their 4 year program in 5 years, ie. decelerate and redo courses. SGU is very strict with these students and dismisses them, SGU students only have 1 chance to redo a course and that is only if they drop it before the final exam. Anyone with an average below 75 by the end of MS1, or by the end of MS2 is dismissed from the school. The higher attrition rate in these schools should not be a factor as it's the final quality of applicants who finish their basic sciences that end up in the States that matters. In my opinion, the higher attrition rate indicates the school's high standards and not its low quality. Many US medschools will go above and beyond so that their students do not drop out for the sake of their statistics.

I think it's important to make a distinction between Caribbean medical schools, there are schools like SGU that have been operating since 1979, investing back into their own program and facilities, attracting some of the best faculty and visiting professors from the US and across the world, and working hard to secure good rotations in the US, and now have graduates working for the benefit of the US health care system. In my opinion, based on my research and my own experience here in Grenada, SGU is better than many European, Indian, and Asian medical schools. It is simply unfair to say that all Caribbean medical schools run pyramid schemes.

Our students here are very very hard working with very interesting backgrounds and it's unfair for US medical students to actively work against their futures when they have sacrificed so much to achieve their goals and return to their own country to practice medicine. And no we do not have rich parents, most here are on hefty loans and when you have close to 300K in debt and see people "celebrating" their progress towards limiting our medical education and acting arrogant about it, it's truly disheartening. My classmates include a fighter jet pilot, oral surgeon, optometrist, survivor of hurricane Katrina, mothers, fathers, PhD students, etc, etc.. people who for one reason or another could not afford to keep trying to get into the limited spots in the US and Canada.

Most of us have already faced numerous challenges and we would hope that our future colleagues don't actively work to kick us while we are down, but believe me we will make it back into our own country to practice and we will outperform those who spend their time and energy to sabotage our careers.
 
I'm generally not one for slippery slope arguments, but setting the precedent of selling rotation slots to the highest bidder is just asking for a bidding war, in which the losers are medical students and the public at large. This will increase medical school debt beyond its already ridiculous levels, which will push even more med students out of primary care (hence harming the public).

This will also boost the debt at Caribbean schools, because guess who is going to foot the bill for these million dollar hospital deals? The students. The only reason they can afford it without massive tuition hikes is due to their pyramidal nature (e.g. 4 first years contributing to the clinical payments for the 1 that makes it through to 3rd year). American schools would have to either follow suit or massively hike tuition. Does either of those sound like a good idea for American medicine? I think not.
 
Here is where I preach about attending a school with a hospital both physically linked and structurally linked. Our hospital CEO reports to the University President.

It's a huge problem with most DO schools, and lesser of a problem with MD schools except for those in very large metro areas.
 
Yup. Part of the expansion attempts is to properly make the american education net bigger so that the qualified students have enough seats to all go somewhere. Another policy being pushed by other states is to cut down on the carib grads and increase the ease of foreign (Africa, india, europe, asia) doctors to come into the country. Studies repeatedly show that the american trained physician is ~8% better than the non-american caribbean graduate, and ~10% better than the US-born caribbean graduate, just as they show the indian doctor is about 7-8% better than the US doctor. We want more american seats so we get all the good american candidates (and still filter out the poor ones) and we want more true FMGs (aka not from caribbean unless they clean up their educational standards).

Where are you getting these numbers from? I would like to know in what context and see the source (maybe we should all be training in India lol).

I have to admit I don't know much about this issue (thanks for posting all this info), but considering the tremendous physician shortage that we are faced with in America, I fail to see how preventing other students from training here will be helpful. You say Caribbean students are not US-trained, but it seems that if they are doing core rotations in these prestigious US hospitals, they are to an extent trained here. One could even argue that the preclinical years of med school are mostly just to attain background knowledge and prepare for licensing exams, which can pretty much be done anywhere (that is actually what most FMG's do- take a couple years after getting their MD in their country and study for the boards on their own).

