NY Times: NY vs. Caribbean schools

[nick_carraway]

The New York Times has written an article about Caribbean med schools making a deal with NY hospitals for clinical training. Each side throws some punches on page 2 and I was surprised to learn that the Senate even got involved before.

Read it here: http://www.nytimes.com/2008/08/05/nyregion/05grenada.html?ref=health

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[malfee]

Yikes, I really hope those predicted increases in student payments don't happen!

 

[flaahless]

Damn, they really were going at it. Good look eats.

 

[sshashid87]

Wait, so what happens to the people at Ross? I have a friend attending there this coming year, does this mean he won't get a clerkship? Or will Ross just have to bid on another place to send 3rd years?

 

[Law2Doc]

Yikes, I really hope those predicted increases in student payments don't happen!

Not going to happen. There is too much public and political pressure behind the notion that US trained students get these rotations. The US med schools are going to win in this battle.
It's really an example of SGU getting too piggy and not staying below the radar by trying to get exclusivity in their contract. More likely there will we a whipsaw result where not only will the US schools will get all the spots they need but also Ross and the other caribbean schools will get a fair shake at bidding for those spots SGU was trying to wrap up. Which probably will drive offshore tuitions up.

 

[malfee]

Not going to happen. There is too much public and political pressure behind the notion that US trained students get these rotations. The US med schools are going to win in this battle.
It's really an example of SGU getting too piggy and not staying below the radar by trying to get exclusivity in their contract. More likely there will we a whipsaw result where not only will the US schools will get all the spots they need but also Ross and the other caribbean schools will get a fair shake at bidding for those spots SGU was trying to wrap up. Which probably will drive offshore tuitions up.

Well, I hope not! I have no problem with getting a foreign education or anything, but when you have such high standards already, coupled with already-high monetary costs, it only seems fair for the U.S. students to get first dibs, if you will. Is there a particular reason that these Caribbean schools don't try to have their students perform their clerkships at hospitals elsewhere in the U.S.? I'm not very familiar with all of this, but it just strikes me as odd.

 

[Lokhtar]

Considering the number of FMG's currently practicing because of AMA's purposefully created doctor shortage by limiting enrollment despite knowing how bad the need was, they get what they deserve.

Good for SGU. I'm not particularly a fan of the Caribbean model, but I support them 100% in this.

The AMA kept the enrollment low for decades by warning of a 'coming oversupply', while knowing full well that there was a critical shortage with FMGs filling up thousands of spots every year while potential US students were denied seats. The AMA created the Caribbean system because of those policies, and I hope it bites them in the ass.

He staunchly defended the contract, saying it had drawn the ire of medical school deans only because it had threatened their monopoly. Indeed, about a third of doctors licensed in New York State went to foreign medical schools, according to the State Education Department.
"There has always been a need for foreign-trained students because these same deans like to limit the numbers arbitrarily," Mr. Modica said of school admissions policies. "They have a lot of nerve to tell us that we're taking places from them."
Dr. Eric Manheimer, medical director of Bellevue Hospital, was one of two doctors who spent a week visiting St. George's on behalf of the hospital corporation before the contract was approved and said that the Caribbean school "passed the threshold" of being a competent medical school. He said that it was hypocritical for universities with connections to pharmaceutical companies to criticize the contract.
"Some of our best doctors at N.Y.U. went to medical school in Mexico and then came in through the back door," he said.

 

[beachblonde]

Considering the number of FMG's currently practicing because of AMA's purposefully created doctor shortage by limiting enrollment despite knowing how bad the need was, they get what they deserve.

Good for SGU. I'm not particularly a fan of the Caribbean model, but I support them 100% in this.

I agree with this as well; it seems that most of the whining from the American side in the article was about how 1) they may not get for free what they're used to getting for free and 2) having FMGs around devalues the status of their MD degree. They're just being snotty.

While I personally wouldn't want to attend a Caribbean med school, I'm glad that they're able to train their students in the US so that they have comparable backgrounds to their US-soil peers. If a person is a good doctor, who really cares where they went to school?

 

[Lokhtar]

The problem is that it's their fault that the Caribbean schools even exist. They kept the market really tight for doctors. Admitting thousands of FMG's while denying seats to potential American students to keep the enrollment artificially down while knowing that they were blowing smoke up people's rear end by their 'physician oversupply' warnings.

When they couldn't keep saying that with a straight face anymore, they finally relented and admitted there was a chronic under supply and that all schools should increase enrollment. You force US students to go elsewhere, and then you complain that they are infringing on your God Given Right to get the best clinical spots? Tough ****, as far as I'm concerned.

 

[beachblonde]

Exactly! There are more than enough spots in US colleges for students, and as a result the vast majority of US students stay in the US for their education. With med school, not so much. But just because there aren't spots available doesn't mean that people are going to abandon their desire to become a physician. Hence, the off-shore med schools that keep popping up. It's smart business sense for them: they've identified a need and now they are filling it.

