MORENO VALLEY, Calif. — It’s easy to dismiss the for-profit medical schools that dot many a Caribbean island as scams, set up to woo unqualified students who rack up huge debts, drop out in staggering numbers, and — if they make it to graduation — end up with an all but worthless degree. That’s been the rap against them for years.

But the schools are determined to change that image. Many are quietly churning out doctors who are eager to work in poor, rural, and underserved communities. Their graduates embrace primary care and family practice, in part because they’re often shut out of training slots for more lucrative specialties.

And they just might help solve an urgent physician shortage in California and beyond.

The deans of two of the Caribbean’s medical schools — Ross University School of Medicine in Dominica and American University of the Caribbean in St. Maarten — are on an aggressive campaign to improve their image. They’ve published a series of editorials and letters with titles like “Why malign overseas medical students?” and hired public relations giant Edelman to make the case that their humble, hard-working, and compassionate students may be precisely the kinds of physicians America needs most.

“Our students have persevered. They haven’t had all the opportunities in life and they still want to help people,” said Dr. Heidi Chumley, dean of American University of the Caribbean School of Medicine. “Absolutely we want to get our story out.”

That story is unfolding on the ground in places like Moreno Valley, a city of about 200,000 in California’s Inland Empire, a former agricultural region just east of Los Angeles that grew explosively in the ’80s but has since fallen on harder times.

Here, the Riverside University Health System Medical Center rises from a stretch of largely undeveloped land once slated for luxury housing developments. The health system acts as the county’s public safety net for an ethnically diverse, mostly low-income population — including patients like retired carpenter José Luis Garcia.

Bajwa checks over a log documenting his patient’s blood sugar levels after meals.

On a recent clinic visit, Garcia, 69, came in to follow up on a urinary tract infection and his high blood sugar. He saw Dr. Moazzum Bajwa, 30, a second-year resident and graduate of Ross.

In a crisp white coat and bow tie, Bajwa entered the examining room and pulled up a low stool. Sitting eye to eye with Garcia, he spoke in a steady stream of fluent Spanish. The visit lasted nearly an hour.

In an attempt to keep his patient off insulin, Bajwa had asked Garcia to improve his diet and track blood sugar levels after meals. “Números fantásticos!,” Bajwa exclaimed, looking at the folded sheet of carefully written numbers Garcia had brought to show him.

“This is a very great doctor. Normally, I don’t feel important.”

José Luis Garcia, patient

Bajwa, a former middle school science teacher, then spent 10 minutes drawing a careful diagram — complete with neurons, intestinal walls, and red blood cells, or células rojas — to explain to a rapt Garcia exactly why certain foods raised his blood sugar. He then examined Garcia — noting he had a harmless but interesting muscle wall abnormality — and checked his medical records. Was there a colonoscopy report on file? Retinal photos?

As the visit was ending, Bajwa asked Garcia about stress. Garcia said his wife had recently had surgery for glioblastoma multiforme, one of the most malignant of brain tumors. “Wow,” Bajwa said quietly as he quickly scanned the medical summary Garcia handed him. “Wow.” He sat down again on his low stool.

Lo siento mucho, señor,” Bajwa said, clearly moved.

Then he gave Garcia a hug.

“This is a very great doctor,” Garcia said later, through a translator. “Normally, I don’t feel important.”

Bajwa, an American citizen raised in Michigan and North Carolina, is the grandson of Pakistani Nobel physics laureate Abdus Salam and holds two advanced degrees, one in neuroanatomy and one in public health. But he couldn’t get into an American medical school. So he attended Ross University in Dominica.

Bajwa joined the family medicine program after graduating from Ross University School of Medicine in Dominica.

“It was the only school that gave me an opportunity,” he said.

‘Second-chance’ schools under fire

There are some 70 medical schools throughout the Caribbean, most of them established in recent decades and run by for-profit businesses that cater to Americans.

These so-called “second chance” schools accept students with poorer grades and lower MCAT scores, or sometimes no MCAT score at all. Compared to American medical schools, their tuition and dropout rates are higher and their class sizes large: Ross enrolls more than 900 students per year.

Graduates can practice medicine in the United States after passing their American medical licensing exams and completing a residency. But the schools have come under fire for generating a stream of students who don’t end up as physicians, but do end up with crushing medical school debt because they flunk out or don’t win residency spots after graduating.