Also, if it is true that the Caribbean schools select only the best of their students to do these rotations, and that only students who are expected to do well are allowed to take exams, it would seem that the students who do make it to these rotations are of a similar level of competence as AMG's.

I am US MD student and I can empathize with students at schools that do not have access to enough clerkship spots in desirable hospitals to train their students. However, I also understand that most Caribbean students are US citizens who intend to return to the US to practice (many in primary care), and I don't see how denying them the opportunity to get some training here in "prestigious hospitals" is beneficial to anyone, least of all their future patients. I am surprised that alternative resolutions that would be be beneficial to all parties have not being proposed, and that the first option is to simply ban these students from training in their own country.
 
I won't refute your arguments but just a few things I want to point out:

- The figure of $100 million isn't just for 600 students, it is a 10 year agreement to have our rotations at those hospitals.

- We do not rotate at Columbia Presbyterian, and I don't think Ross does either, which Caribbean medschool rotates there?

- And yes I believe if we are doing our rotations and residencies in the US, then we should be considered US trained physicians. There is a difference between the FMG who has been practicing in his own country for many years who applies for a US residency and an American citizen who has done his basic sciences abroad and returned to complete the rest of his career in his own country. To discriminate against him or her, who just a few years ago was your own classmate is simply cruel and represents a very cut-throat attitude which I frankly don't think should have any place in medicine (it unfortunately does).

- Someone pointed out that Caribbean students have a lot more time to study for the USMLE, this is not true. Only the minority of students who start in the January term have a few extra months, and this should not matter much as all FMGs who apply for US residencies have potentially been studying for the exam for years. This is perhaps one reason why they are discriminated against by PDs. Either way I don't think those few months will make a big difference in terms of performance.

- Many US medical schools have also do not promote their students to the next MS year unless they perform well enough on their own standardized end of term exams. Many US medical schools also have tracks for those who opt to finish their 4 year program in 5 years, ie. decelerate and redo courses. SGU is very strict with these students and dismisses them, SGU students only have 1 chance to redo a course and that is only if they drop it before the final exam. Anyone with an average below 75 by the end of MS1, or by the end of MS2 is dismissed from the school. The higher attrition rate in these schools should not be a factor as it's the final quality of applicants who finish their basic sciences that end up in the States that matters. In my opinion, the higher attrition rate indicates the school's high standards and not its low quality. Many US medschools will go above and beyond so that their students do not drop out for the sake of their statistics.

I think it's important to make a distinction between Caribbean medical schools, there are schools like SGU that have been operating since 1979, investing back into their own program and facilities, attracting some of the best faculty and visiting professors from the US and across the world, and working hard to secure good rotations in the US, and now have graduates working for the benefit of the US health care system. In my opinion, based on my research and my own experience here in Grenada, SGU is better than many European, Indian, and Asian medical schools. It is simply unfair to say that all Caribbean medical schools run pyramid schemes.

Our students here are very very hard working with very interesting backgrounds and it's unfair for US medical students to actively work against their futures when they have sacrificed so much to achieve their goals and return to their own country to practice medicine. And no we do not have rich parents, most here are on hefty loans and when you have close to 300K in debt and see people "celebrating" their progress towards limiting our medical education and acting arrogant about it, it's truly disheartening. My classmates include a fighter jet pilot, oral surgeon, optometrist, survivor of hurricane Katrina, mothers, fathers, PhD students, etc, etc.. people who for one reason or another could not afford to keep trying to get into the limited spots in the US and Canada.

Most of us have already faced numerous challenges and we would hope that our future colleagues don't actively work to kick us while we are down, but believe me we will make it back into our own country to practice and we will outperform those who spend their time and energy to sabotage our careers.

I'm aware. Its $10 million a year for 10 years with an undisclosed limit of bonus pay for schools that take more than x number of students (pretty sure x=50, but that is not something I ever memorized). It still makes it a $100 million deal

Ross is the one at C-P. Assume if it is in NY that this rule applies: if its a public hospital, it has SGU in it (Bellevue being the exception) and no Ross students. If its a private hospital assume that it has Ross in it, and some have SGU in them as well.

