President's Blog

Dear Dr. Levine:
 
In the June 4, “This New England” blog of the Providence (RI) Journal, Stephen Rodger, Founder of the Rhode Island School of Osteopathic Medicine and President of R3 Education discusses and advocates the proposed school and addresses its for-profit status.  Frankly, the piece is well-written and one of the more cogent arguments supporting for-profit medical education.  Unfortunately, Mr. Rodger omitted some pertinent data that will have potentially negative implications for this profession, should the school be accredited.
 
Nowhere in the article does he describe the mission and motivations of R3 Education, or even make any reference to R3 Education.  His association is only mentioned by the Journal in a brief biographical signature line.  R3 Education is a Massachusetts-based holding company that acquires and manages for-profit medical schools in the Caribbean, including Saba University School of Medicine, the Medical University of the Americas and St. Matthew’s University.  Is it not curious that a company with no ties or historical relationship with osteopathic medicine, whose core business is for-profit MD (allopathic) schools, now wants to open a DO (osteopathic) school in Rhode Island, which is not most people’s idea of a state suffering from a physician shortage?  Actually, it is just good business.  The Caribbean medical school industry is facing a crisis of sorts, as their graduates are finding it increasingly difficult to match into US residency programs.  Allopathic and osteopathic school enrollments in the US have greatly increased, while federal funding for residency positions is capped at 1997 levels.  Many residency programs in the US no longer consider graduates of Caribbean schools, regardless of their qualifications, as there are ample US applicants.  I have personally seen this in multiple ACGME programs and, of course, AOA residency programs have never been open to Caribbean allopathic graduates.  So, to protect their business, the Caribbean schools need to open de facto US campuses.  The easiest way to do this is by opening osteopathic schools, which are accredited by COCA, a more permissive body than the LCME, which accredits MD schools.  The pioneer for this was the Rocky Vista College of Osteopathic Medicine in Denver, whose founder/owner, was associated with the American University of the Caribbean School of Medicine.  Its success in opening and operating as the only for-profit medical school in the industrialized world has paved the way for the “Caribbean gold rush”, as these institutions look for a way to sustain their business model.  Whether or not this is a good thing is subject to debate, but it is disingenuous to argue that the primary motivation behind this school is a humanitarian concern for the health and welfare of the people and state of Rhode Island.  Indeed, one of the Deans of Brown University has already commented that for-profit education may be inferior to not-for-profit.
 
Dr. Levine, is this the future of our profession?  Given your history in Osteopathic Medicine, you know far better than me the struggles we have undergone to become a credible and full member of the US medical community.  I am concerned that, not only does this tarnish the profession to the public eye, it puts us at jeopardy when difficult decisions are made at the Federal level regarding educational funding and support.  When Brown University competes with the Rhode Island Caribbean consortium, who do you think will be left short?  Ultimately, we will become doctors of a lesser sort, who will eventually be supplanted by nurse practitioners and other allied health professionals.  While the pro and con arguments regarding for-profit education have been discussed ad nauseam, it is basically a question of whether we are “as good as possible”, or just “good enough”.  Do we invest in research and education to the fullest or do we delegate that to the allopathic profession so that the for-profit investors can realize a greater fiscal return?
 
I well understand the role of COCA and limitations of the AOA.  It is also unquestionably true, however, that you, as our president have a bully pulpit and need only to speak out regarding for-profit medical education, as the LCME already does in their accreditation standards.  The allopathic profession quite clearly and publicly states that medical education should be non-profit.  What say you?

Fraternally,
George Mychaskiw II, DO, FAAP, FACOP
Professor of Anesthesiology
AOA #50323