Posted by: oldmedicine | June 9, 2010

Palm Beach Medical College and For-Profit Medical Education

As I’ve stated before, education is a bubble. The student loan situation in this country is making things look increasingly shaky in the world of high finance. If you weren’t aware, Wall Street makes it easy for 18 year olds to secure guarantees of hundreds of thousands of dollars to attend the school of their, and their parent’s, choice.  The reason that Wall Street makes it easy is because Washington makes it easy – the loans that banks make are guaranteed by the federal government.  These loans are impossible to discharge: personal bankruptcy doesn’t get you out of your student loan debt, and your untimely death is also unlikely to help.  Since the government is on the hook, they can garnish your wages and take your tax returns if you don’t pay. If you go into medical school with zero savings and expect to finance it all through loans, expect to be paying about $1500 dollars a month for 30 years. If you have a mortgage, you know the deal, except the interest is usually much higher and there are no granite countertops.

Of course, since you will be a Doctor of Medicine and will be making the big bucks, you could just eat ramen for a year and pay it all off…maybe, 7 to 10 years after you walk through the pearly gates of your chosen medical school.  However you rationalize taking out $300,000 for medical education, just make sure you are on the right side of the bubble and aren’t destroying your life with debt before you even have the chance to earn a living.

As bright-eyed students have ridden the clichéd wave of easy money over the past ten or so years, other, more devious entities have been along for the ride.  For-profit schools have taken all of that government guaranteed money and built empires out of what were formerly non-tier backwater institutions. These for-profit schools are still garbage, they just make a lot more money now. Alas, the bloodsuckers who run fourth-rate MD schools in the Caribbean have hit the beaches like it was Normandy in 1944, gunning to monetize the “ivory tower” that is standardized medical education in the United States – they want a piece of that government gravy train just like the boys at Phoenix and Cappella and Kaplan University (stick to test prep, Kaplan, actually don’t – Examkrackers is superior for the MCAT).

The first for-profit medical school in the United States opened in 2008, run by the family that owns American University of the Caribbean – the absolute bottom tier of medical education for a U.S. citizen. For our enjoyment and educational fulfillment, these people have kindly brought Caribbean-style, for-profit medical education to the United States. Rocky Vista University (note that it’s website ends with .org instead of .edu because it is not yet fully accredited) is located in the “Denver Metroplex” and is a Osteopathic outfit.  It is in an office park, or, if you prefer, the warehouse district.

Because it isn’t accredited or linked with a university that has regional accreditation, its first four classes can’t take out government loans and must get financing from a private bank. These 600 or so people (because Osteopathic schools don’t have to limit their entering classes like MD schools) are truly in the hurt locker financially if they do not come from wealth or won the nickel slot jackpot at the local reservation casino. These private loans may, depending on credit score, have interest rates well above 10%.  Like many new Osteopathic schools, its 3rd and 4th years (the vital clinical years of medical education) are a huge question mark, and there are rumblings that things aren’t looking good for those inaugural students.

Dr. George Mychaskiw, an osteopathic anesthesiologist who is chairman of that specialty at Drexel, has put together a more coherent argument against for-profit medical education than I ever could. From his editorial in the Journal of the American Osteopathic Association(1) in opposition to Rocky Vista and its for-profit model:

  • Both for-profit and nonprofit institutions must produce a high-quality product to stay competitive in the marketplace. However, the difference between these two types of institutions lies in their use of excess revenue. In the case of a nonprofit medical school, all excess revenue is returned to the institution and used to improve its facilities, expand its programs, and engage in research to increase the existing body of medical and scientific knowledge. Frequently, these endeavors realize no short-term reward for the school and would be viewed as fruitless in the for-profit world.
  • When the health care funding crisis occurs, as it inevitably will, what is going to get cut first- the large non-profit medical schools (providing patient care, education, and research) or the smaller for-profit medical schools (generating income for real estate investors)?

Finally, Mychaskiw quotes Abraham Flexner – the author of the study that summarily destroyed the pervasive and unimpressive for-profit medical education system in the United States one hundred years ago:

  • Such exploitation of medical education is strangely inconsistent with the social aspects of medical practice…the medical profession is an organ differentiated by society for its highest purposes, not as a business to be exploited.

Without diving into the ethical and philosophical reasons for avoiding for profit medical education in the United States and elsewhere,  I view attending Rocky Vista as a risky proposition and would avoid it unless you truly have no other options in the United States.

Let us now turn to the newest “innovator” in medical education – Palm Beach Medical College.  The first thing that sends up warning flares in my skeptical brain is the fact that its name is the most similar name I have heard to Hollywood Upstairs Medical College, the school that Dr. Nick from The Simpsons attended. The second thing is its website, which is chock full of crappy stock photography of people in white coats.  I hate that.