US med schools have been asked to increase their class sizes, but they're only doing it by 5-10 seats a year. 10 x 126 MD schools = not quite enough to compete with the Caribbean schools.

 

[Carlin]

Wait, so what happens to the people at Ross? I have a friend attending there this coming year, does this mean he won't get a clerkship? Or will Ross just have to bid on another place to send 3rd years?

My brother is starting at Ross this fall, and from what I remember hearing, they do their clerkships either in Florida or Michigan. It sounds like the NY problems are specifically affecting SGU.

 

[Excelsius]

Wow. This article shows that the Caribbean schools have come really far in terms of credibility and respect. Is it possible that soon it might be a better idea to get an MD from Caribbean schools rather than a US DO degree?

Of course, it is also apparent how biased the schools are towards the Caribbean students. This might be detrimental when the residency time comes.

 

[tacoman2493]

US med schools have been asked to increase their class sizes, but they're only doing it by 5-10 seats a year. 10 x 126 MD schools = not quite enough to compete with the Caribbean schools.

Where have you been the last year? There's 35 new/planned med schools in progress state-side.

Here's the list:

http://forums.studentdoctor.net/showthread.php?t=277016

 

[tacoman2493]

The problem is that it's their fault that the Caribbean schools even exist. They kept the market really tight for doctors. Admitting thousands of FMG's while denying seats to potential American students to keep the enrollment artificially down while knowing that they were blowing smoke up people's rear end by their 'physician oversupply' warnings.

When they couldn't keep saying that with a straight face anymore, they finally relented and admitted there was a chronic under supply and that all schools should increase enrollment. You force US students to go elsewhere, and then you complain that they are infringing on your God Given Right to get the best clinical spots? Tough ****, as far as I'm concerned.

There is no doctor shortage. The US is top 5 in the world in number of docotors per capita. New York City has the highest doctor/patient ratio in the world. There's a huge oversupply of doctors in the NYC area, and these carib med schools making deals there will only make things worse.

 

[OldBlue]

There is no doctor shortage. The US is top 5 in the world in number of docotors per capita. New York City has the highest doctor/patient ratio in the world. There's a huge oversupply of doctors in the NYC area, and these carib med schools making deals there will only make things worse.

SGU students have been doing their rotations in NY for a while now. check their website for the hospital list. it's not like there's suddenly going to be a huge flood of thousands of new doctors into the NYC area.

if what you say is true and there are already that many docs in NYC, then what better place to train new docs!

SGU has a good boards passage rate, comparable tuition, and it has been training good doctors. I say more power to them.

 

[beachblonde]

Where have you been the last year? There's 35 new/planned med schools in progress state-side.

Here's the list:

http://forums.studentdoctor.net/showthread.php?t=277016

Ok, yeah, but "planned" is not the same as seats available now. These schools also are starting out small: UCF may be new, but they've only got 40 seats to offer! I haven't looked at the numbers, but I'll bet that there are more seats available in Caribbean schools than there are in all the new MD schools combined.

Wow. This article shows that the Caribbean schools have come really far in terms of credibility and respect. Is it possible that soon it might be a better idea to get an MD from Caribbean schools rather than a US DO degree?

Of course, it is also apparent how biased the schools are towards the Caribbean students. This might be detrimental when the residency time comes.

Tread carefully....I don't see why an off-shore MD degree would be more valuable than an American DO degree...ya know, given that a DO degree is pretty much equal to an MD degree.

 

[Bradstein]

There is no doctor shortage. The US is top 5 in the world in number of docotors per capita. New York City has the highest doctor/patient ratio in the world.

Just because we have the most doesn't mean we have enough.

 

[HPMMajor]

Taco,

You bring up a good point, but it could use some clarification. Yes, NYC and many major metro areas do have an oversupply of doctors. This is especially true in wealthy suburbs. However, in other places around the USA, there is a critical shortage of caregivers, especially primary care docs (which is why NPs are becoming so necessary). While we do need to train more docs to fill shortages in rural areas and poor urban neighborhoods, it may also be a good idea (it will probably never happen though) to redistribute our current doctors who are overcrowding wealthy suburbs where the profits are highest.

The same goes with nurses. The USA is, without a doubt, poaching the best and brighest foreign nurses from their home countries (currently Africa is a hot spot). I read somewhere that Ghana had trained 300 nurses in 2006 and 150 of them had emigrated to wealthy countries. This puts a huge strain on Ghana who needs the nurses perhaps more than we do.

Most people do not know that we have enough American licensed nurses is our country, the problem is that many of them are not in the workforce, despite their degree and qualification. Many take time off to raise their family and never return because of poor working hours and conditions. We need to encourage them to re-enter the workforce, rather than rely on foreign nurses to fill the void

I know this is way off topic, but the physician "over-supply" is only evident in certain areas.

 

[beachblonde]

Nice post, HPMMajor.

