Medical Schools’ Competition for Clinical Training Sites

To the Editor:

Why would a prominent medical school in New York send its third- and fourth-year students to Texas for clinical training, while an offshore medical school sends its students to the New York hospital that once trained the New York school’s students? Medical schools have increased class size dramatically over the past decade, and more than two dozen new medical schools have been accredited.¹ The numbers of physician assistant, nurse practitioner, osteopathic, and other educational programs have grown even more.² Today there are upwards of 33% more students requiring clinical training than there were 10 years ago.³ Since enrollment is constrained primarily by the number of clinical teaching slots available, it is not surprising that high-quality training sites are coveted, and schools find themselves competing for clinical space by acquiring sites from one another. While medical schools that own hospitals have greater control over clinical training capacity, those that do not may find themselves competing vigorously for clinical teaching venues, and sometimes having to “outbid” other medical schools. The moment has come for a national dialogue about how to realign medical schools with local clinical teaching sites so that schools throughout the country can train their students in reasonable proximity to their schools.

As recently as a generation ago, teaching hospitals highly prized their “voluntary” academic relationships, and loyalty to their medical school partners was the norm. Faculty achieved professorial status, which generated perks such as the ability to conduct funded clinical research or work for industry as consultants and advisors. Today these relationships have been substituted with an economic model, and many clinical teaching sites address their own revenue shortfalls by negotiating on behalf of these valued relationships.⁴ Caribbean schools, for example, have aggressively purchased clinical teaching opportunities in the United States to satisfy clinical demands and raise their academic profiles.⁵ This threatens the quality, stability, and cost of undergraduate medical education as resources are diverted to create distant campuses.

New local sources of clinical teaching are required, and community hospitals and physicians have been the most obvious choice.⁶ We must reestablish solid relationships between medical schools and local clinical teaching sites to allow schools to train students in clinical settings nearby.

Paul Beninger, MD, MBA
Assistant professor, Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts.

Deeb N. Salem, MD
Professor and chair, Department of Medicine, Tufts Medical Center, Boston, Massachusetts.

Marcia M. Boumil, JD, LLM
Professor, Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts; [email protected]

Rohan Jotwani
Medical student, Tufts University School of Medicine, Boston, Massachusetts.