Quality vs Costs of US Corporate Owned but Offshore Medical Schools

<b>Background: Off-Shore Medical Schools for US Students Owned by US Corporations </b><br /><br />While US health care appears to be more corporate than health care in any other developed country, one part of health care that has remained a bit less corporate is medical education.  In particular, no US medical school is a for-profit venture, to my knowledge.  (This just makes US <a href="http://hcrenewal.blogspot.com/search/label/medical%20schools">medical education</a> a bit less corporate than the rest of health care because, as we have discussed endlessly, academic medical institutions in the country have frequent <a href="http://hcrenewal.blogspot.com/search/label/institutional%20conflicts%20of%20interest">institutional conflicts of interest</a>, and their boards of trustees, administration, and faculty have frequent individual c<a href="http://hcrenewal.blogspot.com/search/label/conflicts%20of%20interest">onflicts of interest.</a>) <br /><br />Nonetheless, there are many Americans attending for-profit medical schools owned and run by US based corporations.  It is just that these schools are not physically located in the US.  Since the number of US citizens who want to go to medical school has been greatly exceeding the capacity of US medical schools, many who want to become physicians have sought medical training in other countries.  Some go to medical schools outside of the US which are primarily operated to provide doctors to the countries in which they operate. However, the limited availability of places available in such schools for foreign students, and the difficulties of training in unfamiliar medical systems and often in unfamiliar languages limit the attractiveness of this option. <br /><br />Enter American entrepreneurs into the picture, who realized they could set up schools in willing locations (often in small countries in the Caribbean) meant to educate Americans in English.  While there are plenty of reasons to be concerned about the role US based medical schools play in the dysfunction of US health care, there may even be more reasons to be concerned about for-profit, US owned, but off-shore medical schools that cater to US students.  Yet although such schools now train a large number of students, they tend to fly under the radar.<br /><br /><b>Reasons for Concern about US Corporate Owned but Off-Shore Medical Schools </b><br /><br />In 2010, we <a href="http://hcrenewal.blogspot.com/2010/01/to-whom-does-leading-off-shore-medical.html">posted </a>about an investigative report in the St Petersburg (FL) Times that provided reasons for concern.  These included suggestions of quality problems, such as high attrition rates, high rates of failure to complete residency training and lack of quality controls over clinical education, high costs imposed on students, and the role of extremely well compensated executives with no apparent knowledge of medical education.<br /><br />Now Bloomberg has published another <a href="http://www.bloomberg.com/news/2013-09-10/devry-lures-medical-school-rejects-as-taxpayers-fund-debt.html">report </a>on for-profit, US owned Caribbean medical schools that underscores these concerns.  The report focused on schools owned by the US based, publicly traded DeVry Inc.  These include American University of the Caribbean School of Medicine, <a href="http://www.aucmed.edu/">located in St Maarten</a>, and Ross University School of Medicine, <a href="http://www.rossu.edu/about/">located in Dominica</a>...  <br /><br /><u>Quality Concerns</u><br /><br /><br />- Attrition<br /><br /><blockquote class="tr_bq"> Many DeVry students quit, particularly in the first two semesters, taking their debt with them. While the average attrition rate at U.S. med schools was 3 percent for the class that began in the fall of 2008, according to the AAMC, DeVry says its rate ranges from 20 to 27 percent. </blockquote><br />One reason for this is that for-profit schools may take students who are less academically qualified,<br /><br /><blockquote class="tr_bq"> Many of those students, ..., failed to gain admission to U.S. schools, where the mean score on the Medical College Admission Test, or MCAT, was <a href="https://www.aamc.org/download/321494/data/2012factstable17.pdf" rel="external" title="Open Web Site">31.2</a> out of a possible 45 last year. At DeVry’s schools, the average score was 25. </blockquote><br />- Time to Completion of Training<br /><br /><blockquote class="tr_bq"> Of those who