Because of the nature of this particular forum, there aren't a lot of posts regarding the current practicing nursing shortage. Nurses are absolutely critical to our healthcare system, and it's too bad many of them choose to leave the field.

Getting doctors to go to the underserved areas is a battle-I know some states offer incentives, but sometimes it's just not enough. I know that I wouldn't want to live in a rural area, regardless of my profession, and I imagine that a lot of young people who are entering medicine feel that way. Combine that with the poverty that often affects those areas, and the diminishing reimbursements from Medicare/Medicaid for PCPs....it pains a grim picture.

 

[jult24er]

Under the contract, which was signed last year but never publicly announced, St. George's pays the hospitals $400 to $425 per student per week

So thats the cost of shadowing ... if i put an add on craigslist - wanted -day of shadowing - offer $80, would i get any hits?

 

[Lokhtar]

There is no doctor shortage.

Tell that to my two month wait times to see a PCP.

 

[tacoman2493]

Tell that to my two month wait times to see a PCP.

BS. Give me your zip code, and I'll find a PCP that can see you within 2 weeks, max.

 

[tacoman2493]

Just because we have the most doesn't mean we have enough.

Read the Dartmouth Report. More doctors = more useless tests, more risky procedures, more hospitalizations, more deaths from those hospitalizations.

The shocker is that despite all those interventions, healthcare outcomes are identical or worse than those areas that have many fewer doctors.

Part of the reason Medicare is going broke is because every Medicare enrollee now has 10 different specialists treating them for crap that a primary care doc used to take care of 20 years ago. Cardiologists for simple hypertension checkups, scopes for every conceivable GI discomfort that never would have been worked up 20 years ago.

New York and Boston have the highest concentration of doctors in the world. Guess what, they also have the highest HEALTHCARE costs per capita in the world too, even though their health outcomes are NO BETTER than stixville, kentucky. There's a connection there, folks

 

[jult24er]

Read the Dartmouth Report. More doctors = more useless tests, more risky procedures, more hospitalizations, more deaths from those hospitalizations.

The shocker is that despite all those interventions, healthcare outcomes are identical or worse than those areas that have many fewer doctors.

Part of the reason Medicare is going broke is because every Medicare enrollee now has 10 different specialists treating them for crap that a primary care doc used to take care of 20 years ago. Cardiologists for simple hypertension checkups, scopes for every conceivable GI discomfort that never would have been worked up 20 years ago.

New York and Boston have the highest concentration of doctors in the world. Guess what, they also have the highest HEALTHCARE costs per capita in the world too, even though their health outcomes are NO BETTER than stixville, kentucky. There's a connection there, folks

Interesting. Although I gotta place a wager that life expectancy in Boston is higher then in Stixville.

 

[Law2Doc]

US med schools have been asked to increase their class sizes, but they're only doing it by 5-10 seats a year. 10 x 126 MD schools = not quite enough to compete with the Caribbean schools.

Actually that is huge. If you increase med school enrollment by this much each year without commensurately increasing residency slots (which seems to be the current plan), that cuts heavily into the percentage of caribbean students who land a slot. Last year only 45% of caribbean students matched. Eliminate another thousand slots and this percentage gets significantly worse. Expect offshore schools to start feeling a crunch in the very near term. And as a result it's pretty likely deals like SGU tried to cut with NY are going to get undone.

 

[mterp45]

The New York Times has written an article about Caribbean med schools making a deal with NY hospitals for clinical training. Each side throws some punches on page 2 and I was surprised to learn that the Senate even got involved before.

Read it here: http://www.nytimes.com/2008/08/05/nyregion/05grenada.html?ref=health

something is wrong with this link. It isn't working. :cry:

 

[Karen12345]

The link works just fine for me.

 

[beachblonde]

Actually that is huge. If you increase med school enrollment by this much each year without commensurately increasing residency slots (which seems to be the current plan), that cuts heavily into the percentage of caribbean students who land a slot. Last year only 45% of caribbean students matched. Eliminate another thousand slots and this percentage gets significantly worse. Expect offshore schools to start feeling a crunch in the very near term. And as a result it's pretty likely deals like SGU tried to cut with NY are going to get undone.

Hmmm, I didn't think about residency spots.

Do they ever increase? I really don't know much about them and how they come into existence. I realize some of them go unfilled each year, but clearly not everybody who wants one gets one if only 45% of the Caribbean students match (and goodness I had no idea that was so low).

 

[genswim24]

There are a LOT of Caribbean schools, with a good majority of them being of very low quality. On the other hand, there is a small handful of Caribbean schools who have decent residency match, with MCAT averages higher than a few American MD and DO schools (SGU and ROSS as examples). To lump them all together and say 45% percent of Caribbean students get matched for residency is just intellectually lazy. There is a large array of residency match success at each of these schools, and doing proper research for each is a must before anyone should decide to do one of these programs.

