This article was written by Heidi Chumley, MD (pictured), executive dean and chief academic officer at American University of the Caribbean School of Medicine (AUC).
In the November 4, 2015 edition of the New England Journal of Medicine, Dr. Fitzhugh Mullan, a respected longtime observer of physician workforce trends, articulates clearly why the often rumored residency squeeze is unlikely to occur. In the article, entitled “Why A GME Squeeze is Unlikely,” Mullan looks at the recent and projected growth of US medical school enrollment and the rate of increase of residency program positions, and calculates that while the gap between medical school graduates and positions is narrowing, it is doing so very slowly. He projects that in 2024 the number of available first-year residency positions will exceed the number of US medical school graduates by about 4,500.
So who will fill this residency surplus?
International medical graduates (IMGs) continue to seek positions in the US through the annual residency match. However, to fill the remaining residency positions and deliver physicians to communities that sorely need them, the US need not recruit physician talent away from Africa, Asia, or Latin America, thus contributing to the “brain drain” from poorer countries. Instead, US residency programs benefit from an established pipeline of US citizens trained at three long-standing medical schools based in the Caribbean.
American University of the Caribbean School of Medicine (AUC), Ross University School of Medicine (RUSM), and St. George’s University (SGU) were all founded nearly four decades ago by leaders who recognized that, one, there were more qualified medical school applicants in the US than could be trained in US medical schools and, two, that the US needed more physicians than the US medical schools could train. These three schools have addressed that need by collectively supplying more than 28,000 MD1,2,3 graduates, according to institution reports on graduates. The overwhelming majority of these medical schools’ graduates are US citizens.
What makes these schools stand out?
There are dozens of medical schools based in the Caribbean, and hundreds of schools globally with at least some students who aspire to practice in the US. Yet AUC, RUSM, and SGU stand out for several reasons: their longevity, the large numbers of US citizens attending them, and their ability to consistently perform well above international averages on important measures of medical school quality.
For example, the first-time residency match rate of the collective U.S. citizen IMG medical school students and graduates in 2015 is 53.1%4. AUC5 and RUSM6 have reported first-time match rates that are 30-35% higher than the reported averages for international medical schools. On USMLE® Step 1, which all medical students hoping to practice in the US must take, AUC5, RUSM6, and SGU7 all regularly report first-time pass rates above 90%, while the rate for “all international” medical school graduates is typically in the 70s8. (In fact, the “all international” averages on USMLE Step 1 and the residency match would be even lower if the three top-tier Caribbean medical schools were not included in the calculations.)
AUC Students Are Competitive in the Match
Detractors of Caribbean medical schools like AUC, RUSM, and SGU have often used the threat of a looming residency squeeze to warn aspiring medical students away from these three schools. Mullan’s important report in NEJM should help lay that to rest. But it’s possible that the threat of a residency shortage has been a useful motivational tool for our most determined and committed students.
At AUC, we know that our students don’t view their challenge as competing for the residency positions left unclaimed by US graduates. Rather, they study, prepare, and commit themselves as if there are far fewer positions to go around and they therefore must outperform US graduates. And so in many cases they do, and are recognized by residency program directors who select them ahead of candidates from US schools.
They select our graduates on the basis of factors such as strong USMLE performance; observed knowledge, skills, and attitudes during clinical rotations at residency training sites; likelihood to return to a particular state to practice medicine; unique international training experiences; and genuine interest in primary care specialties. Mullan’s view of the future outlook for graduate medical education supports my expectation that AUC graduates will continue to be successful in obtaining a residency match and beginning careers in medicine.
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1. Source: http://www.rossu.edu/medical-school/About-Ross-University-School-of-Medicine.cfm
2. Source: http://aucmed.edu/about.aspx
3. Source: http://sgu.edu/school-of-medicine/index.html
4. Source: Educational Commission for Foreign Medical Graduates: IMG Performance in the 2015 Match.
5. Source: http://aucmed.edu/admissions/parents-guide/outcomes-at-auc-usmle-scores,-residencies,-and-mor.aspx
6. Source: http://www.rossu.edu/medical-school/Facts-and-Figures.cfm
7. Source: http://www.sgu.edu/media/top-reasons/school-of-medicine/reason3.html
8. Source: http://www.usmle.org/performance-data/
Dr. Heidi Chumley
Posted November 20, 2015 10:54 AM