This fall, the New York City Health and Hospitals Corporation will select about a dozen young New Yorkers for a new $11 million medical scholarship program. Called CityDoctors, the program will groom participants for one of the toughest health care jobs in the city: working as a primary care physician at one of the city’s 11 public hospitals, where a typical 10-hour day involves tending to as many as 40 patients with ailments ranging from diabetes to whooping cough.
To prepare for this assignment, students will begin their medical education in the most unlikely of places: the Caribbean island of Grenada, where they’ll enroll as students at St. George’s University Medical School, a for-profit institution founded in 1976 by Long Island native Charles Modica after he was rejected from U.S. medical schools. The scholarship program, which St. George’s is funding entirely, aims to provide a pathway into city hospitals for young doctors who grew up in the city, Modica says. By requiring students to commit to working one year in a city hospital for every year of free tuition, Modica hopes to ease the city’s growing shortage of primary care physicians.
But if CityDoctors, which far exceeds the size of any scholarship program offered by New York schools, is St. George’s way to “give back to New York,” as Modica says, it can also be viewed as the latest offensive in a protracted turf war between St. George’s and New York City medical schools.
News of the program’s launch has faculty and students at New York’s own medical schools asking why the city has teamed up with an international medical school that few Americans have heard of (except for those who remember when U.S. forces invaded Grenada in 1983 on the pretext of evacuating St. George’s students). “Why didn’t the HHC speak with medical schools in the state with which it’s had partnerships for more than 50 years?” asks Dr. Michael J. Reichgott, a professor at the Albert Einstein College of Medicine. “Why didn’t the city come to any of us and say, ‘Let’s talk about some sort of a scholarship plan?'”
HHC president Alan Aviles declined multiple requests by the Voice to comment on why HHC chose to partner with St. George’s, a decision HHC spokesperson Evelyn Hernandez curtly explained by saying, “We have a longtime relationship with them.”
Since the 1970s, New York City’s public hospitals have offered a solution to St. George’s biggest problem: While the school is well equipped to bring students through the first two classroom-heavy years of medical school, Grenada lacks the large teaching hospital that every medical school needs for the third and fourth years, when students learn by shadowing practicing physicians. In 1978, St. George’s sent its first cohort of students to do its clinical training in New York, at Coney Island Hospital. In the years since, St. George’s has sent thousands of students to HHC hospitals and paid the perpetually cash-strapped HHC for the privilege.
The relationship was dramatically consummated five years ago when St. George’s, whose enrollment had swollen to 1,000 students per year, making it five times larger than a large U.S. medical school, signed a 10-year contract to send about 600 students per year through the city hospitals for $100 million. The agreement allows St. George’s to promise clinical training in the U.S., crucial for students who want to be more competitive as they pursue their postgraduate residencies. And it has allowed St. George’s to justify its $226,000 tuition, which is higher than most U.S. schools’.
But the agreement has angered local medical-school leaders, who two years ago banded together to petition the New York State Board of Regents to restrict access to state hospitals by offshore schools. New York medical schools have themselves long used HHC hospitals as a venue for training their third- and fourth-year students, but they have never paid to do so.
With St. George’s paying for its students to train in HHC hospitals, local students have been blocked from doing the same, according to Rob Viviano, a fourth-year student at Touro College of Osteopathic Medicine and a delegate of the American Medical Association. Dean Robert Goldberg confirms that before Touro opened in Harlem in 2007, it discussed a clinical-training arrangement with HHC hospitals in Manhattan. But HHC, he says, asked for the same payments it was getting from St. George’s, something that Goldberg says would have required 50 percent tuition hikes, and Touro students were instead sent to do their clinical training in hospitals on Long Island and in New Jersey. (Some Touro students also do clinical training at hospitals on Staten Island and in Brooklyn.)
Viviano, who grew up in the state, says the CityDoctors scholarship is an “aggressive PR move” for St. George’s, while HHC leaves “New York medical students who would love to have this same opportunity completely in the dust.”
What seems to make local medical-school faculty most irate is their perception that the HHC, lured by cash, has ushered into the city’s public hospitals a school that they regard as second-rate. St. George’s is “not following the regulations that were set up to make sure that people in the medical profession are well-trained,” says Dr. Kristina Maletz, a 2010 graduate of Columbia University College of Physicians and Surgeons who helped draft a response to the $100 million contract from the Medical Student Section of the American Medical Association.
Both Maletz and Reichgott worry that the clinical training students from offshore schools receive in U.S. hospitals is subpar because too many students are assigned to a given department of the hospital at a given time. (Under accreditation rules, U.S. schools are restricted in the number of students they can assign.) Dr. Jessica Freedman, who runs MedEdits, a medical-admissions firm, and has helped students apply to St. George’s and other offshore schools, says that crowding is “one of the things students who go to Caribbean schools complain about most. They say they can’t get access to the attendings, they can’t get their procedures done.”
Judy Wessler, director of the Commission on the Public’s Health System, a city advocacy organization, does not share these concerns. “The reports I’ve seen say that the training is good,” she says. Rather, she suggests, complaints about St. George’s are an attempt to protect the arrangement in which city schools send students into HHC hospitals without paying HHC, even when they receive tuition dollars for the time they spend there.
“It makes me furious that these medical schools are screaming about St. George’s paying HHC for training their students,” Wessler says. “I’ve asked this question of a lot of people and never get an answer: Why do the New York schools get money for the time that the students spend at HHC hospitals and not share the money with HHC?”
St. George’s alumni such as Dr. Rokshana Thanadar, a 2008 graduate, also say fears about quality are unfounded. A former anatomy and physiology instructor who attended St. George’s while in her thirties, Thanadar cites her age and a low undergraduate GPA as factors that limited her chances of being admitted to a U.S. school. Compared to the time she spent at Eastern Virginia Medical School studying for a master’s degree in biomedical sciences, she says, “I found that other than walking out the door and seeing the Caribbean Sea, there wasn’t that much of a difference.”
Allen Reeves, who attended St. George’s for three years before transferring to Northeast Ohio Medical University, concurs: “We use the same textbooks, we learn the same information, we take the same board exams, and—this was my experience before I transferred and after—we can hold our own with our U.S. counterparts.”
Indeed, though medical schools have been popping up in the Caribbean with the frequency of high-rise hotels—some estimate that there are now as many as 60 for-profit Caribbean medical schools, some of which don’t even require the MCAT for admission—St. George’s, with its high rate of residency placement, stands out, as even Reichgott concedes: “If I had to pick a [Caribbean] school that I would say, ‘This one’s not so bad,’ St. George’s is the one that I would say is not so bad.”
Even so, few St. George’s students and alumni pretend their school’s reputation matches that of U.S. schools. “The first thing you have to do is you need to exhaust all of your options onshore,” Reeves says. “I don’t think that for anybody I know their first thought when they decided, ‘I want to be a doctor,’ was to apply offshore.”
Still, HHC’s marketing campaign has drawn plenty of attention. “I saw an advertisement for it on the J train, and I looked it up,” says Antoinette Allen, a Queens native and 2012 graduate of Columbia University. But Allen says that she’ll probably try for admission to U.S. schools before applying for the CityDoctors scholarship: “My family is Caribbean. Going to school in America is the be-all, end-all. I think I would have a very difficult time explaining to my Jamaican parents why I’m going back to the Caribbean when they worked so hard to get here in the first place.”