It is certainly true that things may change in the future, especially if schools such as SGU rattle too many cages. For now, a couple of these Caribbean schools have residency match lists that are only slightly less competitive than some of the lower-tier American medical schools.

 

[Bradstein]

Read the Dartmouth Report. More doctors = more useless tests, more risky procedures, more hospitalizations, more deaths from those hospitalizations

This sounds like a product of legal issues, so when you have plenty of specialists around you send them out to limit your liability.

 

[foster033]

BS. Give me your zip code, and I'll find a PCP that can see you within 2 weeks, max.

It's not necessarily about seeing any doctor, it's about seeing YOUR doctor. Your supposed to trust you're GP and develop a relationship with them...that's hard to do if you never get to see the same one because you can't get an appointment. Plus sometimes you have insurance issues to worry about and you are forced to choose between a limited number of doctors.

Besides, I can vouch for this...I moved a few years ago and tried to get an appointment in my new city (I live downtown in a big city)...everywhere I called, all the doctors covered by my insurance within a 5-10 mile radius, had at least a 5 week --- 3 month wait, and that's the ones that were even accepting new patients...I'd say about 30% of them weren't.

 

[Law2Doc]

To lump them all together and say 45% percent of Caribbean students get matched for residency is just intellectually lazy.... For now, a couple of these Caribbean schools have residency match lists that are only slightly less competitive than some of the lower-tier American medical schools.

Sure. But to just go by match lists of schools with high attrition and which cherry pick their applicants (esp by holding back people they feel aren't ready for the boards) is also kind of intellectually lazy. These schools really do play games to make their match lists look better than the average applicant can expect. The match lists look great, because they are only reflective of the cream of the crop, but aren't reflective of the folks who start the freshman class together. At some of these schools, the enrollment is many many times greater than 4 times the graduating class, meaning high attrition and a good number of people who get stuck between first and fourth year for more than the usual amount of time. Good for statistics, bad for some people's aspirations. Right now, there are no caribbean schools that many residency directors would say are "only slightly less competitive than some of the lower-tier American medical schools". If you look at the statistics, 28,737 applicants vied for one of 22,240 first-year residency positions last year. 94.2 % of US med school grads (15,242) matched, with about 84% of those into one of their top 3 choices, and most of the remainder scrambled. No other group came close to this, and so the way the match has historically worked, the offshore crowd really ends up fighting for the leftover slots. Because there are more slots than US students, schools like SGU, Ross, AUC etc are able to put a decent number of their folks in the leftover slots. But a good number of students (about 6000, per the above numbers) who don't train in the US don't get spots each year. So I would only look at these routes as "second chance" schools if you can't gain admission to a US school. That SGU and others can play games to make their match lists look better than the match statistics suggest they ought means you have to dig deeper and see what the really are doing in terms of attrition, holding people back etc. Certainly if you have to go to an offshore school, one with US rotations is beneficial. But don't buy the school's hype that it is as good as going to school stateside. That's not the perception of folks in the industry. The AAMC in 2005 was already making statements to the effect that something should be done to prevent students from going to these offshore mills where there was no regulated quality. And in fact the increase in med school slots without a comparable increase in residencies is probably a veiled attempt to somewhat curtail this, by forcing more US students to fight with the offshore crowd for the less desirable residency slots.

 

[genswim24]

Sure. But to just go by match lists of schools with high attrition and which cherry pick their applicants (esp by holding back people they feel aren't ready for the boards) is also kind of intellectually lazy. These schools really do play games to make their match lists look better than the average applicant can expect. The match lists look great, because they are only reflective of the cream of the crop, but aren't reflective of the folks who start the freshman class together.

These schools are notorious for not letting all their students take the boards, especially those who are not performing well. They also do fail a lot of students as well, which I don't have a problem with because this is a second or third option for many people. If this is the case, maybe this is what finally shows some people that this is not the career for them. However, these lists are several hundred people long, that is not just the cream of the crop. I have several friends who were by no means all-stars in their medical school class who matched with no problem.

At some of these schools, the enrollment is many many times greater than 4 times the graduating class, meaning high attrition and a good number of people who get stuck between first and fourth year for more than the usual amount of time. Good for statistics, bad for some people's aspirations.

True, especially with people starting classes in January, April, August etc.

Right now, there are no caribbean schools that many residency directors would say are "only slightly less competitive than some of the lower-tier American medical schools". If you look at the statistics, 28,737 applicants vied for one of 22,240 first-year residency positions last year. 94.2 % of US med school grads (15,242) matched, with about 84% of those into one of their top 3 choices, and most of the remainder scrambled. No other group came close to this, and so the way the match has historically worked, the offshore crowd really ends up fighting for the leftover slots.

If the average for US medical schools is a 94.2 % match and 84% get one of their top 3 choice, that means that there are around half of American Medical school that have numbers below this. As you start to go further down this list, these percentages drop down even lower. When you start looking at these schools, the match percentages start to become closer to the number of SGU and Ross.