remained, <a href="http://www.aucmed.edu/gainful-employment-disclosures/" rel="external" title="Open Web Site">66 percent of AUC students</a> <a href="https://www.rossu.edu/medical-school/student-consumer-info.cfm" rel="external" title="Open Web Site">and 52 percent of students</a> at DeVry’s other Caribbean medical school, <a href="http://www.rossu.edu/medical-school/" rel="external" title="Open Web Site">Ross University School of Medicine,</a> finished their program -- typically two years of sciences followed by two years of clinical rotations -- on time in the academic year ended on June 30, 2012. </blockquote><br />- Difficulty Obtaining Residencies<br /><br /><br /><blockquote class="tr_bq"><a href="http://www.nrmp.org/" rel="external" title="Open Web Site">The National Resident Matching Program</a> says 94 percent of fourth-year students schooled in the U.S. landed a <a href="http://b83c73bcf0e7ca356c80-e8560f466940e4ec38ed51af32994bc6.r6.cf1.rackcdn.com/wp-content/uploads/2013/08/resultsanddata2013.pdf" rel="external" title="Open Web Site">first-year match in 2013</a>, while 53 percent of U.S. citizens trained internationally did.<br /><br />DeVry students fare better than the average foreign-trained student. Of the 914 Ross students who applied for residency in 2013, 76 percent, or 699, earned places. Another 41 had preliminary one-year spots, which would require the students to win a second residency in order to be eligible for a medical license in 48 states.<br /><br />Of the 268 AUC students who applied for residency, 212, or 79 percent, got matches, and seven more had one-year slots. The remainder of the students failed to win a residency. </blockquote><br />- Lack of Standards<br /><br /><br />The Bloomberg article also emphasized the fact that the US owned corporate off-shore schools do not have to meet the same accreditation standards as do US based schools:<br /><br /><blockquote class="tr_bq">  <a href="http://www.accredmed.org/" rel="external" title="Open Web Site">The Accreditation Commission on Colleges of Medicine</a>, an Ireland-based body, accredits four Caribbean medical schools, including AUC, according to its website. </blockquote><br /><u>High Costs</u><br /><br />While the quality of education provided by US owned corporate off-shore medical schools may be questioned, there is no doubt about their high costs.<br /><br /><blockquote class="tr_bq"> First-year tuition on Dominica costs <a href="http://www.rossu.edu/medical-school/admissions/Tuition-and-Fees.cfm" rel="external" title="Open Web Site">$56,475,</a> based on the three terms Ross divides the year into. That compares with a median of <a href="https://www.aamc.org/download/152968/data" rel="external" title="Open Web Site">$50,309</a> for tuition and fees at private U.S. medical schools in the 2012-to-2013 school year. </blockquote><br />These costs are of particular concern because many students of off-shore schools amass impressive amounts of debt.  <br />  <br /><blockquote class="tr_bq"><a href="http://www.devryinc.com/" rel="external" title="Open Web Site">DeVry</a>, which has two <a href="http://www.devryinc.com/our-institutions/auc-med.jsp" rel="external" title="Open Web Site">for-profit medical schools</a> in the Caribbean, is accepting hundreds of students who were rejected by U.S. medical colleges. These students amass more debt than their U.S. counterparts -- a median of <a href="http://www.aucmed.edu/gainful-employment-disclosures/" rel="external" title="Open Web Site">$253,072</a> in June 2012 at AUC versus <a href="https://www.aamc.org/download/152968/data" rel="external" title="Open Web Site">$170,000 for 2012 graduates</a> of U.S. medical schools.<br /><br />And that gap is even greater because the U.S. figure, compiled by the Association of American Medical Colleges, includes student debt incurred for undergraduate or other degrees, while the DeVry number is only federal medical school loans. </blockquote><br /> These high debt loads are enabled by US government loans, even though the schools are not located or accredited in the US.<br /><br /><blockquote class="tr_bq">And though neither AUC nor Ross, in the island nation of Dominica, is accredited by the body that <a href="http://www.lcme.org/" rel="external" title="Open Web Site">approves medical programs in the U.S</a>., students at both schools are eligible for loans issued by the U.S. Education Department.