National Conference Plenary Presentation on the Contributions of Caribbean Medical Schools to Meeting the Nation's Primary Care Needs

Mary T Coleman, MD, Ph.D.

The concluding session of the first National Conference day is a plenary discussion – the first on the subject after 20 years of conferences –  on the contributions of the Caribbean medical schools to the nation’s physician supply, particularly that of Ross University. Three of the Ross faculty, each with distinguished careers in primary health care physician education, will make the presentation.

The Ross University team will be comprised of medical school dean Mary Thoesen Coleman, the Chair of Integrated Medicine, Doctor Allan Wilke (a senior fellow of the National Consortium on Community-based Medical Education) and Doctor Enrique Fernandez.

Dr Wilke posed the question “Now that the Patient Protection and Affordable Care Act (PPACA) is the law of the land, what’s next?

“First question: “How do we pronounce PPACA?”  Peepaca (like alpaca)? I can’t believe someone couldn’t have come up with a catchier acronym, something along the lines of the USA PATRIOT Act (Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act). How about the HEALTHI Act (Helping Each American Live wiTh Health Insurance)?

“Second question: “Who will provide the care for an additional 32 million Americans?”  The good news is, if you are a physician providing the care or an educator training the physicians, the provisions don’t kick until January 1, 2014. The bad news is if you are one of the uninsured and you don’t have a pre-existing condition that will allow you to join a temporary high-risk pool on June 21, 2010, the provisions don’t kick in until January 1, 2014.”

Allan Wilke, MD

As Darrell G. Kirch, M.D., President and CEO, Association of American Medical Colleges (AAMC), laments, “…will there be a doctor in the house to accommodate millions of newly covered Americans, as well as a rapidly growing Medicare population?

U.S. medical schools have been working diligently to expand the physician workforce through increased medical school enrollment. Congress must now join the effort by lifting caps on Medicare-supported residency positions so that future physicians can finish their training.” The AAMC reports, “The United States is expected to face a shortage of 124,000–159,000 physicians by 2025.”

There are, of course, sources of new medical school graduates other than US allopathic and osteopathic medical schools. Graduates of international medical schools (IMGs) have long contributed to the US workforce, especially in primary care. This has not gone unnoticed, however.

[Below: morning comes to a black sand beach on Dominica, the island on which the main medical school campus is located; edited image of photograph by Allan Wilke.]

As reported last November by The Chronicle of Higher Education, Former Senator (and original Obama pick for Secretary of Health and Human Services) Tom Daschle says the United States relies too heavily on IMGs to fill primary-care slots. “I don’t feel good about going to other countries and taking their best and brightest and offering them the opportunity to serve here,” he said.

[Below: student housing at Ross University, Dominica; edited image, based on a photograph by Allan Wilke.]

The Caribbean schools represent a unique IMG source. There are 56 medical schools operating in 16 Caribbean countries. Most of their students are US citizens, who for one reason or another, did not enter US medical schools. There have been lingering quality concerns about Caribbean US-citizen international medical graduates (USIMGs), however. A study by Norcini and colleagues showed wide variability among Caribbean schools in ECFMG certification, ranging from 26% to 86%.

Enrique Fernandez, MD, MScEd

With over 7,000 graduates in the last 3 decades, Ross University School of Medicine is the largest single provider of physicians to the US healthcare system, in general, and primary care physicians, in particular.

“Ninety-one percent (91%) of our students are US citizens or permanent residents.” Dr Wilke reported. “We are committed to continuous quality improvement of our curriculum and clinical training to ensure our graduates meet the needs of the US healthcare system.

“We will discuss the high quality primary care physicians trained by RUSM, why paying close attention to international medical education benefits US health systems, and why leaders of US primary care have a huge stake in ensuring that IMGs meet standards of quality in education and training.”