To the Editor:
Halperin and Goldberg1 point out that the aggressive expansion of offshore medical schools into U.S. hospitals is leading to a serious problem in medical education: its monetization. The authors mention profits of the DeVry Corporation, owner of two Caribbean medical schools, whose operating income from for-profit health care education was $111 million in 2010–2011. However, the monetization of medical education is not just happening in the Caribbean. We have witnessed the introduction of a number of new medical schools as well as expansion of existing medical schools within the United States. It is possible that at least some of this expansion is occurring for economic reasons.
Both Halperin and Goldberg1 and Burdick and colleagues2 mention the issue of quality of training in connection with monetization and expansion of medical education. We view this possibility as a major concern. Halperin and Goldberg1 note that 80% of U.S. medical schools report concerns about the adequacy of clinical training sites for medical students. They also mention competition for clinical training sites from physician assistant programs, advanced practice nursing programs, and offshore medical schools. We have experienced several events occurring as a direct result of this competition. First, the number of trainees at existing sites has increased significantly. We have seen and heard about attending physicians who are tailed by a large number of trainees from various disciplines/sources during clinical rounds. What are those trainees, especially at the end of the tail, learning? Is direct patient experience possible in such a setting? Second, offshore medical students are placed in private physician offices for some of their clerkships. Not only do these settings have no structure or quality control, but they also do not provide a didactic education comparable to those of U.S. medical schools. These observations point to the possibility of lower-quality clinical education and training.
Halperin and Goldberg1 list recommen dations that restrict the influx of foreign or offshore medical trainees to the United States. The reality is that with over 50 jurisdictions and legislatures in the United States, this influx is not going to be easily limited without federal action. The reality is also that none of these suggestions will truly address the likely decreasing quality of clinical training. We have a fiduciary responsibility to provide high-quality care to our patients, and we must address this problem with expediency.
Richard Balon, MD
Professor, associate chair for education, and program director, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan; email@example.com.
Mary Morreale, MD
Associate professor and director of medical student education, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan.
1. Halperin EC, Goldberg RB. Offshore medical schools are buying clinical clerkships in U.S. hospitals: The problem and potential solutions. Acad Med. 2016;91:639644.
2. Burdick WP, van Zanten M, Boulet JR. The shortage of clinical training sites in an era of global collaboration. Acad Med. 2016;91:615617.