</blockquote><br />In addition,<br /><br /><blockquote class="tr_bq"> Students at the four schools -- the two DeVry schools, along with <a href="http://www.sgu.edu/school-of-medicine/" rel="external" title="Open Web Site">St. George’s University School of Medicine</a> and, since July, <a href="http://www.saba.edu/saba/" rel="external" title="Open Web Site">Saba University School of Medicine</a> -- are also eligible for tuition benefits from the U.S. Department of <a href="http://topics.bloomberg.com/veterans-affairs/">Veterans Affairs</a>. </blockquote><br /><u>Leadership </u><br /><br />The Bloomberg article briefly questioned the motivations of DeVry leadership, quoting David Bergeron, previously of the US Department of Education<br /><br /><blockquote class="tr_bq">If they have to make a choice between students and profit, they choose profit</blockquote><br />They may do so because the off-shore medical schools bring in a lot of money<br /><br /><br /><blockquote class="tr_bq">DeVry got 34 percent of its revenue in the <a href="http://investors.devryinc.com/Investor-Relations/Press-Releases/Press-Releases/Press-Release-Details/2013/DeVry-Announces-Fourth-Quarter-and-Full-Year-2013-Results/default.aspx" rel="external" title="Open Web Site">year ended on June 30</a> from medical and health-care education, including a chain of U.S. nursing schools. The unit contributed $673 million of DeVry’s $1.96 billion in revenue, up more than sevenfold from $91 million in fiscal 2005.<br /><br />'The diversification strategy is working,' Chief Executive Officer Daniel Hamburger said at an <a href="http://investors.devryinc.com/files/doc_presentations/dv_william_blair_061313_final_web.pdf" rel="external" title="Open Web Site">investor conference in Chicago</a> in June. 'About a third now of our enrollment is in the growing field of health-care education.'</blockquote><br />It seems clear that this revenue stream is greatly dependent on US government money<br />  <br /><blockquote class="tr_bq">DeVry acquired AUC in 2011 for <a href="http://investors.devryinc.com/Investor-Relations/Press-Releases/Press-Releases/Press-Release-Details/2011/DeVry-Inc-Announces-Acquisition-of-American-University-of-the-Caribbean1126184/default.aspx" rel="external" title="Open Web Site">$235 million</a>, attracted partly by the school’s eligibility for federal loans, says Harold Shapiro, <a href="http://www.devryinc.com/about-us/board-of-directors.jsp" rel="external" title="Open Web Site">DeVry’s chairman</a> and a <a href="http://www.princeton.edu/%7Ehts/" rel="external" title="Open Web Site">former president of Princeton University.</a><br />  <br />'Access to federal student loans is very important for a lot of DeVry programs, including that one,' says Shapiro, 78, an economist by training, who plans to <a href="http://investors.devryinc.com/Investor-Relations/Press-Releases/Press-Releases/Press-Release-Details/2013/Harold-Shapiro-to-Retire-from-DeVry-Board-of-Directors/default.aspx" rel="external" title="Open Web Site">retire</a> from DeVry in November after 12 years on the board and five years as chairman. 'Obviously, it’s part of what makes it work.' </blockquote><br /><br /><b>A Quick and Dirty Look at Costs vs Value</b><br /><br />As I noted earlier, little seems to be written about the commercial nature of the US owned, but off-shore medical schools that purportedly educate a growing number of US citizens.  I thought I would try to add a little to the Bloomberg article by trying to see if I could find any other obvious way to contrast the quality of the Caribbean based schools with their high costs.<br /><br />As noted above, the tuition at one DeVry medical school was more than 10 percent higher than the median for US schools.<br /><br />For comparison, I thought I would make some sort of quick assessment of the faculty of one DeVry school, Ross University School of Medicine.  That turned out to be easier than I thought it would be. <br /><br />My first stop was the <a href="http://www.rossu.edu/medical-school/faculty/faculty.cfm">web-page</a> that conveniently lists all of the school's faculty and administration.  I assumed that this would be cumbersome to use.  After all, a typical US medical school has a huge faculty, divided among pre-clinical departments (anatomy, physiology, biochemistry, etc), and clinical departments (usually one for each important specialty and or sub-specialty).  I thought I would start with the Ross department of internal medicine (since my background is in internal medicine).  Imagine my surprise when I discovered that Ross does not have individual departments for clinical disciplines, but simply one Department of Clinical Medicine.