Admission to US medical schools is increasingly difficult. So many who seek medical careers may be tempted to apply to schools outside the US. In the last 30 years, American entrepreneurs have opened offshore medical schools, mostly in the Caribbean, that cater to US students. They teach in English, and do not require immersion in an unfamiliar culture, so may be more attractive than medical schools in other countries whose mission is to educate physicians to practice in those countries. In 2010, Eckhert documented that the number of offshore medical schools, "for-profit institutions whose purpose is to train U.S. and Canadian students who intend to return home to practice," but not to train physicians to practice in the countries in which these schools are located, was rapidly growing.(1) By 2010, there were 33 such schools, 20 of which were new since 2000.
Such offshore medical schools exist in a grey area. The small countries or colonies in which they are located usually do not seek to regulate them, since the physicians they produce are going to practice elsewhere. There is no requirement that these offshore medical schools be accredited in the US. Such accreditation is currently not required for individual graduates of such schools to be admitted to US house-staff programs or for US licensure. So perhaps it is not surprising that little is known about these schools.
How they choose students, the qualifications or even names of their faculty, their curriculum, how they supervise clinical training (which is mostly done by affiliated North American hospitals), and what happens to their graduates are obscure. Eckhert attempted to describe what is known, but noted "variability exists in the availability of information on faculty; where data exists, it is noted that most of the permanent on-site basic science faculty are internationally trained, many have no documented medical education experience in the United States, and it is not uncommon for them to be OMS [offshore medical school] alumni."
Such information as is available about these schools comes from the schools themselves.
DeVry Accused of Deception
Yet now there is reason to be more suspicious about the information the schools choose to reveal. This week, media reports documented that the US Federal Trade Commission (FTC) is suing DeVry University for allegedly "deceptive" recruiting practices. DeVry University is a subsidiary of DeVry Education Group. DeVry has two offshore medical schools as subsidiaries, the American University of the Caribbean School of Medicine, and Ross University School of Medicine.
Here is a summary from the Miami Herald,
On Wednesday, the Federal Trade Commission sued DeVry, which operates three Florida campuses, including one in Miramar, for 'deceptive' recruiting practices. The company is one of the nation’s largest for-profit colleges, with 50-plus U.S. campuses, and more than 41,000 students. In addition to the disputed 90 percent number [of graduates who found work in their chosen field], the FTC alleges DeVry also falsely advertised that its graduates 'earn 15% more than graduates from other colleges and universities.'
The allegations were that DeVry rigged the statistics:
The FTC suit alleges that DeVry fudged the numbers on its 90 percent job placement rate by leaving out some out students who weren’t finding jobs. This was done by classifying the students as not actively seeking employment, even though that wasn’t the case, the FTC says.
According to the FTC, DeVry also boosted its job placement numbers by counting students as placed in their field even when that clearly wasn’t accurate. Examples of DeVry’s 'in field' placements cited in the lawsuit include:
▪ A graduate from the technical management degree program working as a mail carrier.
▪ A business administration graduate working as a waiter at the Cheesecake factory.
▪ A business administration graduate working as a secretary at a prison.
▪ A technical management graduate working as a sales associate at Macy’s.
The Miami Herald reporter found at least one more example,
One former student at DeVry’s Miramar campus told the Herald that the school’s recruiter made it seem like his project management degree would lead to guaranteed employment. But after graduating in 2011, the student, who asked to be identified only by his first name, Luis, said he never got a callback from the more than 50 job postings he applied for.
Luis said he has $30,000 in student loans, and is working the same type of job he had before enrolling at DeVry, as a medical device technician.
A blog post on the Republic Report included two more examples,
graduates who majored in technical management working as unpaid volunteer positions at medical centers;
a business administration graduate with a health care management specialization working as a car salesman.
Not surprising, the corporate leadership of DeVry University denied the claims, and dismissed the evidence as "anecdotal examples that exaggerate the allegations but do not prove them." They focused on the overall numbers, claiming that "there is no national standard for calculating employment statistics...."
Yet they did not challenge the particular anecdoes, all of which seemed to be examples of unsuccessful placements claimed by the University to be the opposite.
Adding to Previous Concerns about DeVry Owned Offshore Medical Schools
In 2013, we posted about a Bloomberg investigative article about the two DeVry owned medical schools, at the American University of the Caribbean and Ross University. The article focused on multiple issues:
- high attrition rates of students compared to those in US based schools
- inability of many students to complete clinical training in the customary two years
- low rates of students matching to US residencies compared to US graduates
- high costs for students, presumably a cause of their high levels of debt
Keep in mind that some of these concerns were based on statistics supplied by DeVry. Yet now there is a new reason to be doubtful about their statistics. Furthermore, while Eckhert wrote in 2010 that the increasing presence of offshore medical graduates in the US "obligates U.S. medicine to take a closer look at these educational programs," no such scrutiny has occurred since then.
Outsourcing US medical education to offshore schools that largely escape regulation in the US, and in the countries in which they are located is another outstanding example of how the US has applied hyper market based solutions to health care. While more US students are attending such schools, and often paying a high price and incurring high indebtedness for the privileges of doing so, there are many reasons to be doubtful about the quality of the education they may receive, and the likelihood of their long-term success as physicians.
Yet health care, and particularly the quality of education received by those who practice medicine in the US, could be viewed as a public good. Dubious training of US doctors affect not only the doctors themselves, but their patients' and the public's health. Outsourcing this education could put a lot of people at risk.
However, it does provide an attractice opportunity for the managers of the outsourced system to make money. Per the DeVry Education Group 2015 proxy statement, CEO received $5,343,407 in total compensation that year, and owned over one million shares of stock (currently valued at just under $20 million). Four other named officers each received at least $1 million.
So, we see another aspect of the US health care system in which money seems to trump mission, facilitated by an unseemly alliance between wealthy corporate executives and bad US government policy. We need to reexamine our fascination for "market based" approaches to health care, when almost nothing about any part of health care resembles, or could resemble a free market. We need to make health care more transparent, and shine more sunshine on the nooks and crannies, like off-shore but US corporate owned medical schools. We need to facilitate health care leadership and governance that puts patients' and the public's health first, way ahead of the personal enrichment of the participants.
As long as the US continues its light touch regulation of the outsourced offshore system which now educates increasing numbers of US doctors(2), Americans who want to become doctors ought to be very skeptical about the futures they may face if they choose to go to such offshore schools.
1. Eckhert NL. Private schools of the Caribbean: outsourcing medical education. Acad Med 1010; 85: 622-630. Link here.
2. Eckhert NL, van Zanten M. U.S.-citizen international medical graduates - a boon for the workforce? N Engl J Med 2015; 372: 1686-7. Link here.