Heartbreaking stories abound: One graduate of St. George’s University School of Medicine took a poor-paying job drawing blood to help pay off $400,000 in medical school loans. Another graduate of AUC entered nursing school after failing to get a residency.

“Are Caribbean medical schools promising something they cannot fulfill?” asked Dr. Glenn Tung, an associate dean at Brown University’s Warren Alpert Medical School who has studied the schools. “What I’m concerned about is the cost to the students who don’t make it and the cost to the American taxpayer when loans aren’t repaid.”

The Riverside University Health System Medical Center in Moreno Valley, Calif.

Illinois Senator Richard Durbin, also concerned, has repeatedly introduced bipartisan legislation to strip the schools of Title IV federal funding for student loans. Three Caribbean medical schools — Ross, AUC and St. George’s — took in $450 million federal funding via student loans in 2012, Durbin said.

“These for-profit Caribbean medical schools need to be accountable to their students and to U.S. taxpayers,” he said in a statement.

Dean Chumley and Dr. Joseph Flaherty, the dean of Ross, take strong exception to such criticism.

They allow that many for-profit medical schools — which have proliferated in the past few decades because they are proven money makers — aren’t doing a good job training and developing students. But they argue that AUC and Ross, two of the oldest Caribbean schools — both owned by for-profit educational juggernaut DeVry Inc. — are creating successful doctors.

They say they are also giving a shot to students with humble backgrounds, often minorities, who can’t get near American medical schools that focus so heavily on test scores and grades.

“Obviously brains help, but judgement, empathy, intuition, that’s all part of it,” Flaherty said. “Our students are gung-ho. They want to practice medicine. That’s their dream.”

Just 54 percent of American medical graduates who trained overseas are matched with a residency program for further training in their first year of eligibility. That’s an abysmal record, compared to the 94 percent of graduates of US schools who get residencies. But Ross and AUC say they have a match rates higher than 86 percent. And they say a vast majority of students pass their step 1 licensing exams on the first try.

“Obviously brains help, but judgement, empathy, intuition, that’s all part of it… Our students are gung-ho.”

Dr. Joseph Flaherty, dean of a Caribbean medical school

(Critics say the schools manipulate the statistics by dismissing weak students shortly before they are allowed to take the exams. Chumley said the schools do weed out poor students early on to prevent their accumulating debt, but in no way encourage poor students to stay for five semesters and then prevent them from taking the exam. “I think that’s ethically wrong,” she said.)

Controversy erupts over deals with hospitals

The schools are also controversial because of their practice of buying their way into hospitals to train students. In 2012, Ross inked a contract — beating out rival St. George’s University School of Medicine of Grenada —  to pay $35 million over a decade to the cash strapped Kern Medical Center in Bakersfield in exchange for the lion’s share of the hospital’s roughly 100 rotation spots for third-year medical students.

Some critics fear such deals will squeeze American-trained students out of rotations; disputes have flared in New York, where St. George paid $100 million for rotation spots, and in Texas, where lawmakers attempted to entirely ban Caribbean students from training in the state.

But Flaherty, Ross’s dean, says the such deals are a win-win. A struggling hospital gets funds. His school, which has no teaching hospital, gets a place to train students. And he gets to show skeptical doctors how good his students really are.

“The doctors get to know our students and say, ‘These guys are good,’” he said. “Our students get there early. They stay late and do extra work. They value any opportunity.”

And they seize those opportunities where they can find them.

While their numbers are up, it’s still harder for international medical grads — known as “IMGs” — to get residency positions. They’ve heard all the jokes about studying anatomy on the beach with Mai Tais in hand. But when it comes to residency positions, they are deadly serious. For there is no practicing medicine without one.

“You have to apply very widely. There’s always a stigma that IMGs don’t get as good an education.”  said Rina Seerke-Teper, 31, a second-year resident who has wanted to be a doctor since she was six, graduated from the University of California at Berkeley and worked in stem cell research before attending AUC.

Dr. Rina Seerke-Teper, a resident at Riverside University Health System.

Many Caribbean graduates don’t even apply to residency programs that are filled only with American trained students. Instead, they look for “IMG friendly” programs like the family practice residency here, run in a busy clinic housed within the county hospital. The program is highly competitive — receiving about 800 applications for 12 positions each year — and of the three dozen current residents, 29 studied in a medical school outside the US.

Competition for the coveted slots is likely to grow even more as California, which just got one new medical schools and is slated to soon add another, starts spitting out more locally trained grads.