This school has applied for candidate school status with the LCME, which basically means that it has paid a $25,000 dollar fee to be studied as a possible new site for medical education.  According to the recent report by Michael Whitcomb, MD for the Josiah Macy, Jr. Foundation (3rd report down, .pdf file), this school will be a for-profit MD institution – something that is expressly forbidden in the LCME accreditation standards:

I. INSTITUTIONAL SETTING

A. Governance and Administration

IS-2. A medical school should be, or be part of, a not-for-profit institution legally authorized under applicable law to provide medical education leading to the M.D. degree.

– LCME Accreditation Standards

Now, I am not a lawyer, but there seem to be some loopholes in that sentence – most glaringly in the “be part of” modifier. It seems, on second glance, that for-profit schools are NOT expressly forbidden by the LCME. And this, future medical students, is the loophole that PBMC and the LCME are probably going to use to land the first for-profit (or “proprietary” in the language of the school’s website) MD school in 100 years down on U.S. soil. If you spend some time visiting palmbeachmedicalcollege.com you will see that a couple of organizations are listed as “affiliates”- Caridad Center and MedEDirect. The basis for the “affiliate” strategy of gaining accreditation is the Virginia Tech Carilion School of Medicine, where an independent school was tied to both a public university (Virginia Tech) and a non-profit health system (Carilion) – this provided the school with research faculty at the school and a clinical base and hospitals for students from the health system(2).  My guess is that PBMC is trying something similar, with the major caveat being that the school will be for-profit with non-profit affiliates.

PBMC’s current affiliates leave a lot to be desired. Caridad Center is a volunteer organization that provides care to the indigent. Awesome. It is also small facility that has no organic medical staff and relies totally on volunteers to provide services. Caridad is not exactly the Carilion Health System, and its ability to train students in any way is a total unknown at this point.  MedEDirect is a CME (continuing medical education) company that has a few linked CME lessons on its website.  MedEDirect also has more information on its “non-profit status” than pretty much anything else, including actual continuing medical education. There also seem to be some uncomfortable similarities between the people running PBMC and MedEDirect.

The CEO of PBMC, Dr. Carlos Martini, seems to have a lot of connections and knows how to get a med school going – in fact, he was the Vice President of Medical Education for the AMA for 11 years (that should help move things along) and has opened 5 medical schools during his career, including the new school at FIU.  Being that the AMA selects people on the board of the LCME, he is probably the best asset that PBMC has to get accreditation.

All in all, PBMC looks shady as hell, and I will be closely watching what happens with this candidate school.  I hope beyond hope that the medical community will stand together against the opening of a for-profit MD school – but the track record is poor: Rocky Vista exists.  The combination of for-profit economics, affiliates out of left field, zero university ties, and (possibly worst of all) a website filled with crappy stock photography leads me to the conclusion that it is the dawn of a dark time in medical education.  Abraham Flexner’s scathing report on medical education helped rid us of for-profit schools and quackery like homeopathy and eclectic medicine – but just as quackery has seen a resurgence, so has for-profit medical education. Sadly, the motivation to open new medical schools is not based on need, although it is there – new medical schools, especially for-profit ones, are being built to tap the never-ending funny money of educational loans. If you have ever been to Las Vegas, Riverside County, or parts of the Phoenix area, you know what the housing bubble did to people and communities – empty tracks of houses, roads to nowhere, and rotting strip-malls and McMansions.  The consequences for medicine and education in general are much greater – the loss of public confidence in our institutions and our ability to educate the next generation of doctors. Tread carefully, and be on the right side of the bubble.

(1) Mychaskiw G 2nd. Dangers of for-profit education: more than just words. J Am Osteopath Assoc. 2008 Aug;108(8):366-458; author reply 458-461.

(2) Whitcomb M. New and developing medical schools: Motivating factors, major challenges and planning strategies. Josiah Macy Jr Foundation. 2009 Oct. Accessed 7 Jun 2010.

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Responses

  1. I have to disagree with you on many issues. I understand that for profit school may not have top classs research facilities but I believe that they can provide top class education while still yearning profit. Every year many qualified applicants are not able to obtain admission and have to go to carribbean or other foreign schools. Non-profit schools have failed to address this issue and allowed carribbean schools to flourish. If for profit schools are offering a solution, i think we should stop objecting it. As this would keep qualifited applicants from going to offshore school and address physician shortage in the US. You might say people who would attend for profit schools would graduate with higher debt and more likely to pursue career based on monteary awards. I would like to give examle of people SGU, Grenada. Students here pay 45K / year and more students go to primary care than any other school in the US. In conclusion, whether for profit or non profit, we need more medical schools, and physicians.

    Just to keep haters away ( I had 32 M and 3.65 gpa from one of the top schools)

  2. they talk about for profit schools not able to provide quality education and therefore not able to provide quality care to patients but fail to address the fact that although U.S. med schools may be non profit, but U.S. health care is all for profit. So in the end whether you come from a for profit or non profit school, the actual care for the patient is for profit. And by that logic patient care sucks. FUCK YOU AMA and LCME and all you medical boards and for profit licensing outfits. Cant wait for the economic collapse so that you have to sell your souls to the for profit industries, you egomaniacal bastards. You people have hurt a lot of offshore students in a lot of ways.


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