Improved Certification Needed for Offshore Medical Schools

Article excerpt

Thirty years ago, the Graduate Medical Education National Advisory Committee predicted a surplus of 145,000 physicians by the year 2000, and recommended a limitation of the number of entering positions in U.S. medical schools and the number of international graduates coming to the United States. No restrictions were placed on international graduates coming to America, but the number of positions available for students to enter U.S. medical schools has remained static until the last 2 years. This led many students to seek education at offshore medical schools (OMS), particularly in the Caribbean.

The flawed predictions of a surplus of doctors were made in anticipation of an expanded role of health maintenance organizations as gatekeepers for access to family and specialty doctors. GMENAC also failed to foresee the expansion of the elderly population as a result of the baby boomer generation and the increased availability of new diagnostic and therapeutic technologies. It is estimated that by 2020 or 2025, there will be a shortage of almost 200,000 doctors in the United States (J. Gen. Intern. Med. 2007;22:264-8). U.S. medical schools are projected to graduate 16,000 doctors annually, and that number is expected to increase by 30% in 2015, unless the proposed restrictions to education budgets by Congress take place. This increase will continue to fall short of national requirements if physician retirement is factored into the estimates.

I recently visited a Caribbean medical school to observe the students in the classroom. I learned a great deal about the role that the OMS plays in mitigating the doctor shortage in the United States. The students in these schools are clearly different from those who attend American medical schools. They are distinguished, not exclusively by their MCAT scores, as though that really matters, but also by being very motivated to become doctors. Many had been out of undergraduate programs for some time--some as long 15 years--and had tested other careers before realizing that medicine is what they really wanted.

Most will spend 2 years in the Caribbean and then move to clinical training in hospitals throughout the United States, ultimately entering residency programs and practice in mainland America. One of the first hurdles that the OMS students will face is the United States Medical Licensing Examination taken by both U. …