Monday, 1 October 2018

Quality vs Costs of US Corporate Owned but Offshore Medical Schools

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Background: Off-Shore Medical Schools for US Students Owned with the aid of means of method of technique of US Corporations

While US nicely being care appears to be desire to be extra corporate than nicely being care in any different constructed country, one section of nicely being care that has remained moderately so much lots much less corporate is scientific education.  In particular, no US scientific school is a for-profit venture, to my knowledge.  (This simply makes US scientific tuition moderately so much lots much less corporate than the relaxation of nicely being care because, as we've discussed endlessly, educational scientific institutions within the nation have common institutional conflicts of interest, and their forums of trustees, administration, and school have common certain consumer conflicts of interest.) 

Nonetheless, there are many Americans attending for-profit scientific colleges owned and run with the aid of means of method of technique of US founded mostly principally corporations.  It is absolutely that these colleges typically are typically now not physically situated within the US.  Since the quantity of US residents who desire to transfer to scientific school has been widely exceeding the potential of US scientific schools, many that desire to develop into physicians have sought scientific instructions in different countries.  Some transfer to scientific colleges lawn of the US which would possibly be primarily operated to provide scientific scientific professionals to the countries wherein they operate. However, the restricted availability of puts helpful in such colleges for overseas students, and the points of instructions in unfamiliar scientific courses and typically in unfamiliar languages restrict the magnificence of this option.

Enter American entrepreneurs into the picture, who discovered they would possibly arrange colleges in prepared puts (often in small countries within the Caribbean) meant to instructor Americans in English.  While there are lots of causes to be involved concerning the role US founded mostly principally scientific colleges play within the illness of US nicely being care, there would likely even be extra causes to be involved about for-profit, US owned, but off-shore scientific colleges that cater to US students.  Yet though such colleges now teach a vast quantity of students, they have a tendency to fly under the radar.

Reasons for Concern about US Corporate Owned but Off-Shore Medical Schools

In 2010, we posted about an investigative record within the St Petersburg (FL) Times that bought causes for concern.  These blanketed suggestions of severe nice problems, comparable to severe attrition rates, severe charges of failure to entire residency instructions and loss of severe nice controls over scientific education, severe prices imposed on students, and the role of tremendous right compensated executives with out obvious wisdom of scientific education.

Now Bloomberg has discovered out one different record on for-profit, US owned Caribbean scientific colleges that underscores these concerns.  The record concentrated on colleges owned with the aid of means of method of technique of the US based, publicly traded DeVry Inc.  These contain American University of the Caribbean School of Medicine, situated in St Maarten, and Ross University School of Medicine, situated in Dominica... 

Quality Concerns

- Attrition

 Many DeVry scholars quit, fairly within the very important NULL semesters, taking their debt with them. While the common attrition cost at U.S. med colleges was 3 percentage for the magnificence that started within the autumn of 2008, according to the AAMC, DeVry says its cost levels from 20 to 27 percent. 

One goal for it truly is that for-profit colleges would likely take scholars who're so much lots much less academically qualified,

 Many of these students, ..., did now not get hold of admission to U.S. schools, the neighborhood the imply rating on the Medical College Admission Test, or MCAT, was 31.2 out of a doubtless 45 final year. At DeVry’s schools, the common rating was 25.

- Time to Completion of Training

 Of these who remained, 66 percentage of AUC scholars and 52 percentage of scholars at DeVry’s different Caribbean scientific school, Ross University School of Medicine, completed their instrument -- typically NULL years of sciences adopted with the aid of means of method of technique of NULL years of scientific rotations -- on time within the educational yr ended on June 30, 2012. 

- Difficulty Obtaining Residencies

The National Resident Matching Program says 94 percentage of fourth-year scholars schooled within the united states landed a first-year match in 2013, whereas 53 percentage of U.S. residents skilled internationally did.