It also means that I, as a citizen living in the United States (specifically NY) are paying for the hospitals to train US students. It is not that you do not deserve to be trained, you do. It is that you are actively displacing american trained student doctors. I saw first hand that the argument of "we were your classmates just 2-3 years ago" has no traction against "we never left and now we're the least-favored ones for clerkships?". Medicine is cut throat, you said it and I'll agree. Its pretty clearly stated right in the NRMP that US-IMGs are considered american residents, but foreign doctors. No matter how much you rotate in the US you wont have an American MD, you'll have a Granadian MD. Does it matter? No, only residency and practice matters. But it is the definition of what is an American-trained doctor. I want it very clear that what I did and what was voted on was to protect american-trained students from being displaced by students from a system that, and i dont think anyone disagrees with this, lures in students who stand no chance to build enough funds to financially back the ones who are capable (and to profit. always). Its a system that can always create more money to counteract anything the US schools could do if they were to raise the tuition $13,500 per year to try to match SGU/Ross.

The few months probably dont make a huge difference. IDK if everyone would agree with me, but I think after 2 months of study, you're as ready as you'll ever be. So 6+ isnt much different. FMGs have an advantage because they are usually long-practicing doctors. If they speak english well, the USMLE is a cakewalk for them.

Please name these schools that pre-screen or formally. Not doubting they exist, doubting they are many. Though I will say almost no one is kicked out of US medical school, you choose to leave. But that usually attributed to not having the personality for it, not lacking the academics for it. Obviously "usually" is not "always and exclusively"

Studies have shown american students from SGU are inferior to European, Asian, African and Indian/Pakistani graduates who practice in america with the same number of years of global practice. Journal of Academic Medicine. They publish a new study on this pretty much every year for the last 5 years. Its always the same result. If AMGs are the "center point", US-IMGs specifically from the "big 4" have ~10% worse outcomes. All caribbean graduates together have ~8% worse outcomes (so the non-americans in your school are, statistically, better doctors in practice) and FMGs from other continents have 8-9% BETTER outcomes than american doctors. So no one competes with those guys. Now I previously said that this should be considered as a small but consistent trend among doctors that are clearly not being chased out of practice. They're more than capable, but close analysis does show a lingering slight deficit in performance.

Its not like anyone is saying you cant go and rotate here. This is to say stop buying out entire programs and entire hospitals. You are lessening the AMG education by doing so. Instead "share and share alike". All these schools have tons of hospitals more than willing to take them, especially if they pay. Spread the wealth around and you 1) will still be able to go to these hospitals, just in lower numbers and 2) wont piss off the New York medical schools. We're not blocking your education, we're protecting our own. And you are still allowed in when we are protecting our own by saying you cant come in and remove overnight a school that effectively built the hospitals prestige.

It really is a case of New York finally protecting New York students. I can *totally* understand any argument that this is the equivalent of the classic american isolationist stand that I, as a liberal, normally wouldn't espouse... but in this case I also view it as government protection of services against the harshness of open market capitalism.... so my liberal side is happy. The opposite theory can totally be argued. I get it. But just remember, this doesn't kick out students. It simply begins making laws (and one lawsuit) that will remove the preference money can give, prob in tax impacts.
 
Where are you getting these numbers from? I would like to know in what context and see the source (maybe we should all be training in India lol).

I have to admit I don't know much about this issue (thanks for posting all this info), but considering the tremendous physician shortage that we are faced with in America, I fail to see how preventing other students from training here will be helpful. You say Caribbean students are not US-trained, but it seems that if they are doing core rotations in these prestigious US hospitals, they are to an extent trained here. One could even argue that the preclinical years of med school are mostly just to attain background knowledge and prepare for licensing exams, which can pretty much be done anywhere (that is actually what most FMG's do- take a couple years after getting their MD in their country and study for the boards on their own).