Because there are more slots than US students, schools like SGU, Ross, AUC etc are able to put a decent number of their folks in the leftover slots. But a good number of students (about 6000, per the above numbers) who don't train in the US don't get spots each year.

Definitely, as I said there are a LOT of terrible schools in the Caribbean with match percentages that are very low. This means that each year there is going to be plenty of students without a match.

So I would only look at these routes as "second chance" schools if you can't gain admission to a US school.

Certainly, this should be a second or third option for people who have exhausted all their options here. These schools are a business first and a school second

The AAMC in 2005 was already making statements to the effect that something should be done to prevent students from going to these offshore mills where there was no regulated quality. And in fact the increase in med school slots without a comparable increase in residencies is probably a veiled attempt to somewhat curtail this, by forcing more US students to fight with the offshore crowd for the less desirable residency slots.

Glad to see the AAMC increasing the amount of med school slots. Hopefully we won't even have to deal with the whole Caribbean Medical School issue 10 years down the road.

 

[peppy6]

I think it's important in this discussion to refrain from grouping schools together and characterizing them as a whole. Just as there are great differences in education, attrition rates, class sizes, and match rates in US medical schools, there are differences at Caribbean and other foreign medical schools as well. Some US medical school class sizes are kept below 100 while there are a handful of schools with well over 200 students...it's just hard to characterize all US medical schools and ALL Caribbean medical schools. Attrition rates are high at some Caribbean medical schools and pretty negligible at others. Not all students match their first year, so is the case in the US. In the US 96% of students complete their MDs in 10 years...so in all places, people drop out, decel, etc. This article should not question the caliber of students offshore since many of them are qualified for US medical schools and simply do not get seats because there aren't enough of them. In 2006 44% of applicants actually matriculated. RIGHT NOW, the US does not have enough seats available so people choose to keep their dreams of becoming doctors and go elsewhere. This article's main point is the availability of rotation spots, the money required to obtain these spots, and the effects of these factors on medical students, both from the US and from other parts of the world. I just think it's disrespectful to speculate on the types of students at these schools when the writers of the obviously biased NY Times article, as well as some posters here and elsewhere, truly have no clue.

 

[Doublecortin]

Sure. But to just go by match lists of schools with high attrition and which cherry pick their applicants (esp by holding back people they feel aren't ready for the boards) is also kind of intellectually lazy. These schools really do play games to make their match lists look better than the average applicant can expect. The match lists look great, because they are only reflective of the cream of the crop, but aren't reflective of the folks who start the freshman class together. At some of these schools, the enrollment is many many times greater than 4 times the graduating class, meaning high attrition and a good number of people who get stuck between first and fourth year for more than the usual amount of time. Good for statistics, bad for some people's aspirations. Right now, there are no caribbean schools that many residency directors would say are "only slightly less competitive than some of the lower-tier American medical schools". If you look at the statistics, 28,737 applicants vied for one of 22,240 first-year residency positions last year. 94.2 % of US med school grads (15,242) matched, with about 84% of those into one of their top 3 choices, and most of the remainder scrambled. No other group came close to this, and so the way the match has historically worked, the offshore crowd really ends up fighting for the leftover slots. Because there are more slots than US students, schools like SGU, Ross, AUC etc are able to put a decent number of their folks in the leftover slots. But a good number of students (about 6000, per the above numbers) who don't train in the US don't get spots each year. So I would only look at these routes as "second chance" schools if you can't gain admission to a US school. That SGU and others can play games to make their match lists look better than the match statistics suggest they ought means you have to dig deeper and see what the really are doing in terms of attrition, holding people back etc. Certainly if you have to go to an offshore school, one with US rotations is beneficial. But don't buy the school's hype that it is as good as going to school stateside. That's not the perception of folks in the industry. The AAMC in 2005 was already making statements to the effect that something should be done to prevent students from going to these offshore mills where there was no regulated quality. And in fact the increase in med school slots without a comparable increase in residencies is probably a veiled attempt to somewhat curtail this, by forcing more US students to fight with the offshore crowd for the less desirable residency slots.

excellent analysis l2d . Some wet-behind the ears pre-meds might learn a think or two

 

[Law2Doc]

T
If the average for US medical schools is a 94.2 % match and 84% get one of their top 3 choice, that means that there are around half of American Medical school that have numbers below this. As you start to go further down this list, these percentages drop down even lower. When you start looking at these schools, the match percentages start to become closer to the number of SGU and Ross.