<br /><br />Imagine my further surprise when I reviewed its membership.  The web-page lists <i>all of 31 people</i> in this department.  The list, with a summary of the individuals' positions at the school, and previous training appears below in the appendix.<br /><br />The qualifications of this small number of clinical faculty were mixed at best. <br /><br />- Note that of the 31, 8 are not actually faculty, but staff (color coded <span style="color: magenta;">pink</span>)<br /><br />- Of the 23 actual faculty, only 5 seem to have received their medical degree and residency training in the US (color coded <span style="color: blue;">blue</span>).  In addition, one received US residency training after medical school in South Africa.  (This is relevant because this school caters to US students, emphatically not students from Dominica.)<br /><br />- Of the remaining 18 faculty, for 10 no background information was supplied (color coded green).<br /><br />While the number of clinical faculty was small, keep in mind that Ross University School of Medicine is very large:<br /><br /><blockquote class="tr_bq">Ross typically enrolls 900 to 950 students per <a href="http://www.rossu.edu/medical-school/calendar/13" rel="external" title="Open Web Site">academic year</a>, who start in either January, May or September.<br /><br /> That’s about seven times the average of 139 for the 2013 graduating class of U.S. med schools, according to figures from the AAMC. </blockquote><br />Yet a typical American school has orders of magnitude more faculty for almost one order of magnitude less students.  For example, my own medical school, <a href="http://brown.edu/academics/medical/about-us/facts-and-figures">Alpert Medical School of Brown University</a>, has 457 students in four classes, and has 180 campus-based and 652 hospital-based faculty.  Its Department of Internal Medicine, just one of many clinical departments, is much larger than Ross University's single Department of Clinical Medicine.<br /><br />While the argument could be made that Ross only provides the first two years of medical education at its Dominica campus, and farms out the rest to a variety of hospitals in the US, keep in mind that the second year of a typical medical school curriculum is clinical topics and taught by faculty in clinical departments, often hospital based.   <br /><br />So what in the world is the rationale for charging a higher tuition rate than a typical US based medical school, when the school only has to support a tiny faculty whose qualifications do not seem sufficient to demand a high price?<br /><br /><b>Summary</b><br /><br />Based on admittedly limited information mainly from media sources, we find that US corporate owned but off-shore based medical schools make large amounts of revenue, charge their large student bodies big amounts for tuition, yet provide proportionately minuscule numbers of not clearly all well-qualified faculty, producing high attrition and residency completion rates.  Yet these schools' revenue streams are derived mainly from US government loans, made even if many students will not eventually obtain medical qualification and work as physicians. <br /><br />This seems like a great deal for the corporate executives and perhaps stockholders, but a poor deal for the students and the US tax-payers who support them.<br /><br />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 (see this post).  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.   <br /><br /><span style="font-size: x-small;"><b>Appendix</b></span><br /><br /><span style="font-size: x-small;"> <b>"Faculty" Listing for Ross University School of Medicine Department of Clinical Medicine</b></span><br /><br /><span style="font-size: x-small;"> Jane Bateson - <span style="color: magenta;">"Data Analyst & Research Associate"</span><br /><br />Anne M Beaudoin - <span style="color: magenta;">"Operations Specialist"</span><br /><br />Liris Benjamin - "Associate Professor," "Doctorate in Physiology from the University of West Indies" <br /><br />Lisa Buckley - <span style="color: magenta;">"Simulaton Cordinator"</span><br /><br />Yasmin Burnett -"Associate Professor" <span style="color: lime;">[no further details listed]</span><br /><br />Diana Callender - "Professor and Chair" "graduate of the University of the West Indies where she completed her MBBS and <br /><br />Residency in Clinical Hematology."