Also, if it is true that the Caribbean schools select only the best of their students to do these rotations, and that only students who are expected to do well are allowed to take exams, it would seem that the students who do make it to these rotations are of a similar level of competence as AMG's.

I am US MD student and I can empathize with students at schools that do not have access to enough clerkship spots in desirable hospitals to train their students. However, I also understand that most Caribbean students are US citizens who intend to return to the US to practice (many in primary care), and I don't see how denying them the opportunity to get some training here in "prestigious hospitals" is beneficial to anyone, least of all their future patients. I am surprised that alternative resolutions that would be be beneficial to all parties have not being proposed, and that the first option is to simply ban these students from training in their own country.

Does *not* block offshore students from training here. Blocks them from taking 100% of the spots and precluding US students. You realize, for example, Jacobi is the hospital connected to Einstein. And Jacobi has never saturated their rotations because thats just not how Einstein does it. There have always been openings. Now there aren't because SGU purchased all the openings AND purchased some of the spots previously reserved for the students who are enrolled in the university that makes jacobi a 'university hospital'.

Its preventing the ability to just purchase the pre-filled spots. Its like you getting into UCLA medical school and then a week later getting a letter saying that you have been un-enrolled because I agreed to pay 12x the tuition in cash and UCLA realized there wasn't enough spots for both of us, so you got booted even though I wasn't accepted until just now. You did get into UCLA, so you have the smarts to apply somewhere else and get in too, but how do you feel about what happened to you at UCLA? In this allegory there are other schools in Cali that have openings that I could have gone to, still paid 12x tuition if I wanted, and would not boot anyone out. But I chose to pay UCLA and have them boot you.
 
Where are you getting these numbers from? I would like to know in what context and see the source (maybe we should all be training in India lol).

I have to admit I don't know much about this issue (thanks for posting all this info), but considering the tremendous physician shortage that we are faced with in America, I fail to see how preventing other students from training here will be helpful. You say Caribbean students are not US-trained, but it seems that if they are doing core rotations in these prestigious US hospitals, they are to an extent trained here. One could even argue that the preclinical years of med school are mostly just to attain background knowledge and prepare for licensing exams, which can pretty much be done anywhere (that is actually what most FMG's do- take a couple years after getting their MD in their country and study for the boards on their own).

Also, if it is true that the Caribbean schools select only the best of their students to do these rotations, and that only students who are expected to do well are allowed to take exams, it would seem that the students who do make it to these rotations are of a similar level of competence as AMG's.

I am US MD student and I can empathize with students at schools that do not have access to enough clerkship spots in desirable hospitals to train their students. However, I also understand that most Caribbean students are US citizens who intend to return to the US to practice (many in primary care), and I don't see how denying them the opportunity to get some training here in "prestigious hospitals" is beneficial to anyone, least of all their future patients. I am surprised that alternative resolutions that would be be beneficial to all parties have not being proposed, and that the first option is to simply ban these students from training in their own country.


I think a lot of people not from a NY school fail to realize the issue. There are US students in NY that cannot find clerkships rotations due to a large influx in carrib students. Imagine half of your schools rotations taken this year. What would your school do? This doesn't affect my school but as a NY student I have heard from other NY schools that are having a problem created by non US schools. The idea is the NY US schools should have the first choices, and shouldn't lack rotation spots in the US, before we allow non US schools to send students over.
 
Here is where I preach about attending a school with a hospital both physically linked and structurally linked. Our hospital CEO reports to the University President.

It's a huge problem with most DO schools, and lesser of a problem with MD schools except for those in very large metro areas.

Didn't stop SUNY Health Center in Brooklyn from losing an entire rotation program (peds I think), despite downstate being located within the hospital.
 
I'm aware. Its $10 million a year for 10 years with an undisclosed limit of bonus pay for schools that take more than x number of students (pretty sure x=50, but that is not something I ever memorized). It still makes it a $100 million deal

Ross is the one at C-P. Assume if it is in NY that this rule applies: if its a public hospital, it has SGU in it (Bellevue being the exception) and no Ross students. If its a private hospital assume that it has Ross in it, and some have SGU in them as well.

