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Letters to the Editor

More About Offshore Medical Schools Buying Clerkships in U.S. Hospitals

Flaherty, Joseph A. MD

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doi: 10.1097/ACM.0000000000001429
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To the Editor:

In their recent Perspective, Halperin and Goldberg1 attempt a sleight of hand. With its provocative title and sentiments about duty, the article is purportedly about the threat to U.S. medical education from schools that compensate hospitals for clinical teaching. Yet the bulk of the article is devoted to maligning Caribbean medical schools, a subset of schools that compete directly with the authors’ institutions not only for clinical teaching opportunities but also for qualified students and, later, residency positions. It is important to clarify this context since the authors elected not to.

The scarcity of clinical training opportunities is an important issue. As former dean of a Liaison Committee on Medical Education (LCME)-accredited medical school, I appreciate the economic burden that some U.S. schools would face if required to pay for their students’ clinical education. The authors decry compensation for clinical teaching, but in fact hospitals enjoy numerous benefits from entering into such arrangements, including funding for capital investments, resident and faculty education, and resident stipends. These affiliations benefit all students, residents, and faculty in the hospital, regardless of their origin, and also help support safety-net hospitals that serve an at-risk patient population and may themselves be at risk for survival. They also enable hospitals to have increased influence over their resident and physician pipeline. And as Halperin and other U.S. medical school leaders know, the practice of paying for clinical teaching is growing rapidly, not just among Caribbean schools but also among their peers in the United States.

Burdick and colleagues,2 in response to Halperin and Goldberg, note that direct payments to hospitals bring “transparent accounting of the true cost of clinical education.” Transparency is an important concept to consider here—not just to understand cost of instruction but to provide aspiring doctors with information they need to make appropriate educational choices. In my institution we strive to be transparent, and I am confident that we outperform our U.S. peers in this regard. I know this because of the scarcity of publicly available data on how individual LCME-accredited or osteopathic schools perform on licensing examinations and in the residency Match.

The gross generalizations, cherry-picked opinions, and misinterpreted data employed by Halperin and Goldberg are too numerous to refute in a letter. However, we would welcome a “transparent accounting” of how all schools—U.S. allopathic, U.S. osteopathic, and offshore—perform against important metrics of quality.

Joseph A. Flaherty, MD
Dean and chancellor, Ross University School of Medicine, Miramar, Florida;


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.
Copyright © 2016 by the Association of American Medical Colleges