Clarifications on the medical school issue

I wish to commend Dr. Jesus D. Camacho for beginning the process of asking very hard questions in his three-part series, “Medical school proposal will end up being another ‘fiasco.'” While Dr. Camacho’ makes one very crucial factual error in his statements regarding Liaison Committee on Medical Education (LCME) accreditation, I believe that the future of the project—whether it will succeed or be another “fiasco”—could hinge on the LCME issue. First allow me to give a bit of background that Dr. Camacho did not give.

1998 figures show that there were 14,610 U.S. medical school graduates, and this number has remained roughly stagnant to the present day. At the same time, there are approximately 21,500 postgraduate residency positions available. U.S. medical school graduates, including ones from Canadian medical schools and the three LCME accredited schools in Puerto Rico (the LCME does accredit medical schools in U.S. territories), are guaranteed first dibs on all residency slots. Most of the remaining slots are filled by international medical school graduates through an intensely competitive process that includes students’ USMLE (licensing exam) scores, and frequently their performance at interviews, immigration status, and other factors. This competitive process is called “the match” by participants, because they are seeking to match into the “left over” residency slots.

Among the applicants for the “left over” residency slots is a special group called U.S. international medical school graduates. These are U.S. citizens who were typically highly qualified to enter a U.S. allopathic or osteopathic medical school but, because of limited slots in U.S. medical schools, were unable to gain admission.

To fulfill their dreams of becoming a doctor, a great many of these U.S. citizens, thousands each year, leave their country to attend medical schools abroad. Go read some of their voluminous online conversations at the Forums at http://www.valuemd.com. As you will see, the vast majority of these students end up studying on small islands in the Caribbean, and anyone who wishes to study a few of the schools can search the internet for St. George’s University School of Medicine, Grenada; Ross University School of Medicine, Dominica, American University of the Caribbean, St. Maarten; Saba University School of Medicine, Saba; Medical University of the Americas, Nevis—and these are just to name a few of the over dozen of small-island medical schools set up to cater to well-qualified U.S. citizens who did not gain admission to a U.S. medical school because of a lack of slots. Keep in mind that these Caribbean island medical schools cannot acquire LCME accreditation because they are not located in the United States or one of its territories, such as Puerto Rico, Guam, or the CNMI. However, many of the schools receive U.S. federal loans. The typical total price tag of attending one of the Caribbean medical schools reaches over $100,000.

In light of the above, three hard question must be answered.

The first question is, “Could a medical school in the CNMI receive LCME accreditation?” Based upon the precedent of the three LCME medical schools in Puerto Rico, I believe the answer is ‘yes.” Also, Cornell University now has an LCME medical school in Qatar.

The second question is, “Would U.S. international medical school graduates spoken of above rather attend an non-LCME medical school on a small island in the Caribbean or the Pacific?” I believe the answer is that they would much prefer to attend in the Caribbean. The region’s proximity to the mainland is just too convenient for students. The Pacific could never adequately compete.

The third question is, “Would the same above U.S. students rather attend a non-LCME medical school on a small island in the Caribbean, or would they rather attend an LCME accredited medical school on a small island in the Pacific?” As someone who for years has advised U.S. citizens applying to international medical schools through a small non-profit organization as well as the Student Doctor Network (http://www.studentdoctor.net, I believe that all but the most missionary-oriented among them would literally leap, if given the chance, to attend an LCME medical school, no matter where it was located. Recall that graduates of LCME schools are guaranteed U.S. residency slots, which means these students have a guaranteed return on their enormous investment of time and money in medical school, while all other graduates do not.

If the CNMI wishes to have a medical school, it must be an LCME medical school. This is non-optional, in my view. Those four letters—LCME—is one crucial piece that must be in place if the medical school it is to have a chance of not spelling “FIASCO.” Acquiring LCME accreditation will of course have significant ramifications for the Commonwealth Health Center, Northern Marianas College, and a host of other parties. And those ramification raise a new set of hard questions that must be asked…and very carefully answered over at least several years time.

Stephen Ewen
As Terlaje