A desperate need for more doctors

More doctors are desperately needed: California will need an estimated 8,000 additional primary care doctors by 2030. The United States as a whole is projected to need some 30,000 additional primary care physicians in coming decades.

Dr. Michelle Quiogue works in one of the areas hit hardest by the shortage — rural Kern County. A graduate of a prestigious medical school — at Brown University — Quiogue says she’s worked alongside many foreign-trained doctors and “would never know what college they graduated from.”

In her mind, the problem is not a lack of medical students but a lack of residency programs to train them. The governor has proposed cutting $100 million for primary care residency training, and her organization, the California Academy of Family Physicians, is scrambling to get it replaced.

Those who do win residency spots say it seems to matter less and less where they went to school as they climb up the medical training ladder. And it seems to matter not at all in clinics where patients are grateful for any medical care they receive.

“I have never heard a patient ask where a physician is trained,” said Carly Barruga, a third year medical student at nearby Loma Linda University who said she is getting excellent training in her rotation here from Caribbean-trained doctors like Dr. Tavinder Singh.

Singh, 30, is chief resident here and also a graduate of Ross. While he traces his interest in medicine to the open heart surgery his grandmother had when he was a boy, Singh didn’t apply to American medical schools because his MCATs weren’t as strong as they should have been. He didn’t want to wait a year to retake them.

“I had the goal in mind I was going to be a doctor,” said Singh, a California native. “Nothing was going to stop me.” He’s loved his residency, especially the chance to work in needy communities where medical zebras — unlikely and rare diagnoses — can be common. “You see chronic disease that have never been treated,” he said. “You see rare diseases like Zika.”

Dr. Tarvinder Singh speaks with nurses between seeing patients.

While Singh was once the one begging for a chance, the tables have turned. In a state hungry for family practice physicians, he’s now fielding numerous job offers.

‘Honestly, he’s great’

Bajwa’s future is bright as well.

For now, though, he’s just happy to be practicing medicine, thrilled to be delivering babies and focusing on preventative care. He loves helping patients like Wendy Ocampo, a 19-year-old with limb girdle muscular dystrophy. During an appointment this month, Ocampo came in to see Bajwa with respiratory symptoms.

It was supposed to be a quick visit, but he ended up spending a half hour with her once he discovered bureaucratic hurdles had left her waiting seven months for the wheelchair she needs for her job and college. (Bajwa credits his clinic staff and nurses for working through lunch and juggling his schedule so he can offer longer visits.) Ocampo also hasn’t been able to get the physical therapy she needs for her ankle.

“It burns me up that these things are falling through the cracks,” said Bajwa, after taking a few minutes to compliment Ocampo’s “impressive new shoes” and ask if she was growing out her hair.

Though sick, Ocampo beamed. “Honestly, he’s great,” she said. “He calls me to check on me. I have, like, 30 doctors and none of them have ever done that.”

Correction: A previous version of this story misstated the population for Moreno Valley and the status of a proposed funding cut for residency training.

  • That’s still not enough. The us has increased by 45 million people since 2003. When medical schools take in 100 students at most that 30% is still not making a dent. You need to wake up and stop misleading people.

  • AAMC data has 30% increase in US MD positions since 2003. I have tracked these for decades. Stop misinformation. Stop promotions. Be kind to potential graduates. Keep them informed properly. Those who do the training are not.

    And when the baby boomers are thinning out, the elderly drivers of demand will level out. 2010 to 2030 was the time of their big increase.

  • Robert the population has increased and the number of us medical schools seats have not. Your information is incorrect. The DO and carribean schools keep up with the physical shortage. Especially when the baby boomers are all retiring

  • Once again – there is absolutely positively no need for additional expansions of any source of NP PA DO or MD graduates – zero, zip, nada. Be very careful about considering any health professional career at the current time. The health professional leaders have completely lost touch with what they are all doing – to the graduates that they are producing. They cannot guarantee a job, much less a good job, because of the massive gluts of graduates being created.

    Current levels of expansion in recent decades are many times the annual population growth and far exceed the increases in health care spending (and the health professional spending category is stagnant). No more dollars should dictate limited expansion.

    The evidence about workforce is very clear. One should not expand any health professional workforce faster than population growth at 0.6% or 1.2% a year considering the temporary increase in the elderly (which may be tempered by virus).