It also means that I, as a citizen living in the United States (specifically NY) are paying for the hospitals to train US students. It is not that you do not deserve to be trained, you do. It is that you are actively displacing american trained student doctors. I saw first hand that the argument of "we were your classmates just 2-3 years ago" has no traction against "we never left and now we're the least-favored ones for clerkships?". Medicine is cut throat, you said it and I'll agree. Its pretty clearly stated right in the NRMP that US-IMGs are considered american residents, but foreign doctors. No matter how much you rotate in the US you wont have an American MD, you'll have a Granadian MD. Does it matter? No, only residency and practice matters. But it is the definition of what is an American-trained doctor. I want it very clear that what I did and what was voted on was to protect american-trained students from being displaced by students from a system that, and i dont think anyone disagrees with this, lures in students who stand no chance to build enough funds to financially back the ones who are capable (and to profit. always). Its a system that can always create more money to counteract anything the US schools could do if they were to raise the tuition $13,500 per year to try to match SGU/Ross.

The few months probably dont make a huge difference. IDK if everyone would agree with me, but I think after 2 months of study, you're as ready as you'll ever be. So 6+ isnt much different. FMGs have an advantage because they are usually long-practicing doctors. If they speak english well, the USMLE is a cakewalk for them.

Please name these schools that pre-screen or formally. Not doubting they exist, doubting they are many. Though I will say almost no one is kicked out of US medical school, you choose to leave. But that usually attributed to not having the personality for it, not lacking the academics for it. Obviously "usually" is not "always and exclusively"

Studies have shown american students from SGU are inferior to European, Asian, African and Indian/Pakistani graduates who practice in america with the same number of years of global practice. Journal of Academic Medicine. They publish a new study on this pretty much every year for the last 5 years. Its always the same result. If AMGs are the "center point", US-IMGs specifically from the "big 4" have ~10% worse outcomes. All caribbean graduates together have ~8% worse outcomes (so the non-americans in your school are, statistically, better doctors in practice) and FMGs from other continents have 8-9% BETTER outcomes than american doctors. So no one competes with those guys. Now I previously said that this should be considered as a small but consistent trend among doctors that are clearly not being chased out of practice. They're more than capable, but close analysis does show a lingering slight deficit in performance.

Its not like anyone is saying you cant go and rotate here. This is to say stop buying out entire programs and entire hospitals. You are lessening the AMG education by doing so. Instead "share and share alike". All these schools have tons of hospitals more than willing to take them, especially if they pay. Spread the wealth around and you 1) will still be able to go to these hospitals, just in lower numbers and 2) wont piss off the New York medical schools. We're not blocking your education, we're protecting our own. And you are still allowed in when we are protecting our own by saying you cant come in and remove overnight a school that effectively built the hospitals prestige.

It really is a case of New York finally protecting New York students. I can *totally* understand any argument that this is the equivalent of the classic american isolationist stand that I, as a liberal, normally wouldn't espouse... but in this case I also view it as government protection of services against the harshness of open market capitalism.... so my liberal side is happy. The opposite theory can totally be argued. I get it. But just remember, this doesn't kick out students. It simply begins making laws (and one lawsuit) that will remove the preference money can give, prob in tax impacts.

"Studies have shown american students from SGU are inferior to European, Asian, African and Indian/Pakistani graduates who practice in america with the same number of years of global practice. Journal of Academic Medicine. "

Can you please provide a source for this? I've read the most recent studies by Journal of Academic Medicine and I believe SGU had a first time pass rate of ~91%. As far as I know there is no study comparing performance of SGU students against other FMGs. The other study that was done showed that patients of foreign-born, foreign-trained physicians had 15% less mortality rate, in comparison to ALL US graduates. [http://www.businessweek.com/lifestyle/content/healthday/641766.html].