Um no, you misunderstand the statistic. This is national. Last year, 94.2% of ALL US meds students who entered the match matched, and of this group, 84% got a top 3 choice. This percentage was pretty homogeneous down the ranks of schools. It doesn't mean that the top schools got 100% matched and the bottom schools got 89%, because each specialty had its own level of competitiveness; truth of the matter is that some percentage of folks who didn't get one of their top choices because they were top school students trying for uber competitive specialties, whereas some of the less competitive US schools will have gotten a higher percentage matched because they more strongly push the primary care fields. Most of the remainder of US allo students historically scramble successfully. So you really need to look at it as if the US allo students get all their choices off the top, because that's basically the way it plays out in reality. The US trained students take the most desirable slots. Then everyone else fights for what's left. Because give or take a few exceptions (everyone will know one, but that doesn't change the numbers), that is the way it historically works, and certainly did last year.

 

[Law2Doc]

Just as there are great differences in education, attrition rates, ..., and match rates in US medical schools,

But there aren't. The education is pretty similar across the board; 90% of all US students pass the boards. Attrition nationally is less than 5%, with less than 2% for academic reasons. Match rates in US schools nationally were 94.2%. That's a very homogeneous group. In general, if you get into a US school, statistically you will graduate and you will pass the boards and you will match. No other group can say this as definitively.


I agree with you that the Caribbean schools are not similarly situated. There are 3-4 that are far more legitimate than the dozen others that will provide you with a worthless piece of paper bearing an MD for the right price. But it's a leap to say those 3-4 are competitive with US schools, or that they have better match lists or that they aren't playing different games with attrition and holding people back so they can demonstrate statistics comparable to US counterparts. You can't get around the fact that US allo students AS A GROUP as well as by individual school dominate the US match, and that 94.2% get one of their choices. No other group comes that close.

Bear in mind that I have nothing but the highest respect for those folks who make it through caribbean schools, pass the boards, and manage to match into US residency programs. Many won't. These are the best of the offshore crowd and have had a much harder road and have overcome a lot more than the typical US student. But it is inaccurate (, as well as insulting to them,) to suggest they ever had equal footing to get to where they got. These paths represent a good "second chance" at medicine for those who cannot, with multiple attempts and improvements, gain acceptance at a US school. For folks with no US option, this is a way for some percentage of people to actually still become a doctor licensed in the US. But it shouldn't be anyone's first choice, and nobody should get suckered into the statistical games some of these schools play.

 

[OldBlue]

But there aren't. The education is pretty similar across the board; 90% of all US students pass the boards. Attrition nationally is less than 5%, with less than 2% for academic reasons. Match rates in US schools nationally were 94.2%. That's a very homogeneous group. In general, if you get into a US school, statistically you will graduate and you will pass the boards and you will match. No other group can say this as definitively.


I agree with you that the Caribbean schools are not similarly situated. There are 3-4 that are far more legitimate than the dozen others that will provide you with a worthless piece of paper bearing an MD for the right price. But it's a leap to say those 3-4 are competitive with US schools, or that they have better match lists or that they aren't playing different games with attrition and holding people back so they can demonstrate statistics comparable to US counterparts. You can't get around the fact that US allo students AS A GROUP as well as by individual school dominate the US match, and that 94.2% get one of their choices. No other group comes that close.

Bear in mind that I have nothing but the highest respect for those folks who make it through caribbean schools, pass the boards, and manage to match into US residency programs. Many won't. These are the best of the offshore crowd and have had a much harder road and have overcome a lot more than the typical US student. But it is inaccurate (, as well as insulting to them,) to suggest they ever had equal footing to get to where they got. These paths represent a good "second chance" at medicine for those who cannot, with multiple attempts and improvements, gain acceptance at a US school. For folks with no US option, this is a way for some percentage of people to actually still become a doctor licensed in the US. But it shouldn't be anyone's first choice, and nobody should get suckered into the statistical games some of these schools play.

I agree that there are differences in some of the carib schools, like you mentioned. Yes, there are certainly some who operate more like "diploma mills" but there are others that seem to have truly geared themselves to produce talented physicians who will succeed in the US healthcare system. i also agree that misrepresentation of statistics for the purposes of improving a school's image is an unfortunate occurence. I just don't think that only one or two schools (US or FMG) are the only ones that do it. No school is going to talk much about students who don't make it through (and if they do, I haven't seen the detailed stats from those schools).

And as far as the holding back/cherry-picking subject, I really don't understand what the problem is. I look at it as an internal quality control mechanism to make sure that only those who are ready make it through. There are going to be kids who take more than 4 years to complete a degree at pretty much any school. And I think that there are a lot of other things that need to be considered when it comes to attrition, etc. For example, living in the caribbean makes it tough to be near family. It is entirely possible that some students drop out after a term or two because they can't tolerate the distance...whereas if they had gone to their state school it wouldn't have been an issue. Certainly it isn't always possible to go to a nearby school (take CA as an example). I just agree with Peppy6 that it is inappropriate for these big generalizations to be drawn over all schools.