    To expand workforce one must expand dollars. There is no indication of expansion of health care dollars related to the team members who deliver the care. Increases are eaten up by management, administration, middlemen, hospital care, drugs, and highly specialized care. There is a substantial and successful lobby plus common business practices (profit motive) that prevents more dollars going to those who deliver the care).

    Nurse practitioners have increased from 10,000 past 35,000 annual graduates and are still increasing at 6 – 7% a year. This is the best example of the diploma mill expansions going on. The glut will mostly impact NP but will impact all others as well.

    Physician assistants and osteopathic physicians (and likely Caribbean grads) have been increasing at about 8 to 10 times the annual population growth rate. Studies document that increases in these graduates yield no additional primary care as the sources produce that much less due to fewer entering and staying in primary care. US MD expansions of 30% since 2003 are associated with lower levels of primary care result as so few enter and stay.

    Shortages of workforce are about shortages of dollars to support that workforce – rural areas, underserved areas, areas with Medicare and Medicaid patients, and counties lowest in health care workforce.

    The dollars to support generalists and general specialists in the 2621 counties lowest in health care workforce with 40% of the US population have been declining. This primary care segment with about 60,000 to 70,000 primary care physicians (half enough) had 38 billion to invest in team members in 2008 but HITECH to MACRA to Primary Care Medical Home at only 30% penetration for each has subtracted (stolen, diverted) 8 billion from these practices a year. They now have only 30 billion to invest in primary care delivery. They require 90 billion for adequate and higher functioning primary care. Instead they retain even fewer dollars thanks to CMS and other payers. Their dollars are shrinking and are diverted away (creating more disparities) and the population is growing fastest in numbers, demand, and complexity – reaching 50% of the US pop by the 2050s (minus virus changes).

    As long as the US has the worst public and private insurance plans concentrated where most Americans most need care, the shortages and access barriers will remain.

    Enter coronavirus in these places where practices, emergency rooms, and hospitals are most being penalized, closed, and compromised where the elderly and chronically ill are concentrated – total nightmare.

  • Caribbean medical schools like Windsor School of medicine has been producing doctors to full fill the market needs in healthcare. Quality of education is highly appreciated by western doctors.

  • To be realistic about it United States medical examination step 1 is no longer score exam it’s pass-fail

  • Health of a human is a serious issue.
    It seems that now it is fall in the categories of good or bad potatoes in a store.
    The bipartisan congress efforts desperately calls for elimination of these school to save first human life and second the tax payer money and restore the dignity , prestige and
    respect for this respectable profession.America can do it!!!!

  • I’m applying to Ross. My. mcat scores are high 513 GPA 3.7. I just don’t want to study in United States medical school there’s too much distraction for me ex-wife family and friends I just need to get away from United States for a while

    • You should really think about SGU over Ross. Their stats are way better and much lower attrition rate. Also almost double the affiliated hospitals than Ross. I also went down to visit Ross and the dorms are 25 min bus ride from campus. Not something Im willing to do daily

    • Jim, I went to SGU for similar reasons. As you know, medical school requires intense dedication to study. I chose SGU, because the distraction of TV, internet, and family likely would have caused me to fail out of medical school. Good luck on your endeavors and to all out there; I read an article that SGU is on pace to have placed more doctors in US residency than any other school, including American schools. I thank God almost every day as I practice Plastic Surgery for the opportunity the Caribbean schools provide.
      I do find it interesting that articles never sort of mention the drop out rate at American schools or the substantial debt graduates are labored with. Also, this article mentions that the Caribbean schools had to pay for rotations in hospitals. That is how it works. Then you look at an American University Medical teaching hospital. The hospital receives significant funds from tax payer dollars to stay afloat. Then the “University”, who had their students pay for tuition, sends their graduates to the hospital and taxpayers pay the hospital for resident training. Which based on the figures floated from the recent Philadelphia hospital closure are very substantial. So the only thing I see is that Caribbean schools are offering a different model of training and of course it flies against the ingrained, corrupt model of American training.
      As you all know, the typical IMG is much harder working, more dedicated and typically end up being much better doctors than the American grads.
      Good luck changing the World!
      Floyd Herman, MD, MS
      Board Certified by The American Board of Plastic Surgery

  • Great thanks for your view but we will still be pursing medical school. You seem like someone that is bitter towards the system. My father is an actual physician and a medical director and we talk about this extensively. You are disagreed with and again your views do not represent the majority.

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