Also, SGU is not BUYING OUT entire hospitals as you imply, this is simply misleading. The only exclusivity clause in the agreement is that the spots do not go to OTHER Caribbean medical schools, this to me makes sense if not simply because of the wide discrepancy in performance between the lower end Caribbean medical schools and those on the caliber of SGU and Ross. SGU has made this clear on numerous occasions but some (ie. Dean of Albert Einstein) believe this will set a bad precedent. SGU has never asked for hospitals to decline positions to US medschools and offer them to SGU students.

If anyone is curious, these are SGU's hospital affiliations. Far from buying out every position and taking them away from NY medschools:

The Brooklyn Hospital Center
Richmond University Medical Center
Cony Island Hospital
Jamaica Hospital Medical Center
Long Island College Hospital
Lutheran Medical Center
Maimonides Medical Center
New York Methodist Hospital
The Queens Hospital Network,
Elmhurst Hospital Center
 
"Studies have shown american students from SGU are inferior to European, Asian, African and Indian/Pakistani graduates who practice in america with the same number of years of global practice. Journal of Academic Medicine. "

Can you please provide a source for this? I've read the most recent studies by Journal of Academic Medicine and I believe SGU had a first time pass rate of ~91%. As far as I know there is no study comparing performance of SGU students against other FMGs. The other study that was done showed that patients of foreign-born, foreign-trained physicians had 15% less mortality rate, in comparison to ALL US graduates. [http://www.businessweek.com/lifestyle/content/healthday/641766.html].

Also, SGU is not BUYING OUT entire hospitals as you imply, this is simply misleading. The only exclusivity clause in the agreement is that the spots do not go to OTHER Caribbean medical schools, this to me makes sense if not simply because of the wide discrepancy in performance between the lower end Caribbean medical schools and those on the caliber of SGU and Ross. SGU has made this clear on numerous occasions but some (ie. Dean of Albert Einstein) believe this will set a bad precedent. SGU has never asked for hospitals to decline positions to US medschools and offer them to SGU students.

If anyone is curious, these are SGU's hospital affiliations. Far from buying out every position and taking them away from NY medschools:

The Brooklyn Hospital Center
Richmond University Medical Center
Cony Island Hospital
Jamaica Hospital Medical Center
Long Island College Hospital
Lutheran Medical Center
Maimonides Medical Center
New York Methodist Hospital
The Queens Hospital Network,
Elmhurst Hospital Center

Now add Saba, Ross, AUC, AUA etc etc etc... It adds up in total to quite a bit.
The carrib schools should go into an area that dosent already have 16 medical schools. I mean US students should have first priority over any non US school, they can have the left overs. The AMA's official position "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."
 
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"

Also, SGU is not BUYING OUT entire hospitals as you imply, this is simply misleading. The only exclusivity clause in the agreement is that the spots do not go to THER Caribbean medical schools, this to me makes sense if not simply because of the wide discrepancy in performance between the lower end Caribbean medical schools and those on the caliber of SGU and Ross. SGU has made this clear on numerous occasions but some (ie. Dean of Albert Einstein) believe this will set a bad precedent. SGU has never asked for hospitals to decline positions to US medschools and offer them to SGU students.

You don't have to have an exclusivity agreement. A given hospital can only support so many rotating medical students. Buying as many spots as a hospital can support (or the vast majority of them) is the same as denying that hospital to other rotating medical students.
 
"Studies have shown american students from SGU are inferior to European, Asian, African and Indian/Pakistani graduates who practice in america with the same number of years of global practice. Journal of Academic Medicine. "

Can you please provide a source for this? I've read the most recent studies by Journal of Academic Medicine and I believe SGU had a first time pass rate of ~91%. As far as I know there is no study comparing performance of SGU students against other FMGs. The other study that was done showed that patients of foreign-born, foreign-trained physicians had 15% less mortality rate, in comparison to ALL US graduates. [http://www.businessweek.com/lifestyle/content/healthday/641766.html].

