TMA Objects Substituting Medical Students Core Clerkships

TMA Testimony by David Wright, MD

Senate Higher Education Committee
Senate Bill 301
April 10, 2013

My name is David Wright, and I am a family physician in Austin and chair of the Texas Medical Association’s Council on Medical Education. I trained in Austin and have practiced medicine here for 27 years.  I am the director of a family medicine clerkship and supervise family medicine residents as well. Today, I am testifying on behalf of TMA’s 47,000 physicians and medical student members. 

Senator Zaffirini and Senator Duncan, we want to express our gratitude to you both for filing this critically important bill. It addresses a problem TMA is highly concerned about: Preserving the ability of our medical students to do their core clerkships here, at home in Texas.   

Our colleagues in New York State have urged us to adopt legislation EXACTLY like Senate Bill 301.  Without it, we are very concerned our regulatory process will not be strong enough, and our medical students may be priced out or squeezed out of critical training opportunities.  Our publicly funded medical schools cannot compete with the potential large amounts of money used by offshore medical schools to buy clerkship spots.  {We already have at least one major hospital system in the state saying it may be interested.}

In New York State, St. George’s Medical School in Grenada paid $100 million to a New York hospital system for a 10-year exclusive contract for clerkship space.  Let me emphasize this was an exclusive contract. And, St. George’s is now for sale for reportedly $1 billion!  We are talking about deep pockets.

You have worked hard for many years to keep our medical school tuition affordable. We would not want to see this changed to accommodate students from schools that do not have to meet rigorous U.S. accreditation standards.

Some have suggested capping the number of foreign student doing clerkships, at say, 20, or a set percentage. Is it reasonable to think we can really limit the number? There are 35 medical schools in the Caribbean offering instruction in English and 10 more are planned. And, these schools are much larger than our own schools. Ross University in Dominica, which is owned by DeVry, has a class size of 350 and starts three new classes a year. Our schools start one class a year, with an average of 200-220.

TMA does not support any proposal that could jeopardize the accreditation of our own medical schools. U.S. medical school accreditation standards specify core clinical training must be provided by the parent medical school.  This is the educational model the American Medical Association and TMA support.

We strongly object to substituting clerkships in the U.S. for the core clinical curriculum of foreign medical schools.    

The timing is not right for this. As you know, our medical schools are growing class enrollments in response to rapidly growing population. And, our schools and hospitals are working hard to grow graduate medical education.  We already know of cases where some students must travel across the state for core clerkships. Our schools are working with hospitals and clinics to remedy this.

Allowing foreign schools to buy clerkships does not bring in “doctors” as some will tell you.  We are talking about students.  For many years now, our state has been setting new records in bringing new physicians to the state, with more than 3,000 newly licensed per year.  We are doing many things right to improve our workforce.  We don’t need to sell our clerkship positions to accomplish this.

Texas medical students should and must come first.  We urge each committee member to do what is best for Texas, to vote favorably on SB 301.  We need this bill in Texas.
Thank you for the opportunity to testify before you today.   

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