<br /><br />Terri Carlson- "Associate Professor," <span style="color: blue;">"Creighton University Medical School in Omaha, Nebraska and completed residency <br /><br />training in Family Practice at University of California, San Francisco in 2001." </span><br /><br />John Charyk - "Assistant Professor," <span style="color: blue;">"medical school at Georgetown University in Washington DC. In 1981 he completed his <br /><br />family medicine residency program at the University of Colorado in Denver."</span><br /><br />Phillip E. Cooles - "Professor," "BSc at King's College, London, then a medical degree at St George's Hospital medical <br /><br />school, and then a residency in internal medicine in Aberdeen, completing the MRCP"<br /><br />Lauri Costello - "Assistant Professor," <span style="color: blue;">"UC Davis for medical school then further north to Spokane Washington for her <br /><br />residency at Family Medicine Spokane,"</span><br /><br />Hedda Dyer - "Associate Professor," "University of Edinburgh Medical School with a bachelor of Medicine and Surgery (MB <br /><br />CHB). She is a Member of the Royal College of Surgeons of Edinburgh, Scotland (MRCS Ed)" <br /><br />Sean Fitzgerald - "Assistant Professor" <span style="color: lime;">[no further details]</span><br /><br />Lyudmyla Golub - "Associate Professor," "Doctor of Medicine degree in 1983 from Vinnitsa National Medical University, <br /><br />Ukraine. She completed an Internship in Surgery at Vinnitsa Teaching Hospital #3, Ukraine"<br /><br />Lata Gowda - <span style="color: magenta;">"Harvey Facilitator"</span><br /><br />Aimee Hougaboom - <span style="color: magenta;">"Simulation Coordinator"</span><br /><br />David Johnson * - <span style="color: magenta;">"IME Facilitator"</span><br /><br />Sybille Koenig - <span style="color: magenta;">"Coordinator, Standardized Patients Program"</span><br /><br />Jaya Kolli - "Professor," "undergraduate degree at the Guntur Medical College, Andhra University, India. He went on to the <br /><br />Government General Hospital/Guntur Medical College, Nagarjuna University, in Guntur, India and completed a residency in <br /><br />Internal Medicine"<br /><br />Kamalendu Malaker * - "Visiting Faculty" <span style="color: lime;">[no further details]</span><br /><br />Ganendra Mallik - "Associate Professor" <span style="color: lime;">[no further details]</span><br /><br />Sanghita Mallik - "Assistant Professor"<span style="color: lime;"> [no further details]</span><br /><br />Robert Nasiiro - "Professor" <span style="color: lime;">[no further details]</span><br /><br />Worrel Sanford * - "adjunct Assistant Professor" <span style="color: lime;">[no further details]</span><br /><br />Robert Sasso - "Professor" <span style="color: lime;">[no further details]</span><br /><br />Harold Schiff - "Associate Professor," "board certified neurologist, trained at Boston City Hospital, Boston University and <br /><br />has a fellowship in Behavioral Neurology, Higher Cognitive Function and Geriatric Neurology. He graduated from the <br /><br />University of the Witwatersrand, Johannesburg South Africa"<br /><br />Nancy Selfridge - "Associate Professor" <span style="color: cyan;">"medical training and MD degree from Southern Illinois University School of <br /><br />Medicine" </span><br /><br />Rose-Claire St. Hilaire * - "IME Instructor" <span style="color: lime;">[no further details]</span><br /><br />Lynn Sweeney - "Assistant Professor,<span style="color: cyan;">"graduated from the University Of Tennessee School Of Medicine in 1987. She completed <br /><br />residency in emergency medicine at the University of Arkansas for Medical Sciences"</span><br /><br />Valarie Thomas - "Assistant Professor," "D.V.M. degree from the Universidad Agraria de La Habana in Havana Cuba"<br /><br />Nash Uebelhart - "Assistant Professor," <span style="color: lime;">[no further details]</span><br /><br />Miscilda Vital-Harrigan - "Assistant Professor," <span style="color: lime;">[no further details]</span></span><br /><span style="font-size: x-small;"><br /></span><span style="font-size: x-small;"><br /></span><span style="font-size: x-small;"><br /></span><span style="font-size: x-small;"><br /></span><br />

Quality vs Costs of US Corporate Owned but Offshore Medical Schools

Background: Off-Shore Medical Schools for US Students Owned by US Corporations While US health care appears to be more corporate than health care in any other developed country, one part of health car…

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To Whom Does a Leading "Off-Shore" Medical School Owe its Allegiance?

