The Cost of Training Doctors Offshore
U.S. tax dollars are financing for-profit medical schools in the Caribbean that are not accredited in the U.S., Janet Lorin reports in the October issue of Bloomberg Markets magazine, putting taxpayers, students and patients at risk. The U.S. may face a doctor shortage, but this isn’t the way to fix it.
Thanks to a legal loophole, three schools -- American University of the Caribbean in St. Maarten and Ross University in Dominica, both owned by DeVry Inc., and privately owned St. George’s University in Grenada -- received about $450 million last year in federal student loans, despite lacking the same certification as U.S. medical schools. A fourth school, Saba University School of Medicine, will soon be able to receive federal money as well.
These schools differ from their U.S. counterparts in other ways. Students at AUC and Ross have lower test scores, are less likely to graduate, take longer to do so, and are less likely to become practicing doctors if they do. Class sizes are larger -- almost 1,000 students in the first year at Ross, compared with a U.S. average of 139. And for all that, they cost more: $56,475 for a year’s tuition at Ross, compared with median tuition and fees of $50,309 at U.S. schools.
That’s not just a problem for people who attend them. These schools also pay U.S. teaching hospitals to get their students clinical training slots, which are necessary to complete medical school. That takes spots away from students at U.S. schools. If less-qualified students are able to buy their way into teaching hospitals, it raises the danger that patients will get lower-quality care.
And if those same students aren’t able to become licensed doctors, they’re at greater risk of defaulting on their loans, leaving taxpayers on the hook.
At first glance, the counter to these arguments may seem to be the Affordable Care Act. The law will lead to an estimated 25 million more Americans getting health insurance by 2016, increasing the demand for doctors. Coupled with the pressures of an aging population, there’s a clear public interest in training more physicians.
But U.S. medical schools are already doing just that. In 2006, the Association of American Medical Colleges set out to increase enrollment by 30 percent by 2017. They say they’re on track to meet that goal, with more than a dozen new schools.
That leaves little reason not to impose higher standards on offshore for-profit medical schools, even if it means they produce fewer doctors. Congress should also consider preventing for-profit schools without U.S. accreditation from getting U.S. federal loans, as Senator Dick Durbin, an Illinois Democrat, suggests.
Many of the students who attend overseas for-profit medical school will go on to become excellent doctors, so in making any changes policy makers should weigh those students’ ability to get an education. That may mean greater funding for U.S. teaching hospitals’ residency programs, which could help replace the revenue they now get from overseas schools and encourage U.S. medical schools to expand enrollment further. What doesn’t make sense is to continue providing federal money for subpar results.
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