DeVry scholars fare better than the common foreign-trained student. Of the 914 Ross scholars who utilized for residency in 2013, 76 percent, or 699, earned places. Another 41 had initial one-year spots, which would require the scholars to win a moment residency so as to be eligible for a scientific license in 48 states.

Of the 268 AUC scholars who utilized for residency, 212, or 79 percent, got matches, and 7 extra had one-year slots. The the relaxation of the scholars did now not win a residency.

- Lack of Standards

The Bloomberg article also emphasized the reality that the US owned corporate off-shore colleges don't have to meet the comparable accreditation criteria as do US founded mostly principally schools:

  The Accreditation Commission on Colleges of Medicine, an Ireland-based body, accredits 4 Caribbean scientific schools, adding AUC, according to its website.

High Costs

While the severe nice of tuition bought with the aid of means of method of technique of US owned corporate off-shore scientific colleges would likely be questioned, there isn't any doubt about their severe costs.

 First-year courses on Dominica prices $56,475, founded mostly principally on the three phrases Ross divides the yr into. That compares with a median of $50,309 for courses and charges at private U.S. scientific colleges within the 2012-to-2013 school year.

These prices are of certain enviornment simply attributable to the physical reality many scholars of off-shore colleges amass superb quantities of debt. 

DeVry, which has NULL for-profit scientific colleges within the Caribbean, is accepting lots of of scholars who were rejected with the aid of means of method of technique of U.S. scientific colleges. These scholars amass extra debt than their U.S. counterparts -- a median of $253,072 in June 2012 at AUC versus $170,000 for 2012 graduates of U.S. scientific schools.

And that hole is even better as the united states figure, compiled with the aid of means of method of technique of the Association of American Medical Colleges, contains pupil debt incurred for undergraduate or different degrees, whereas the DeVry quantity is absolutely federal scientific school loans. 

 These severe debt hundreds are enabled with the aid of means of method of technique of US government loans, even though the colleges typically are typically now not situated or legal within the US.

And though neither AUC nor Ross, within the island nation of Dominica, is legal with the aid of means of method of technique of the physique that approves scientific courses within the U.S., scholars at equally colleges are eligible for loans issued with the aid of means of method of technique of the united states Education Department.

In addition,

 Students on the 4 colleges -- the NULL DeVry schools, alongside with St. George’s University School of Medicine and, pondering the reality that July, Saba University School of Medicine -- also are eligible for courses advantages from the united states Department of Veterans Affairs.


The Bloomberg article in transient wondered the motivations of DeVry leadership, quoting David Bergeron, formerly of the US Department of Education

If they have to make a threat amongst scholars and profit, they select profit

They would likely get hold of this as the off-shore scientific colleges deliver in so so much of money

DeVry got 34 percentage of its gross sales within the yr ended on June 30 from scientific and health-care education, adding a chain of U.S. nursing schools. The unit contributed $673 million of DeVry’s $1.96 billion in revenue, up extra than sevenfold from $91 million in fiscal 2005.

'The diversification technique is working,' Chief Executive Officer Daniel Hamburger stated at an investor conference in Chicago in June. 'About a third now of our enrollment is within the rising topic of health-care education.'

It appears to be like clean that this gross sales stream is widely proven on US government money

DeVry acquired AUC in 2011 for $235 million, attracted partly with the aid of means of method of technique of the school’s eligibility for federal loans, says Harold Shapiro, DeVry’s chairman and a former president of Princeton University.

'Access to federal pupil loans would possibly be very very important for therefore so much of DeVry programs, adding that one,' says Shapiro, 78, an economist with the aid of means of method of technique of training, who plans to retire from DeVry in November after 12 years on the board and five years as chairman. 'Obviously, it’s section of what makes it work.'

