AMA House of Delegates

Compensation for clerkship positions opposed

For-profit offshore medical schools create tough competition in some states by paying for clinical training posts for their students.

By — Posted July 2, 2012

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Medical students in states such as New York and New Jersey face increasing competition for clerkship positions from offshore medical schools that are paying academic medical centers handsomely to secure slots for their students.

As a result, some U.S. medical students are having to seek clinical training in other states, delegates said at the Annual Meeting of the AMA House of Delegates.

The AMA is seeking to end the practice by advocating for federal and state legislation to oppose extraordinary compensation for clinical clerkship sites that could result in displacement of U.S. medical students.

“Our AMA supports ensuring that clinical clerkship slots are given first to students of U.S. medical schools,” says AMA policy adopted June 18.

Delegates in support of the policy testified that action is needed quickly to prevent further disruption of U.S. medical students’ education. But some delegates questioned the consequences of interfering with free-market forces at the expense of cash-strapped hospitals.

In New York, multiple teaching hospitals have discontinued long-running relationships with area medical schools or stopped offering clerkship positions to U.S. students, said Robert Viviano, regional medical student alternate delegate with the Medical Society of the State of New York.


Some clerkships are not offered to U.S. students, says med student Robert Viviano. Photo by Ted Grudzinski / AMA

“Students are being told they can’t rotate anymore,” Viviano said. “The school they are going to is saying, ‘Our hospital doesn’t have room for you anymore, because we can’t afford to charge you $20,000 to $30,000 more a year.’ We need to address this issue, and we need to address it now.”

Many of the offshore schools involved are for-profit institutions in the Caribbean that can pay significantly higher per-capita subsidies to teaching hospitals than U.S. schools, said Leonid Vydro, regional medical student delegate with the Wisconsin Medical Society, speaking on behalf of the AMA Medical Student Section.

“We are in strong support that there should not be an arms race of medical schools competing against one another for clerkship slots,” Vydro said.

But some delegates questioned the proposed policy, saying it warranted further study and debate. Many of the teaching hospitals that are accepting the payments from the offshore schools are financially distressed and need the money to cover operating costs, said Nyapati Rao, MD, chair of the International Medical Graduates Section who spoke on his own behalf.

“They are in a very precarious situation,” said Dr. Rao, a psychiatrist from East Meadow, N.Y. “This is a complex issue. It doesn’t have simple solutions.”

The real problem is the shortage of funding for hospitals and clinics to provide clerkship training, said Arthur Palamara, MD, a delegate with Florida Medical Assn. Many students at offshore medical schools are very driven and take on a lot of debt to achieve their dream of becoming a physician, he said.

“They have one thing in common, which is a burning desire to become a physician,” said Dr. Palamara, a vascular surgeon from Hollywood, Fla. “The real reason we have a problem right now is there is a shortage of training spots in he United States.”

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