I think you need to be careful with the "second chance" label. I'm not in med school so maybe I'm just taking it the wrong way. But your stance could be taken to describe domestic medical school selection as well. Since I couldn't get into Yale or Hopkins, I'm going to ___insert lower-tier school name here____. That essentially makes that school a "second chance" option at getting a US medical education. Does that make it a bad school? Of course not! Does the lower tiered school have lower average mcat scores and gpas? YES. Does that make it a bad school. NO. I consider carib schools as AN OPTION for anyone who wants to go to med school, just like DO schools are an option for anyone. Going to such a school might be one's quickest way to become a physician (rather than spending 2-3 years post-bacc, then applying). Stats that get you into certain carib schools get you into many DO schools as well so the whole numbers/tuition/etc. arguments are irrelevent if you ask me. the take home message here, again, is that blanket statements = inappropriate...there are always many factors to consider.

the non-mill carib schools, US DO, and US MD schools all produce physicians who are educated and trained to work in this country. No school is producing massive amounts of people who flop upon entry into the workforce. i guess i just don't see the problem.

 

[flip26]

I agree that there are differences in some of the carib schools, like you mentioned. Yes, there are certainly some who operate more like "diploma mills" but there are others that seem to have truly geared themselves to produce talented physicians who will succeed in the US healthcare system. i also agree that misrepresentation of statistics for the purposes of improving a school's image is an unfortunate occurence. I just don't think that only one or two schools (US or FMG) are the only ones that do it. No school is going to talk much about students who don't make it through (and if they do, I haven't seen the detailed stats from those schools).

And as far as the holding back/cherry-picking subject, I really don't understand what the problem is. I look at it as an internal quality control mechanism to make sure that only those who are ready make it through. There are going to be kids who take more than 4 years to complete a degree at pretty much any school. And I think that there are a lot of other things that need to be considered when it comes to attrition, etc. For example, living in the caribbean makes it tough to be near family. It is entirely possible that some students drop out after a term or two because they can't tolerate the distance...whereas if they had gone to their state school it wouldn't have been an issue. Certainly it isn't always possible to go to a nearby school (take CA as an example). I just agree with Peppy6 that it is inappropriate for these big generalizations to be drawn over all schools.

I think you need to be careful with the "second chance" label. I'm not in med school so maybe I'm just taking it the wrong way. But your stance could be taken to describe domestic medical school selection as well. Since I couldn't get into Yale or Hopkins, I'm going to ___insert lower-tier school name here____. That essentially makes that school a "second chance" option at getting a US medical education. Does that make it a bad school? Of course not! Does the lower tiered school have lower average mcat scores and gpas? YES. Does that make it a bad school. NO. I consider carib schools as AN OPTION for anyone who wants to go to med school, just like DO schools are an option for anyone. Going to such a school might be one's quickest way to become a physician (rather than spending 2-3 years post-bacc, then applying). Stats that get you into certain carib schools get you into many DO schools as well so the whole numbers/tuition/etc. arguments are irrelevent if you ask me. the take home message here, again, is that blanket statements = inappropriate...there are always many factors to consider.

the non-mill carib schools, US DO, and US MD schools all produce physicians who are educated and trained to work in this country. No school is producing massive amounts of people who flop upon entry into the workforce. i guess i just don't see the problem.

Your "second chance" analogy of US Allo to Caribbean being the same as high ranked vs low ranked allo schools is way off base...

Caribbean schools should not only be a second but last chance choice. NOBODY should apply to an offshore school the first go around. Applicants should exhaust the possibilities of US Allo and Osteo schools before opting for the Caribbean...

 

[peppy6]

But there aren't. The education is pretty similar across the board; 90% of all US students pass the boards. Attrition nationally is less than 5%, with less than 2% for academic reasons. Match rates in US schools nationally were 94.2%. That's a very homogeneous group. In general, if you get into a US school, statistically you will graduate and you will pass the boards and you will match. No other group can say this as definitively...QUOTE]

I'm glad you acknowledge the differences among Caribbean schools. I agree that for many, probably most, attending an offshore medical school is not their first choice. However, are some schools in the Caribbean comparable to some US medical schools? Actually, the answer really is yes. The most objective way of measuring and comparing between two groups that we have available is by looking at USMLE scores and Match success rates. You give us great statistics about US medical schools and then go on to say that no other group of schools or schools outside of the US has anywhere close to the same numbers. Do a simple search and you'll see...the attrition rate at SGU during the first two years is also 1-2% for personal reasons and 3-5% for academic reasons. It is pretty negligible the final two years. The average class size is 325 so yes that means a few more people drop out than at a US school but also keep in mind there are schools in the US with close to 300 students as well, so in percentages nearly the same and in raw numbers SGU, just a tad bit higher. Generally every year around 6-7% of students starting with SGU transfer back to US medical schools. The number varies based on availability of spots back in the states, number of applicants, etc…but this combined with the attrition rate explains why people leave.