Also, SGU is not BUYING OUT entire hospitals as you imply, this is simply misleading. The only exclusivity clause in the agreement is that the spots do not go to OTHER Caribbean medical schools, this to me makes sense if not simply because of the wide discrepancy in performance between the lower end Caribbean medical schools and those on the caliber of SGU and Ross. SGU has made this clear on numerous occasions but some (ie. Dean of Albert Einstein) believe this will set a bad precedent. SGU has never asked for hospitals to decline positions to US medschools and offer them to SGU students.

If anyone is curious, these are SGU's hospital affiliations. Far from buying out every position and taking them away from NY medschools:

The Brooklyn Hospital Center
Richmond University Medical Center
Cony Island Hospital
Jamaica Hospital Medical Center
Long Island College Hospital
Lutheran Medical Center
Maimonides Medical Center
New York Methodist Hospital
The Queens Hospital Network,
Elmhurst Hospital Center

Norcini, J. J., Boulet, J. R., et. al. (2010, August). Evaluating The Quality Of Care Provided By Graduates Of International Medical Schools. Health Affairs. 29(8),1461-1468. doi: 10.1377/hlthaff.2009.0222

Spark notes: USIMGs from the 'big 4' have 8% lower outcomes in stabilizing acute CHF outcomes. True FMGs have 9% better outcomes than even american doctors. If you open the article and check the resources cited you'll see that previous studies the last 3 years showed identical trends in trauma surgery outcomes and in specialty society enrollment rates (which the article equates, though idk if I agree, with excellence in the field)

Health Aff (Millwood). 2009 Jan-Feb;28(1):226-33. and J Health Care Poor Underserved. 2008 May;19(2):493-9. should give two other interesting perspectives.


aaaaaalso your list of hospitals is (at least partially) flawed because Harlem Hospital is not listed and it is probably the most cited example of this nonsense since it is a hospital which is now 100% IMGs for core rotations as Columbia dissolved their association with it in anger after the 2008 HHC deal.
 
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Norcini, J. J., Boulet, J. R., et. al. (2010, August). Evaluating The Quality Of Care Provided By Graduates Of International Medical Schools. Health Affairs. 29(8),1461-1468. doi: 10.1377/hlthaff.2009.0222

Spark notes: USIMGs from the 'big 4' have 8% lower outcomes in stabilizing acute CHF outcomes. True FMGs have 9% better outcomes than even american doctors. If you open the article and check the resources cited you'll see that previous studies the last 3 years showed identical trends in trauma surgery outcomes and in specialty society enrollment rates (which the article equates, though idk if I agree, with excellence in the field)

Health Aff (Millwood). 2009 Jan-Feb;28(1):226-33. and J Health Care Poor Underserved. 2008 May;19(2):493-9. should give two other interesting perspectives.


aaaaaalso your list of hospitals is (at least partially) bullcrap because Harlem Hospital is not listed and it is probably the most cited example of this nonsense since it is a hospital which is now 100% IMGs for core rotations as Columbia dissolved their association with it in anger after the 2008 HHC deal.

I read your source. Like I said, it does not compare SGU graduates with other FMGs. The study compares ALL US citizens who went to the Caribbean and broadly states that they don't perform as well as US graduates. Two out of the three sources that they used to make this claim are studies done in the 80s. Nonetheless, there is no sense in putting together all Caribbean graduates together when there are schools like 50 Caribbean medical schools and only 3-4 among them are legitimate educational institutions.
 
I read your source. Like I said, it does not compare SGU graduates with other FMGs. The study compares ALL US citizens who went to the Caribbean and broadly states that they don't perform as well as US graduates. Two out of the three sources that they used to make this claim are studies done in the 80s. Nonetheless, there is no sense in putting together all Caribbean graduates together when there are schools like 50 Caribbean medical schools and only 3-4 among them are legitimate educational institutions.

Just to clarify, you werent referring to the 3 sources cited to make the argument. I know thats what you said, but that cant be what you meant cause the sources are from 2006, 2006 and 2008. I'm assuming you mean you randomly plucked three sources out from the notes page, regardless of where they were cited, and identified two of them as from the 80s. Then yes. you're correct.