We have noted how existing US medical schools seem unwilling to invest or reward teaching (see post <a href="http://hcrenewal.blogspot.com/2007/04/medical-schools-to-faculty-show-me.html">here</a>.)   It is no secret in academic medicine that for years, US medical schools have been unable to train enough students to meet the country's current demand for doctors.<br /><br /><strong>Brain Drain</strong><br />Hence, a significant proportion of physicians practicing in the US were trained by medical schools in other countries.  One well-known adverse consequence of our disinclination to put sufficient resources into medical education is "brain drain," the migration of physicians from countries with severe physician shortages and major unmet health care needs to the US.  (For more discussion of this issue, see our 2005 post <a href="http://hcrenewal.blogspot.com/2005/10/physician-brain-drain.html">here</a>, and also Mullan F. The metrics of the physician brain drain. N Engl J Med 2005; 353: 1810-1818. Link <a href="http://content.nejm.org/cgi/content/full/353/17/1810">here</a>.)<br /><br />At the end of 2009, the St Petersburg (Florida) Times published an <a href="http://www.tampabay.com/news/health/medicine/article1061189.ece">investigative report</a> which showed some further adverse effects of the US disinclination to support medical education sufficient to meet the country's needs.  <br /><br /><strong>Ross University and Its Problems</strong><br /><br />The report profiled the problems at one important "off-shore" medical school.<br /><blockquote><em>Ross University School of Medicine may be the biggest medical school you've never heard of.</em><br /><br />For decades, the school <em>on the Caribbean island of Dominica</em> has been <em>accepting U.S. students whose poor test scores make it impossible for them to get into medical schools in the States.</em><br /><br />And though Ross is 1,500 miles from the mainland, U.S. residents who attend the school, and about two dozen other offshore medical schools, qualify for federal student loans.<br /><br />That has meant more than $150 million a year in government-guaranteed aid for Ross, which has about 3,500 students, double the biggest U.S. medical school.<br /><br /><em>Ross and other foreign medical schools say they're responding to U.S. demand for new doctors</em> as the population ages.<br /><br />And there's no question that these schools have produced thousands of practicing physicians. There are more than 80 Ross graduates in the Tampa Bay area alone.<br /><br />But federal regulators are taking a closer look at evidence suggesting taxpayers and students may be getting shortchanged by foreign medical schools.<br /><br />• <em>At Ross, fewer than one-third of the students finish in four years</em>, compared to nearly 100 percent at U.S. medical schools. [And as reported later in the article, the six-year graduation rate is only 66% - editor]<br /><br />• Since Ross, like other Caribbean medical schools, doesn't have a teaching hospital, it pays hospitals stateside for students' clinical training, with <em>wide variations in quality</em>.<br /><br />• <em>Students of foreign medical schools like Ross graduate with higher average debt, $235,000</em> compared to the average $158,000 owed by graduates of U.S. medical schools, according to an August report to Congress by regulators.<br /><br />• <em>About 20 percent of Ross graduates fail to land a residency</em>, the key to a license to practice in the United States. If they cannot pay their student debts, taxpayers are left holding the bag.<br /></blockquote><br />The article concludes with:<br /><blockquote>In a report to Congress in August, the group that accredits offshore medical colleges recommended that the schools raise standards and improve reporting on everything from test scores to graduation rates to total cost.<br /><br />[Michael] Rendon, the former Ross registrar, said he agrees with the need to stiffen entrance requirements.<br /><br />'We want doctors but we can't give that kind of money to everyone who's chasing a dream of being an M.D.,' he said. 'We need to be a little bit more discriminating about who those tax dollars go to.'<br /></blockquote><br />Based on what I wrote above, these criticisms do seem very "US centric." It seems obvious that a school based in the tiny Commonwealth of Dominica, with a population of little more than 72,000, and an estimated gross domestic product of $726 million in 2008, (according to the <a href="https://www.cia.gov/library/publications/the-world-factbook/geos/do.html">CIA factbook</a>), might have trouble meeting US standards.  