State Can Permit Foreign Med Schools to Train in Texas

Update, Nov. 20, 5 p.m.:

The Texas attorney general's office has ruled that no laws prevent the Texas Higher Education Coordinating Board from allowing foreign medical schools to send students to complete their training in Texas hospitals. 

"In sum, nothing in the statute indicates that foreign schools are excluded from consideration," the ruling notes. "By the same token, nothing indicates the board must include them, either."

Last spring, the coordinating board's commissioner, Raymund Paredes, recommended that the board approve the American University of the Caribbean's request to allow its students — and in particular those from Texas — to have the opportunity to spend years three and four of medical school in Texas hospitals, clerking or taking clinical electives.

Lawmakers sought an AG opinion over Texas medical schools' concerns that those students would take spots that otherwise could be claimed by in-state students. 

The AG ruling indicates that there's nothing in the current law that prohibits the coordinating board from authorizing such arrangements. But it suggests that there are also no time limits on responding to such requests, and that the board could delay so lawmakers could take up the issue in the legislative session. 

Update, 4 p.m.: On Wednesday, the Texas Higher Education Coordinating Board delayed its decision regarding American University of the Caribbean’s request for a “certificate of authority.” 

A majority of the board voted to seek an opinion from the attorney general regarding the scope of its authority to offer a certificate of authority for a private professional program. State Sen. Judith Zaffirini, D-Laredo, has questioned whether they currently have such authority. 

A certificate of authority would allow AUC to send some students to spend years three and four of medical school in Texas hospitals, clerking or taking clinical electives.

The board members also asked coordinating board staff to conduct a study of the state’s clerkship capacity and the extent to which it could accommodate students from foreign institutions.

Given these delays, the issue will not be back on the table until at least this fall.

Ernest Gibble, a spokesman for DeVry, Inc., said, "We appreciate the THECB's consideration in this matter and will work with them on a solution that serves the interests of all Texas medical students."

Original story: Depending on what the Texas Higher Education Coordinating Board decides today, Texas hospitals could soon open their doors to medical students from the Caribbean, and that prospect has the state’s medical schools fuming.

The American University of the Caribbean, a for-profit medical school owned by DeVry Inc., has requested authorization from the coordinating board to allow its students — and in particular those from Texas — to have the opportunity to spend years three and four of medical school in Texas hospitals, clerking or taking clinical electives.

AUC officials say they have followed the appropriate protocol for applying for a “certificate of authority,” received a positive recommendation from the coordinating board’s outside medical consultants, and are one step away from getting the green light to start paying Texas hospitals to train their students. Yet they are facing stiff opposition from in-state medical schools, which fear they will wrest clerkship slots from in-state students.  

In March, leaders from the state’s public medical schools sent a letter to Texas Higher Education Commissioner Raymund Paredes, who has recommended that the board grant AUC approval. The school leaders argued that allowing students from foreign schools into Texas clerkships would “displace Texas medical students in already limited clinical training settings at hospitals in our state.”

Texas medical schools, charged with increasing enrollment to meet the state’s physician shortage, are already “starting to stumble over each other” finding their students the right clerkships, said Dr. Cynthia Jumper, who heads the Texas Medical Association’s medical education council and chairs the internal medicine department at Texas Tech University Health Sciences Center. While there may be a few extra positions available now, Jumper said, there won’t be for long. 
“What extra room there is now has already been spoken for,” she said.

Senate Higher Education Chairwoman Judith Zaffirini, D-Laredo, also voiced opposition. In a letter to Fred Heldenfels, the chairman of the coordinating board, she said approving AUC’s request would set a precedent opening the door to a slew of foreign schools, and she questioned the board’s authority to approve private professional programs. “May God bless you and inspire you to agree with my perspective,” she wrote.

In response, Heldenfels said he intended to move to “impose a moratorium on future requests for foreign medical schools” until AUC’s proposed two-year approval is up for being renewed. He also noted that in September, the coordinating board staff intends to propose rules that would “significantly tighten” requirements for foreign institutions in Texas.

This didn’t satisfy Zaffirini. “We either have this available to all or we don’t,” she said. “Why should we single out one university just because that’s the first one that requested it?”

As for the question on the coordinating board’s authority to approve professional programs like those sought by AUC, the senator is mulling a request for an opinion from the attorney general. But she said she’d prefer it if the coordinating board would simply delay its decision until the Legislature could consider the matter — she insisted that it would be an open discussion, not just “a way of delaying the kill” — and make sure that the state is putting Texas students first. 

AUC officials say that’s precisely what they aim to do. “We’re trying to give Texas students and Texas residents a chance to come back and do their clinicals back home, and probably eventually stay in the state,” said Ernest Gibble, spokesman for DeVry. “The big argument is it’s going to take away slots from Texas medical students. These are Texas medical students. They just happen to be at the AUC.” 

Jumper argues there’s simply not the capacity for international schools with varying degrees of standards to try to get their students Texas clerkships. While the AUC pays U.S. hospitals to place their students, she said, American medical schools’ budgets preclude it. “In other states, such as New York, these Caribbean medical students have displaced New York State students,” she said.

AUC officials say their research shows there isn’t a shortage of clinical training spots in Texas — but that they’d still be willing to cap the number of Texas students annually at 20. (Of AUC’s 1,100 students in the fall of 2010, 90 were from Texas.) In a letter to the coordinating board in March, Bruce Kaplan, the university’s chief academic officer, vowed that they would “not engage in practices that result in displacing any Texas medical school students from obtaining a clinical learning opportunity.”

And they argue that when students complete their clinical clerkships in Texas, they’re more likely to seek residency slots in Texas — and more likely to want to practice in Texas once they’re out of medical school. Nearly 60 percent of AUC graduates practice in primary care specialties, and half practice in medically underserved areas, two of Texas’ biggest physician shortage realms. Already, AUC graduates practice medicine in 38 Texas counties.

Khushbu Sanjeev Patel was born and raised in Houston, got her undergraduate degree at UT-Austin and enrolled at AUC — all with the goal of coming back to practice in Texas. That would be so much more attainable, Patel said, if Texas — like New York, California, Florida and several other states — allowed AUC students to spend their third and fourth years in a clinical clerkship at a state hospital.

Instead, “I’ll most likely end up going to Miami or New York, and the likelihood of being able to come back to Texas diminishes,” Patel said.

“My entire family is here. This is the community I want to serve. But it makes it so much harder when we don’t get to network with Texas physicians … and to show them AUC Caribbean med students are on par with Texas medical students.”

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