[NPInfo] This is amazing-

[David Mittman]

I trained with people from these schools. Don't know how may of you  
did, but generally the PA students were better than these grads right  
out of school and even through internship. I would put up our students  
(either PA or NP) next to theirs any day. It frustrates me, if you  
read the last sentence of the article, about how many of us with our  
education DO make unbelievable clinicians, and how many more would  
make brilliant physicians if we wanted to enter a bridge program for  
"physicianhood" if our education was recognized (I don't, never did  
want to be an MD BUT the education we get should be totally recognized  
for those that do).  A St. George's education is now as good as any  
other med school but a Yale NP or PA Program grad is not.What a bunch  
of B.S.........Caribbean Medicine is medicine. Funny, this school has  
a class of 1,000 and I agree that finding clerkships can be hard, but  
so can educating 1,000 people. Wonder if it will squeeze us out of  
slots we deserve? After all, we did not go to "medical school" even in  
the Caribbean.

Dave
Maybe things have changed, I doubt it.




August 5, 2008
New York Hospitals Create Outcry in Foreign Deal

By ANEMONA HARTOCOLLIS
New York City’s Health and Hospitals Corporation has signed a 10-year,  
$100 million contract with a profit-making medical school in the  
Caribbean to provide clinical training for hundreds of students at the  
city’s 11 public hospitals.

The unusual deal, proposed by a member of the corporation’s board who  
has long worked for the Caribbean school, has been met by an outcry  
from New York medical schools fearing that clerkship slots will grow  
scarcer and that they might have to increase tuitions to compete.

Critics worry that the hospital corporation, whose mission is to serve  
the city’s poor, is conferring prestige on a foreign school whose  
curriculum, they say, is more vocational than research-based and often  
caters to affluent students who could not get into schools in the  
United States.

They say that the contract, with St. George’s University School of  
Medicine on the island of Grenada, has turned a meritocracy into a  
bounty system in which struggling city hospitals collect more for  
every St. George’s student they take, and could squeeze out local  
students.

“This changes the whole dynamic from an academic relationship to a  
dollar-based relationship,” said Dr. Michael J. Reichgott, associate  
dean for clinical affairs and graduate medical education at Albert  
Einstein College of Medicine in the Bronx.

Traditionally, medical schools have sent third- and fourth-year  
students into city hospitals to work — and learn — alongside doctors  
without being charged. Health and Hospitals Corporation officials said  
some institutions had recently begun paying a flat fee of $250,000 a  
year, which Dr. Andrew W. Brotman, a senior vice president at New York  
University School of Medicine, likened to a gratuity.

The clerkships, in which students assist and observe medical personnel  
through a rotation of individual specialties, are considered a  
critical component of medical education.

Over all, there are about 3,700 rotations for students at United  
States medical schools at the city’s public hospitals.

Under the contract, which was signed last year but never publicly  
announced, St. George’s pays the hospitals $400 to $425 per student  
per week — St. George’s charges students about $1,000 a week in  
tuition — on top of an annual fee of $50,000 for hospitals that take  
24 or more St. George’s students.

“If that $400 per week per student algorithm were applied to the New  
York schools, I think it’s not affordable and it would certainly be a  
problem,” said Dr. Brotman, estimating that it would cost N.Y.U. $2.8  
million per year. “I don’t come at this from a quality point of view.  
I come at this from a volume and logistics point of view.”

The contract also bans the hospitals from providing clerkships to  
other Caribbean medical schools — a critical provision to St.  
George’s, which has faced heightened competition in recent years,  
particularly from Ross University on the island of Dominica, part of  
DeVry Inc., a publicly traded educational company, since 2003.

The board member who first proposed the exclusive contract, Dr. Daniel  
D. Ricciardi — a 1981 graduate of St. George’s and a rheumatologist  
affiliated with Long Island College Hospital in Brooklyn — said he had  
recused himself from deliberations involving St. George’s. Dr.  
Ricciardi, who has been on the 16-member corporation board since 2000  
and on the St. George’s faculty for about 15 years, said he did not  
benefit financially from the deal. He was promoted to St. George’s  
dean of clinical studies and put in charge of United States clerkships  
shortly before the contract was signed.

“I don’t have to go to confession on this one, I really don’t,” he  
said. “Everybody’s saying there’s a conflict here, and it comes back  
to me. They’re disgruntled, jealous. A report was written on the  
school, and the judgment was made based on merit, not on political  
push.”

Dr. Ricciardi, 55, who was honored by the hospital corporation last  
year “for his selfless dedication to furthering the mission of  
H.H.C.,” compared the objecting American medical school officials to  
children crying, “ ‘Daddy, I can’t have my free candy anymore.’ ”

Neither the president of the hospital corporation, Alan D. Aviles, nor  
its senior vice president of operations, Frank J. Cirillo, would  
discuss the contract. Ana Marengo, a spokeswoman for the agency, gave  
a primarily fiscal rationale, saying that the arrangement with New  
York medical schools does not cover costs, and that the hospitals  
operate on “razor-thin” margins and need the revenue.