But instead of trying to do so, wouldn't it be better if the school could concentrate on training physicians to practice in the Caribbean region?<br /><br />But wait, it is not so simple...  <br /><br /><strong>Who  Really Owns Ross University?</strong><br /><br />It is true that the missions of most of the medical schools outside of the US which make substantial contributions to the US physician workforce are mainly to train physicians to practice within their countries.  But that description hardly applies to Ross University.  Per the St Petersburg Times,<br /><blockquote><em>Robert Ross, a commodities trader in New York, opened <strong>his medical school</strong></em> in 1978 in a motel in Dominica's capital at the suggestion of an employee whose son couldn't get into medical training in the States. By 2000, Ross had sold majority interest in both the medical school and an affiliated veterinary school in St. Kitts to a group of New York investors. Three years later, both schools were <em>acquired by <a href="http://www.devryinc.com/index.jsp"><strong>DeVry, [Inc]</strong></a> for $310 million</em>.<br /><br />Ross is the only offshore medical school <em><strong>owned by a publicly traded corporation</strong></em>, which must disclose more financial data than privately owned schools.<br /><br />Last year, DeVry, better known for its tech training schools, reported $165.7 million in net income after taxes. But the company also reported an additional <em>$140 million in tax-free income from the Ross operations</em>.<br /></blockquote><br />"<a href="http://www.rossu.edu/">Ross University</a>" <a href="http://www.rossu.edu/about/">describes itself</a> as:<br /><blockquote>Ross University is one of the largest and most successful medical educators in the world – and remains one of the great secrets in medical education.<br /><br />Since opening in 1978, Ross has been committed to our students with a rigorous curricula that mirrors the education of its U.S. peers.<br /></blockquote>I see nothing obvious on the "<a href="http://www.rossu.edu/">Ross University</a>" web-site that mentions DeVry Inc.  <br />But "Ross University" and "<em><a href="http://www.rossu.edu/medical-school/">Ross University School of Medicine</a></em>" are really just operating subsidiaries of DeVry Inc, which does <a href="http://www.devryinc.com/index.jsp">describe itself</a> as:<br /><blockquote>one of the largest publicly held, international, higher educational organizations in North America, is the parent organization for DeVry University, Ross University,....<br /></blockquote>This raises questions whether the US students who apply to the medical school know they will be taught by a for-profit US corporation?<br /><br /><br /><strong>Who Leads Ross University?</strong> <br />  <br />Note that the CEO of DeVry Inc, and his lieutenants most responsible for medical education at Ross University do not seem to have the sort of qualifications you would expect from those in charge of a "unviversity" and a medical school.  Per the DeVry Inc., web-site:<br /><br /><em><a href="http://www.devryinc.com/corporate_information/about/srmgmt_daniel_hamburger.jsp">Daniel Hamburger</a></em>:<br /><blockquote>Daniel Hamburger is <em>President and Chief Executive Officer of DeVry Inc</em>.<br /><br />Hamburger joined DeVry in 2002 as Executive Vice President, responsible for DeVry’s online operations and Becker Professional Review. He was named President and Chief Operating Officer in 2004, and Chief Executive Officer in 2006.<br /><br />Prior to DeVry, Hamburger served as Chairman and Chief Executive Officer of Indeliq (pronounced 'in-DELL-ik'), now owned by Accenture Learning. In addition, his previous experience includes serving as Division President of WW Grainger's Internet Commerce group, growing revenues from $10 million to over $100 million in one year. Previously, Hamburger started the Internet Services Group for RR Donnelley’s Metromail division, and was responsible for its venture capital investments. He also served as a consultant with Bain & Company in London, Warsaw and Boston.<br /><br />Hamburger graduated in 1986 from the University of Michigan with <em>bachelor's and master's degrees in Industrial Engineering</em>. In 1990, he earned an <em>MBA from Harvard Business School.</em><br /></blockquote><em><a href="http://www.devryinc.com/corporate_information/about/thomas_shepherd.jsp">Dr Thomas C Shepherd</a></em>:<br /><blockquote>Dr. Thomas C. Shepherd has been the <em>president of Ross University</em> since 2004. In this position, Dr. Shepherd is responsible for the operations of the School of Medicine, located in Dominica,....