We thank Drs. Balon and Morreale for their thoughtful comments. We agree that the attempted monetization of medical education is taking place on many fronts. Clinical education of physicians, advanced practice nurses, and physician assistants place growing demands upon educational sites. Furthermore, the epidemic of hospital mergers and acquisitions creates a constantly changing landscape for hospital-based clinical education. As more and more physicians become employees of health systems and large practice groups, the independent practitioner possessing relative control of his or her time and who may choose to spend part of that time in medical education is becoming a disappearing breed.
We respectfully disagree with Drs. Balon and Morreale that the individual states are not the appropriate venue to battle the for-profit medical schools. Indeed, recent legislation in Texas and Nevada has shown that highly effective action can be taken on the state level to halt for-profit schools from buying clinical clerkships.1
We agree that, in addition to action at the state level, federal action is necessary. In addition to the legislative solutions we describe in our article, we also note that the U.S. Department of Education has recently proposed regulations that seek to improve oversight of distance education.2 These regulations will fortify the authority of states over distance learning providers from colleges and universities chartered outside the individual states. These rules are equally applicable to onshore medical schools accredited by the Liaison Committee on Medical Education (LCME) and the Commission on Osteopathic College Accreditation. We can hope that offshore for-profit schools will be held to equal standards and that this does not become yet another example of the failure of offshore schools to meet the standards applicable to U.S. schools.
Drs. Flaherty and Olds, employees of for-profit offshore medical schools, both come to the defense of their employers. Dr. Flaherty makes the astonishing claim that the monetization of medical education will “benefit all students.” He seems to have forgotten both the for-profit students left deeply in debt and with no future and the U.S. students denied educational opportunities by for-profit schools buying clerkship slots out from out under them.
Medical education is a social good. Turning it into a for-profit business is immoral. Admitting students with inferior grades and standardized test scores to medical and veterinary schools, for-profit schools condemn their students to enormous student loan indebtedness, inferior training, and a low chance of ever entering the health care workforce.3 Dr. Olds writes that “St. George’s students are held to the same standards as U.S. medical students.” He seems to have left out LCME accreditation.
Edward C. Halperin, MD, MA
Chancellor and chief executive officer, New York Medical College, Valhalla, New York, and provost for biomedical affairs, Touro College and University System, New York, New York; Edward_halperin@nymc.edu.
Robert B. Goldberg, DO
Director of strategic medical initiatives, Touro College and University System, New York, New York.
1. SB301. Texas Senate Bill. Relating to the authority of the Texas Higher Education Coordinating Board to issue to a foreign postsecondary institution a certificate of authority to grant professional degrees. 83rd legislature. 2013. http://openstates.org/tx/bills/83/SB301/
. Accessed September 14, 2016.
2. U.S. Department of Education. Education Department proposes rule on state authorization of postsecondary distance education, foreign locations. http://www.ed.gov/news/press-releases/education-department-proposes-rule-state-authorization-postsecondary-distance-education-foreign-locations
. Published July 22, 2016. Accessed September 14, 2016.
3. Segal D. High debt and falling demand trap new vets. N Y Times. February 23, 2013. http://www.nytimes.com/2013/02/24/business/high-debt-and-falling-demand-trap-new-veterinarians.html?_r=0
. Accessed September 12, 2016.