healthy4u: brain drain

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. Brain Drain 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>.) 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.  Ross University and Its Problems The report profiled the problems at one important "off-shore" medical school. <blockquote>Ross University School of Medicine may be the biggest medical school you've never heard of. For decades, the school on the Caribbean island of Dominica has been accepting U.S. students whose poor test scores make it impossible for them to get into medical schools in the States. 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. 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. Ross and other foreign medical schools say they're responding to U.S. demand for new doctors as the population ages. 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. But federal regulators are taking a closer look at evidence suggesting taxpayers and students may be getting shortchanged by foreign medical schools. • At Ross, fewer than one-third of the students finish in four years, 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] • Since Ross, like other Caribbean medical schools, doesn't have a teaching hospital, it pays hospitals stateside for students' clinical training, with wide variations in quality. • Students of foreign medical schools like Ross graduate with higher average debt, $235,000 compared to the average $158,000 owed by graduates of U.S. medical schools, according to an August report to Congress by regulators. • About 20 percent of Ross graduates fail to land a residency, the key to a license to practice in the United States. If they cannot pay their student debts, taxpayers are left holding the bag. </blockquote> The article concludes with: <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. [Michael] Rendon, the former Ross registrar, said he agrees with the need to stiffen entrance requirements. '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.' </blockquote> 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? But wait, it is not so simple...  Who  Really Owns Ross University? 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, <blockquote>Robert Ross, a commodities trader in New York, opened his medical school 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 acquired by <a href="http://www.devryinc.com/index.jsp">DeVry, [Inc]</a> for $310 million. Ross is the only offshore medical school owned by a publicly traded corporation, which must disclose more financial data than privately owned schools. 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 $140 million in tax-free income from the Ross operations. </blockquote> "<a href="http://www.rossu.edu/">Ross University</a>" <a href="http://www.rossu.edu/about/">describes itself</a> as: <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. Since opening in 1978, Ross has been committed to our students with a rigorous curricula that mirrors the education of its U.S. peers. </blockquote>I see nothing obvious on the "<a href="http://www.rossu.edu/">Ross University</a>" web-site that mentions DeVry Inc.  But "Ross University" and "<a href="http://www.rossu.edu/medical-school/">Ross University School of Medicine</a>" are really just operating subsidiaries of DeVry Inc, which does <a href="http://www.devryinc.com/index.jsp">describe itself</a> as: <blockquote>one of the largest publicly held, international, higher educational organizations in North America, is the parent organization for DeVry University, Ross University,.... </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? Who Leads Ross University?   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: <a href="http://www.devryinc.com/corporate_information/about/srmgmt_daniel_hamburger.jsp">Daniel Hamburger</a>: <blockquote>Daniel Hamburger is President and Chief Executive Officer of DeVry Inc. 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. 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. Hamburger graduated in 1986 from the University of Michigan with bachelor's and master's degrees in Industrial Engineering. In 1990, he earned an MBA from Harvard Business School. </blockquote><a href="http://www.devryinc.com/corporate_information/about/thomas_shepherd.jsp">Dr Thomas C Shepherd</a>: <blockquote>Dr. Thomas C. Shepherd has been the president of Ross University since 2004. In this position, Dr. Shepherd is responsible for the operations of the School of Medicine, located in Dominica,.... 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. Dr. Shepherd received a bachelor of science degree in business administration cum laude from Fairleigh Dickinson University in 1972, a master’s degree in hospital administration from George Washington University in 1975, and a doctor of health administration from the Medical University of South Carolina in 1999. </blockquote><a href="http://www.devryinc.com/corporate_information/about/wiliam_hughson.jsp">William Hughson</a>: <blockquote>William Hughson is President of the Medical and Healthcare group at DeVry Inc. 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. 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. </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>. 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. Conclusions 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. 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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