<br /><br />Prior to joining Ross University, Dr. Shepherd was the president of Bastyr University, a Washington-based university with multiple offerings in healthcare education. Prior to Bastyr he co-founded Royale Healthcare, Inc., a hospital management company in North Carolina, to provide hospitals and health systems throughout the United States with management and consulting services. He has served in senior management roles for a variety of [for-profit] hospitals and healthcare systems, including Hallmark Healthcare (now Community Health Systems), American Healthcorp, Inc., and HCA.<br /><br />Dr. Shepherd received a <em>bachelor of science degree in business administration</em> cum laude from Fairleigh Dickinson University in 1972, a <em>master’s degree in hospital administration</em> from George Washington University in 1975, and a <em>doctor of health administration</em> from the Medical University of South Carolina in 1999.<br /></blockquote><em><a href="http://www.devryinc.com/corporate_information/about/wiliam_hughson.jsp">William Hughson</a></em>:<br /><blockquote>William Hughson is <em>President of the Medical and Healthcare group</em> at DeVry Inc.<br /><br />Hughson joined DeVry from DaVita Inc., a leading provider of dialysis services in the United States. At DaVita, he managed a wide number of business units including co-founding DaVita at Home, and founding DaVita Rx. Prior to that, he headed Ultra Lucca from 1997-1999, which under his guidance, rebranded itself A.G. Ferrari Foods and more than doubled in size. Previously, Hughson was president and chief financial officer of Noah’s New York Bagels, which he helped to grow from one to 39 stores. Hughson began his career in the Capital Markets Division of Morgan Stanley in 1986 and subsequently worked at Bain & Company in 1990.<br /><br />He received his bachelor’s degree in English from Williams College and graduated from the Stanford Graduate School of Business with a master’s in business administration.<br /></blockquote>For their pains, Mr Hamburger had amassed 548,666 shares of DeVry stock, worth $30,966,709, at today's price of $56.44/share, and received $3,454,711 in total compensation in fiscal 2009, while Mr Shepherd had amassed 74,950 shares, worth $4,230,179,  and received $714,688, according to the <a href="http://ccbn.10kwizard.com/xml/download.php?repo=tenk&ipage=6551795&format=PDF">2009 DeVry Inc proxy statement</a>.<br /><br />Yet none of the three top leaders of DeVry Inc with responsibilities for the Ross University medical school subsidiary are physicians, have any obvious direct clinical or biomedical scientific experience, or have any educational expertise or experience.<br /><br /><strong>Conclusions</strong><br /><br />So here we have a new kind of example of what laissez faire unregulated capitalism has wrought for US health care.  The medical school in tiny, impoverished Dominica exists only to train physicians for the US not for Dominica, or the Caribbean area.  Nonetheless, the school does not do a great job: one-third of its students do not graduate even in six years, and one-fifth of those graduates never even start a residency.  Yet the students pay more than $30,000 a year in tuition, and graduate with an average debt much higher than US trained medical students.   In fact, the school is actually a subsidiary of a large, US for-profit corporation, although it is not clear if this is made obvious, or even revealed to prospective students.  The leaders to whom the school report to seem to have no expertise or background in clinical medicine, biomedical science.   Yet they are handsomely rewarded for their lack of relevant expertise and experience, and apparently for the poor performance of their graduates.<br /><br />There is something really <a href="http://hcrenewal.blogspot.com/2010/01/more-on-perversity-in-hit-world.html">perverse</a> about a nation that spends $2.3 trillion a year on health care, yet does not spend enough on medical education to educate the physicians it needs, while drawing physicians from unregulated, for-profit schools located in less developed countries, but owned by US corporations.

To Whom Does a Leading "Off-Shore" Medical School Owe its Allegiance?

We have noted how existing US medical schools seem unwilling to invest or reward teaching (see post here.)   It is no secret in academic medicine that for years, US medical schools have been unable to…

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