A Quick and Dirty Look at Costs vs Value

As I famous earlier, little appears to be desire to be written concerning the commercial nature of the US owned, but off-shore scientific colleges that purportedly teach a rising quantity of US citizens.  I concept I would try so as so as to feature moderately bit to the Bloomberg article with the aid of means of method of technique of constructing an try to see if I would possibly discover any different visible method to distinction the severe nice of the Caribbean founded mostly principally colleges with their severe costs.

As famous above, the courses at one DeVry scientific school was extra than 10 percentage upper than the median for US schools.

For comparison, I concept I would make simply a few sort of speedy evaluation of the school of 1 DeVry school, Ross University School of Medicine.  That became out to be simpler than I concept it is going to be.

My first cease was the web-page that with out difficulty lists all the school's school and administration.  I assumed that this might be bulky to use.  After all, a regular US scientific school has a vast faculty, divided amongst pre-clinical departments (anatomy, physiology, biochemistry, etc), and scientific departments (usually one for every one very important specialty and or sub-specialty).  I concept I would bounce with the Ross branch of inside drugs (since my historical past is in inside medicine).  Imagine my marvel once I discovered that Ross would now not have certain consumer departments for scientific disciplines, but simply one Department of Clinical Medicine.

Imagine my further marvel once I reviewed its membership.  The web-page lists all of 31 folks on this department.  The list, with a precis of the individuals' positions on the school, and past instructions appears to be like beneath within the appendix.

The qualifications of this small quantity of scientific school were mixed at best.

- Note that of the 31, 8 typically are typically now not truly faculty, but staff (color coded pink)

- Of the 23 real faculty, only 5 appear to have acquired their scientific degree and residency instructions within the US (color coded blue).  In addition, one acquired US residency instructions after scientific school in South Africa.  (This is comparable simply attributable to the physical reality this school caters to US students, emphatically now not scholars from Dominica.)

- Of the relaxation 18 faculty, for 10 no historical past news was able (color coded green).

While the quantity of scientific school was small, grasp in thoughts that Ross University School of Medicine would possibly be very large:

Ross typically enrolls 900 to 950 scholars per educational year, who bounce in equally January, May or September.

 That’s about seven instances the common of 139 for the 2013 graduating magnificence of U.S. med schools, according to figures from the AAMC. 

Yet a regular American school has orders of magnitude extra school for virtually one order of magnitude so much lots much less students.  For example, my very own scientific school, Alpert Medical School of Brown University, has 457 scholars in 4 classes, and has 180 campus-based and 652 hospital-based faculty.  Its Department of Internal Medicine, simply absolutely one in every one of many scientific departments, is so so much better than Ross University's single Department of Clinical Medicine.

While the argument would possibly be made that Ross only adds the very important NULL years of scientific tuition at its Dominica campus, and farms out the relaxation to a sort of hospitals within the US, grasp in thoughts that the moment yr of a regular scientific school curriculum is scientific subjects and taught with the aid of means of method of technique of school in scientific departments, typically hospital based.  

So what within the international is the motive for charging a upper courses cost than a regular US founded mostly principally scientific school, while the school only has to assist a tiny school whose qualifications don't appear enough to identify for a severe price?


Based on admittedly restricted news primarily from media sources, we discover that US corporate owned but off-shore founded mostly principally scientific colleges make vast quantities of revenue, price their vast pupil our our our bodies vast quantities for tuition, yet provide proportionately minuscule numbers of now not for certain all well-qualified faculty, producing severe attrition and residency completion rates.  Yet these schools' gross sales streams are derived primarily from US government loans, made even while many scholars won't eventually get hold of scientific qualification and work as physicians. 

This appears to be like like a nice deal for the corporate executives and maybe stockholders, but a poor deal for the scholars and the US tax-payers who assist them.