In 2000 (this is the most recent data I could find) 94% of SGU students, 93% of US students and 65% of all other foreign students passed the USMLE step 1. More recently I believe the percentage is about the same but I couldn’t find an exact number. In 2002, the overall pass rate for USMLE step 1 for US osteopathic schools in the US was 67%. For years our pass rates have been the same and even above US rates. 98% at SGU pass steps 1 and 2 in 10 years. In the US, 96% complete the degree in 10 years. It is true that students at SGU and possibly other medical schools have to sit for another examination and pass certain criteria in order to sit for the USMLE. But a very small minority of students end up being ineligible to sit for the USMLE with their class. These individuals, after making small changes, usually take the exam within a semester of their originally decided date. I personally don’t have a problem with this either, it’s not cherry-picking for the sake of inflating statistics, it’s ensuring that students receive the proper knowledge base to succeed as good physicians in the future. I think this is logical and similar in a way to US shelf exams in assessing knowledge gained in the basic sciences. This is no different to me than weeding out those students in the US that simply fail the USMLE (any step) and have to wait to continue on and pass the exam.

The match rate, as you stated, in the US in 2008 was 94.2%. At SGU, 98% of eligible applicants match. Eligible means they passed internal exams, passed the USMLE steps 1 and 2, etc. 29% of students apply for residencies outside of the NRMP- prematch, go to other countries, etc.

I’m not suggesting that Caribbean students have equal footing when they start offshore and I agree that students should do their best to get into medical school in the states before looking elsewhere. I,being a Caribbean medical student, know the challenges we face in not only achieving high scores on the USMLE to be competitive in the US but in working alongside individuals such as those quoted in the NY Times article and running US medical schools discrediting the education reveived by others like me in the Caribbean and elsewhere. We may not have equal footing when we begin at an offshore school, but if you’re going to talk about statistics, it is fair to include statistics that schools such as ours boast because of students who work extremely hard to eventually gain equal footing come rotations/residency-time. These test scores and match rates are the only objective data we can use to compare the schools, and a true side-by-side comparison shows that indeed, some non-US schools ARE on the same level based on these scores. The NY Times article should address the initial problem at hand- rotation spots- and give us substantial information- how many spots are there each year, how many go to foreign students, is there really a shortage, etc etc. You mentioned something about insult in your post, and I felt like the words of some of the commentators in the article were nothing short of uneducated insults. The caliber and type of students at SGU or elsewhere is not and should not be the question because brilliant and poor students are found at every institution. The question posed involves rotation spots in NYC so articles and commentators should address THOSE issues without bringing their own biases into the mix.

Sorry for the long post, I was annoyed, haha.

 

[Law2Doc]

It is true that students at SGU and possibly other medical schools have to sit for another examination and pass certain criteria in order to sit for the USMLE. But a very small minority of students end up being ineligible to sit for the USMLE with their class. These individuals, after making small changes, usually take the exam within a semester of their originally decided date.

This is the part where you are going to have to give some additional proof. Because if you add up the enrollment of these offshore schools, you will see that there are far more than 4 times the graduating class listed as enrolled. Which means either a huge number drop out each year, or a huge number is stuck between first and fourth year. Offshore schools don't have PhD programs or the same ample research opportunities as US schools, so unlike the US student who takes 5-7 years to get his degree by design (eg taking a research year, or getting a second degree or a PhD, folks who aren't graduating at an offshore school in 4 years are being forced to do so. You just have to be careful with these statistics, because they are designed to deceive. No residency director considers an offshore school to be equivalent to a US school, no matter what SGU advertises. It is a great option if you need a shot at physician and the US routes didn't pan out. But I wouldn't look at it otherwise.

 

[Law2Doc]

Yes, there are certainly some who operate more like "diploma mills" but there are others that seem to have truly geared themselves to produce talented physicians who will succeed in the US healthcare system.

You have to realize that ALL of these caribbean schools, good and bad, were created as a cottage industry to make money off those US citizens who wanted to be a doctor but couldn't gain admission to a US school. So it is under this framework that you have to view them. They were not set up to serve a local need, they were set up to educate unsuccessful US students. So their whole underpinning is to be a backstop for the US overflow.

As such it isn't really comparable with comparing it to a lower ranked US school. There are only 120 or so US schools and all are quite competitive. Half of all people who apply to US schools don't get in. So the range from top to bottom isn't that impressive. The range from US school entering credentials to these offshore mills is sometimes absurdly huge. People go to these schools because they couldn't get in in the US. That is what they were set up for. A whole industry in the caribbean is based on unsuccessful US students. Don't kid yourself by thinking otherwise.

 

[Law2Doc]

Going to such a school might be one's quickest way to become a physician (rather than spending 2-3 years post-bacc, then applying). ...there are always many factors to consider.

This is foolish thinking. If you consider quickest to be the smartest route, notwithstanding that one route matches 94.2% of almost everyone who gets admitted, while another route matches 45% of the small percentage that aren't part of the attrition statistic, then you are missing the most critical factors to consider. This is not a race. This is a career you will be doing for the next 40 years plus. If a few more years sets you up to get your dream job it's always worth it.