Teaching Hospitals Get Top Dollar to Reserve Slots for Medical Students
By Page, Leigh
MEDICAL EDUCATION Offshore schools pony up millions for clerkships; U.S. schools may be next
As U.S. medical schools respond to a call by the Association of American Medical Colleges for a 30 percent increase in class size by 2015, one of their biggest hurdles is expanding clerkships-clinical training in teaching hospitals during students’ third and fourth years.
In a nationwide poll in the May issue of the journal Academic Medicine, clerkship directors in internal medicine reported that even a 15 percent increase would require adding an average of 3.7 students to inpatient clerkships and finding almost three new inpatient sites per school. A site can be a new hospital or another specialty.
Super-Sizing Clerkships
Moreover, expanding the clerkships is complicated by a parallel growth of offshore medical schools in the Caribbean, which enroll U.S. citizens and also use clerkships at U.S. hospitals. Offshore schools pay top dollar-as much as $400 per student per week for clerkships. By contrast, U.S. schools usually don’t pay anything, offering only the prestige of an academic affiliation.
Two New York hospital organizations recently negotiated their most lucrative contracts yet for clerkships with offshore schools. Nassau University Medical Center in East Meadow in June announced a 10-year, $19 million contract with American University of the Caribbean School of Medicine in St. Maarten. New York City Health and Hospitals Corp., which operates 11 public hospitals, in July 2007 inked a 10-year, $100 million contract in with St George’s University in Grenada.
Steven Walerstein, M.D., senior vice president for medical affairs at Nassau, says a consultant advised the hospital to double clerkship positions shared with U.S. schools so that American University could buy more slots. He says Nassau needs the money- last year, it logged a $5 million deficit on a $500 million budget The funds will be used to improve educational facilities.
Health and Hospitals is one of the few institutions that already charges U.S. schools for clerkships, billing each contracted school $250,000 per year. Frank Cirillo, senior vice president of operations at HHC, says the fee “does not even cover our costs” and he will be asking them to pay more as he renegotiates their contracts over the next three years. Walerstein says Nassau won’t charge its affiliated U.S. school, Stony Brook University, this year, but “if s going to be an issue as time goes by.”
Other New York hospitals are not charging U.S. schools yet but many of them have told the schools they have no more room for their clerkships, prompting some schools, such as Albert Einstein College of Medicine in the Bronx, to shelve plans for more students.
Michael Reichgott, M.D., associate dean for clinical affairs at Albert Einstein, hopes that medical schools will not cave in to teaching hospitals’ cash demands because it could quickly spread to clerkships at all U.S. schools.
“It’s a game of chicken,” he says. “The hospital says, ‘Unless you give me more money, I won’t let your clerks come in.’ That becomes a really negative game.”-LEIGH PAGE
Copyright Health Forum Inc. Sep 2008
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