We see one different section of the US nicely being care instrument wherein cash appears to be desire to trump mission, facilitated with the aid of means of method of technique of an unseemly alliance amongst rich corporate executives and bad US government policy.  We have to reexamine our fascination for "market based" methods to nicely being care, while virtually nothing about any section of nicely being care resembles, or would possibly resemble a loose market (see this post).  We have to make nicely being care extra transparent, and shine extra sunshine on the nooks and crannies, like off-shore but US corporate owned scientific schools.  We have to facilitate nicely being care leadership and governance that puts patients' and the public's nicely being first, method forward of the private enrichment of the participants.  


 "Faculty" Listing for Ross University School of Medicine Department of Clinical Medicine

 Jane Bateson - "Data Analyst & Research Associate"

Anne M Beaudoin - "Operations Specialist"

Liris Benjamin - "Associate Professor," "Doctorate in Physiology from the University of West Indies" 

Lisa Buckley - "Simulaton Cordinator"

Yasmin Burnett -"Associate Professor" [no further statistics listed]

Diana Callender - "Professor and Chair" "graduate of the University of the West Indies the neighborhood she executed her MBBS and 

Residency in Clinical Hematology."

Terri Carlson- "Associate Professor," "Creighton University Medical School in Omaha, Nebraska and executed residency 

training in Family Practice at University of California, San Francisco in 2001." 

John Charyk - "Assistant Professor," "medical school at Georgetown University in Washington DC. In 1981 he executed his 

family drugs residency instrument on the University of Colorado in Denver."

Phillip E. Cooles - "Professor," "BSc at King's College, London, then a scientific degree at St George's Hospital scientific 

school, after which a residency in inside drugs in Aberdeen, completing the MRCP"

Lauri Costello - "Assistant Professor," "UC Davis for scientific school then further north to Spokane Washington for her 

residency at Family Medicine Spokane,"

Hedda Dyer - "Associate Professor," "University of Edinburgh Medical School with a bachelor of Medicine and Surgery (MB 

CHB). She is a Member of the Royal College of Surgeons of Edinburgh, Scotland (MRCS Ed)" 

Sean Fitzgerald - "Assistant Professor" [no further details]

Lyudmyla Golub - "Associate Professor," "Doctor of Medicine degree in 1983 from Vinnitsa National Medical University, 

Ukraine. She executed an Internship in Surgery at Vinnitsa Teaching Hospital #3, Ukraine"

Lata Gowda - "Harvey Facilitator"

Aimee Hougaboom - "Simulation Coordinator"

David Johnson * - "IME Facilitator"

Sybille Koenig - "Coordinator, Standardized Patients Program"

Jaya Kolli - "Professor," "undergraduate degree on the Guntur Medical College, Andhra University, India. He went on to the 

Government General Hospital/Guntur Medical College, Nagarjuna University, in Guntur, India and executed a residency in 

Internal Medicine"

Kamalendu Malaker * - "Visiting Faculty" [no further details]

Ganendra Mallik - "Associate Professor" [no further details]

Sanghita Mallik - "Assistant Professor" [no further details]

Robert Nasiiro - "Professor" [no further details]

Worrel Sanford * - "adjunct Assistant Professor" [no further details]

Robert Sasso - "Professor" [no further details]

Harold Schiff - "Associate Professor," "board certified neurologist, skilled at Boston City Hospital, Boston University and 

has a fellowship in Behavioral Neurology, Higher Cognitive Function and Geriatric Neurology. He graduated from the 

University of the Witwatersrand, Johannesburg South Africa"

Nancy Selfridge - "Associate Professor" "medical instructions and MD degree from Southern Illinois University School of 


Rose-Claire St. Hilaire * - "IME Instructor" [no further details]

Lynn Sweeney - "Assistant Professor,"graduated from the University Of Tennessee School Of Medicine in 1987. She executed 

residency in emergency drugs on the University of Arkansas for Medical Sciences"

Valarie Thomas - "Assistant Professor," "D.V.M. degree from the Universidad Agraria de La Habana in Havana Cuba"

Nash Uebelhart - "Assistant Professor," [no further details]

Miscilda Vital-Harrigan - "Assistant Professor," [no further details]

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