New York state’s 16 medical schools, with nearly 10,500 enrolled students, educate 10% of the nation’s physicians. Our medical schools have long been at the forefront of advancing diversity in our health care workforce—15% of medical students in the state are from underrepresented minority groups—and of educating physicians to practice primary care and serve in health care-shortage areas throughout the state. The schools also drive major discoveries that advance treatments and cure pressing medical problems.
Yet the future of medical education in New York hangs needlessly in the balance because foreign for-profit medical schools, predominantly in the Caribbean, are displacing New York medical students from third- and fourth-year clinical clerkships. These clerkships are where students learn how to be doctors—to integrate their learned science with the art of diagnosis and treatment.
To meet the need for more doctors, New York’s medical schools have expanded class sizes by 22%, opened new institutions and branch campuses in underserved communities, and increased minority enrollment by 31% to train a more diverse physician workforce. But this expansion is threatened by the overseas schools attempting to buy the clerkship spots that New York’s medical schools need for their growing classes.
Foreign for-profit medical schools already occupy about half the clinical slots in New York hospitals with students who mostly failed to gain acceptance to U.S. medical schools. It is hard to imagine the public-policy rationale for allowing them to impair our schools’ ability to educate better-qualified students.
New York already is an outlier in providing clinical clerkships to students of foreign for-profit schools. Texas, for example, does not permit them access to clinical slots.
In many ways, this is really about money. For-profit foreign schools often pay hospitals handsomely for clinical clerkships. The schools pass on the cost to their students, who have a median debt of $292,000, more than $100,000 higher than the median among U.S. medical-school graduates. Worse yet, many students who enroll in foreign for-profit medical schools don’t graduate. First-year attrition rates of more than 25% are not uncommon (compared with 3% at U.S. medical schools). Of the students who make it to graduation, only 53% will be accepted into a residency program, which is a prerequisite to becoming a practicing doctor.
Based on public data provided by for-profit Caribbean medical schools, only about 25% to 30% of the students entering their classes will graduate on time and obtain a residency in the U.S., compared with about 95% of students who enter New York medical schools. With the increasingly limited number of clerkships and the growing demand, each spot should be put to the best use.
At the turn of the 20th century there were serious concerns about the quality of American health care. The Carnegie Foundation commissioned what became known as the Flexner Report, which found that poor medical education was largely to blame. The report noted that medical schools, a majority of which were for-profit at the time, had a “loose and lax apprenticeship system that lacked defined stand-ards” and seemed solely interested in making money. Major reforms to medical education ensued, including the end of for-profit medical education.
Let’s not go back to the bad old days. Protecting New York’s clinical clerkship slots will allow our students to become the great doctors we need them to be.
Jo Wiederhorn is president and CEO of the Associated Medical Schools of New York, which represents all 16 medical schools in the state.