Now if you looked at the resources cited and did a little look into the authors, you'd see they do this specialty society comparison, or something which addresses it, every 3-5 years. 1981, 1986, 1989, 1993, 1997... all the way up to the latest one being 2008. Most of them are cited right in the article, not sure why you chose to point out that two (actually three) of them are from the 80s and ignore that there were multiple clear follow up studies right in the notes section on the same topic every few years and they are also cited alongside the 80's ones. The journal assesses something about IMG education pretty much every year. I guess you could argue that the journal is biased? idk. I'm trying to play devil's advocate against myself I guess.

Also Medical Education in the Caribbean: A Longitudinal Study of United States Medical Licensing Examination Performance,
2000&#8211;2009. Marta van Zanten and John R. Boulet, PhD

that article had no issue delineating out each school of the 61 carribbean schools open in the last decade.
 
Just to clarify, you werent referring to the 3 sources cited to make the argument. I know thats what you said, but that cant be what you meant cause the sources are from 2006, 2006 and 2008. I'm assuming you mean you randomly plucked three sources out from the notes page, regardless of where they were cited, and identified two of them as from the 80s. Then yes. you're correct.

Now if you looked at the resources cited and did a little look into the authors, you'd see they do this specialty society comparison, or something which addresses it, every 3-5 years. 1981, 1986, 1989, 1993, 1997... all the way up to the latest one being 2008. Most of them are cited right in the article, not sure why you chose to point out that two (actually three) of them are from the 80s and ignore that there were multiple clear follow up studies right in the notes section on the same topic every few years and they are also cited alongside the 80's ones. The journal assesses something about IMG education pretty much every year. I guess you could argue that the journal is biased? idk. I'm trying to play devil's advocate against myself I guess.

Also Medical Education in the Caribbean: A Longitudinal Study of United States Medical Licensing Examination Performance,
2000–2009. Marta van Zanten and John R. Boulet, PhD

that article had no issue delineating out each school of the 61 carribbean schools open in the last decade.

:confused:? No, I took the exact citations, I didn't previously see the 8th reference, here it is, 2 out of 4. And here is the statement with its references:

"International graduates who are U.S. citizens,
especially those who attended medical schools
in the Caribbean, do not perform as well as U.S.
graduates or international graduates who are not
U.S. citizens on the USMLE or on specialty board
exams.8,13–15"

8 Norcini J, Anderson MB, McKinley
DW. The medical education of
United States citizens who train
abroad. Surgery. 2006;140(3):
338–46.

13 Boulet JR, Swanson DB, Cooper RA,
Norcini JJ, McKinley DW. A com-
parison of the characteristics and
examination performances of U.S.
and non-U.S. citizen international
medical graduates who sought Edu-
cational Commission for Foreign
Medical Graduates certification:
1995–2004. Acad Med. 2006;
81(10 Suppl):S116–9.

14 Benson JA, Meskauskas JA, Grosso
LJ. Performance of U.S. citizen-
foreign medical graduates on
certifying examinations in internal
medicine. Am J Med. 1981;71(2):
270–3.

15 Shea JA, Norcini JJ, Day SC, Webster
GD, Benson JA Jr. Performance of U.
S. citizen Caribbean medical school
graduates on the American Board of
Internal Medicine certifying exami-
nations, 1984–1987. Teach Learn
Med. 1989;1(1):10–5.

The other studies that you mention come out every 4 or 5 years do not make any such claims that the performance of USMGs & FMGs is better than USIMGs. The only ones that do are the above and it's the same author, I'd be curious to see what exact criteria he uses.

This article "Medical Education in the Caribbean: A Longitudinal Study of United States Medical Licensing Examination Performance,
2000–2009. Marta van Zanten and John R. Boulet, PhD
" also does not confirm your statement, it breaks down the Caribbean USMLE step 1 & 2 pass rates and again shows that SGU's has consistently been on top. If you remove SGU from the stats in these studies, the average pass rates for the Caribbean fall way down, which is again why I stress that you shouldn't be lumping all of them together to make your points.
 
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