Ms. Marengo said that only two Caribbean schools, St. George’s and  
Ross, met the corporation’s standards for bidding on the contract, and  
that St. George’s made the more attractive offer, including one  
medical-school and one nursing-school scholarship to prospective New  
York City students for each hospital that provides at least 24  
clerkships.

Joan Bates, director of investor relations for DeVry, Ross’s parent  
corporation, declined to comment.

The contract, which has a five-year term automatically renewable for  
another five, unless either side objects, calls for up to 600  
clerkships, but resistance at the city’s prestigious medical schools,  
including New York University and Albert Einstein, has prevented the  
program from getting off the ground at their training hospitals,  
Bellevue Hospital Center on the East Side and Jacobi Medical Center in  
the Bronx.

According to Charles R. Modica, the chancellor of St. George’s, about  
200 students have been placed at six hospitals: Coney Island, Queens,  
Elmhurst, Lincoln, Metropolitan and Woodhull. Ms. Marengo, the  
corporation spokeswoman, said St. George’s paid about $2 million in  
the first year of the contract, adding: “We expect that to grow  
gradually as additional facilities prepare to take on more students.”

Dr. Steven B. Abramson, vice dean of medical education at N.Y.U., said  
the resistance stemmed from concern about the caliber of education at  
St. George’s, which admits about 1,000 medical students a year,  
compared with 160 at N.Y.U. He cited the large student body and the  
fact that the clerkships were divorced from the faculty and academic  
facilities in Grenada, noting that medical schools here integrated  
classroom work, research and clinical training.

“I don’t begrudge the kids,” Dr. Abramson said. “I just think the  
model takes advantage of these kids; the structure is substandard.”

Jennifer Golia, who grew up in Queens and graduated from Princeton in  
2003, spent two years collecting rejection letters from medical  
schools in the United States before enrolling at St. George’s; she has  
done clerkships at five New York City hospitals, most recently in  
neurology at Brooklyn Hospital Center.

“The Albert Einstein students did the exact same thing that we did,”  
Ms. Golia said of her stint at Flushing Hospital Medical Center last  
year. “We were standing next to each other on ward rounds, presenting  
patients together at clinic and presenting cases to each other. We had  
the same supervisors.”

St. George’s students generally attend classes in Grenada for two  
years, then spend the next two in clerkships in Britain or the United  
States, primarily at hospitals in New York, New Jersey, California and  
Florida.

In 1985, New York State’s education commissioner barred St. George’s  
students from New York hospitals, saying that the school’s program was  
too fragmented and the involvement of school officials was too  
tenuous. After the school made some changes, that ruling was reversed,  
and St. George’s has since routinely sent students to New York  
hospitals, but the new contract could quadruple the number while  
raising what until now had been a $300 fee per student per week.

Jo Wiederhorn, executive director of the Associated Medical Schools of  
New York, argued during a presentation to a state medical licensing  
board in May that as American medical schools tried to increase  
enrollment to address a shortage of doctors, the contract could  
threaten access for local institutions and put pressure on them to pay  
the hospitals more. Noting that St. George’s tuition is nearly $50,000  
a year, compared with $40,000 at top American medical schools, Ms.  
Wiederhorn worried in an interview that New York schools would have to  
raise tuition by $20,000 to pay for clerkships and “it would make them  
noncompetitive with the rest of the country.”

The St. George’s medical school accepted its first class in 1977, and  
has an admissions office on Long Island; some 70 percent of its  
students are United States citizens. When the United States military  
invaded Grenada in 1983, a principal goal was to rescue American  
students studying at St. George’s amid the unrest.

In 2005, Senator Jeff Sessions, a Republican from Alabama, led an  
unsuccessful drive to cut off federal student loans to St. George’s,  
Ross and American University of the Caribbean on St. Maarten, saying  
they were little more than diploma mills “created to serve American  
students who cannot get into American medical schools.”

Mr. Modica, the chancellor, acknowledged that St. George’s students  
generally had lower grade-point averages and lower scores on entrance  
exams than students at American schools, but he said the gap was narrow.

He said the school had sought an exclusive contract with the hospital  
corporation because “we have had problems with some of these other  
Caribbean schools overloading these services.”

He staunchly defended the contract, saying it had drawn the ire of  
medical school deans only because it had threatened their monopoly.  
Indeed, about a third of doctors licensed in New York State went to  
foreign medical schools, according to the State Education Department.

“There has always been a need for foreign-trained students because  
these same deans like to limit the numbers arbitrarily,” Mr. Modica  
said of school admissions policies. “They have a lot of nerve to tell  
us that we’re taking places from them.”

Dr. Eric Manheimer, medical director of Bellevue Hospital, was one of  
two doctors who spent a week visiting St. George’s on behalf of the  
hospital corporation before the contract was approved and said that  
the Caribbean school “passed the threshold” of being a competent  
medical school. He said that it was hypocritical for universities with  
connections to pharmaceutical companies to criticize the contract.

“Some of our best doctors at N.Y.U. went to medical school in Mexico  
and then came in through the back door,” he said.


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