Med school knowledgeable folks

[creekland]

I know this is a smaller percentage of those of us on the Hive, but if you have any insight, feel free to comment so my brain can process the information.

 

Why are Caribbean med schools considered inferior?  Middle son just received an advertisement for one and the cost (not to mention location) is pretty darn appealing (at least to us parents).

 

He's going to try for MSTP and if he gets that med school is free, so this question might not matter except in theory.  But if he doesn't get it (the competition is fierce), why is graduating from med school with 100K - 200K in loans better than going with a far less costly - perhaps even affordable - alternative?

 

Until middle son continued his interest in becoming a doctor I can't say I ever asked (or cared) where any doctor I saw went to med school.  Even now, I look at it merely out of curiosity rather than assigning value.

 

What am I missing?

[MeaganS]

Because the number of residencies isn't increasing at the rate med schools are pumping them out. They are more like the "University of Pheonix" of med schools and just not as respected for the more difficult than ever "match". Someone correct me if I'm wrong, but they are also officially considered foreign med students, and that just makes matching so much harder. If he wants to do family med, it probably isn't a problem. Anything else though? I wouldn't risk it if I had the choice. Matching is getting harder and harder.

That's not to say they don't get a quality education. Dh says one of his attendings went to one and is one of the best docs he knows, for example. Once he's done with residency, it would probably matter very little, but the road to residency for a foreign medical student is VERY difficult. And every year it is getting worse and worse because american med schools are upping enrollment, DO schools are gaining more respectability and coveted MD residency spots, and new med schools are opening, while residency spots are stagnating and even decreasing in proportion to the rate of increasing student.

(Dh is a second year internal medicine resident, so we are fresh out of med school right now)

 

ETA: I don't know anything about this website, but this article basically summarizes the problem with the residency shortages. http://thehill.com/blogs/congress-blog/healthcare/266610-shortage-of-residency-slots-may-have-chilling-effect-on-next

Edited April 9, 2016 by Meagan S

[bettyandbob]

I think like anything you have to do the research. What residencies are the graduates getting.

 

Over the years my family has had doctors who got degrees from Caribbean med schools. Those have been internal medicine or Pediatrics. The doctors from whom we had really awful care were specialists who were educated in the US.

[TechWife]

I know someone who went to a Carribean med school because he goofed of for three years of college before he decided he wanted to be an MD. He made solid grades his last few semesters of college but knew he couldn't get into s US med school. He went down to the Caribean and spent some time (I don't know how much) proving himself and the applied to a stateside medical school. He went to med school in his home state (he said some of his credits transferred, but I don't know the details) and matched to UNC Chapel Hill. In his case, I'd say it was beneficial. However, I don't know how much he had to repeat when he started at his state uni.

[TechWife]

Dp

Edited April 10, 2016 by TechWife

[Prairie~Phlox]

We have a friend that is going to the Caribbean medical school this fall. Her sister went there quite a few years ago & is a Md. now.

Edited April 10, 2016 by Prairie~Phlox

[Tree Frog]

I'm following along because we will be in this boat in a couple of years with dd. I know Texas Tech offers some kind of program where the university will pay the cost of tuition and books, and possibly room and board, as well as giving the students a stipend for the 4 years they're there. I didn't know going to med school in the Caribbean is even a possibility.

[creekland]

I'm following along because we will be in this boat in a couple of years with dd. I know Texas Tech offers some kind of program where the university will pay the cost of tuition and books, and possibly room and board, as well as giving the students a stipend for the 4 years they're there. I didn't know going to med school in the Caribbean is even a possibility.

 

You are fortunate to live in TX.  Your state has some affordable med school options.  PA, as usual, does not.  Even Pitt - one of our supposedly state related schools - would cost more than Johns Hopkins for a state resident, and even more than that for out of state.  Pitt is ranked pretty high (#9), but JH is ranked higher (#3).

 

If you want a terrific comparison site that will give you pretty much everything including average debt at graduation, here's a neat site:

 

http://medical-schools.startclass.com/

 

You have to register to see the info, but it's free and I don't think I've gotten any spam from them.

 

Beware that many state schools prefer their state residents, so even if they are less expensive, they aren't always options.

 

As far as the Caribbean is concerned, I'd always heard of it more or less as a joke as an option for med school, but having received the mailer... the cost and location sound appealing.  I really hate the thought of anyone graduating with 100K (or more) of debt, not to mention adding the amount in that is actually paid as well.  What we'll try to contribute will put a bit of a strain on our budget and he'll still have debt if he goes in the US (without getting MSTP).

 

This mailer talks about matching graduates in The US and Canada and says they have the same standards as US med schools.  I'd have to look up what it's talking about, but some sort of pass rate is at 96%.

 

All just musing.  He applies this year to start next.  The flyer says they are still taking applicants for 2016.  I assume we can see what results he gets by this time next year - and costs involved - then make a decision (including him on the decision of course!).  

 

I just wanted more info myself to know how I felt about it all rather than just some sort of background clutter about it, or instantly believing a flyer that came in the mail.

 

I'll admit I'm still not sure how I feel about it, but I appreciate knowing some of the potential cons.  Still, 100+K of debt is a lot of money even for a future doctor IMO.

[MeaganS]

Yeah, our plan, if Dh didn't get into me school the first year was to move to Texas and try again the next year because of the many options if you are a resident there.

 

I will say, $100,000 in debt is on the light side for medical school. The only people I know who are that low are military or their families helped. We did a great job at keeping the debt under control (state school, extreme budgeting, etc.) and are worse off than that. Just trying to be realistic.

[MeaganS]

I'd research it a bit on the student doctor forums. They are like the wtm forums of medical training,and would likely have lots more insight.

Edited April 10, 2016 by Meagan S

[Tree Frog]

I'd research it a bit on the student doctor forums. They are like the wtm forums of medical training,and would likely have lots more insight.

 

Is this the one you're referring to? 

[MeaganS]

Is this the one you're referring to?

Yup. I found it valuable when Dh was first applying for med school, then when he was applying for residency, and now fellowship. Dang, this road is long... (dd7 wasn't born yet when Dh decided to go to med school and will be almost 12 when he's done with training.)

[Catherine]

As you know I'm a veteran of the American system, and despite considerable free help with scholarships and grants, I graduated in 1990 and promptly married someone who also had huge educational debt!  Between the two of us, we owed about $130,000.  In 1990, that was enough to purchase a nice house in our area.  And despite my chronically working part time, and his choice to be an academic (less $$) in a low-paying specialty, we paid off our debts at an accelerated rate before we'd been out of residency for 5 years.  Yes, it meant living like students a little longer, but was more than worth it.  My point is only that doctors can count on having at minimum, a decent, if not huge, income.  Loans can be paid off.  It's not like borrowing 100K for a partly-completed degree in English.  

 

I don't know much about the Caribbean medical schools, but I will say that I've never once regretted the money I borrowed for a good, private secondary and professional education.  When I was a medical student, it was assumed that students did not go to the Caribbean unless they failed to get into an American school, and the few people I knew in that category reinforced that idea.  Things obviously could have changed since that time, but IMO, it's a professional liability that he would have to overcome forever.  

[MeaganS]

As you know I'm a veteran of the American system, and despite considerable free help with scholarships and grants, I graduated in 1990 and promptly married someone who also had huge educational debt! Between the two of us, we owed about $130,000. In 1990, that was enough to purchase a nice house in our area. And despite my chronically working part time, and his choice to be an academic (less $$) in a low-paying specialty, we paid off our debts at an accelerated rate before we'd been out of residency for 5 years. Yes, it meant living like students a little longer, but was more than worth it. My point is only that doctors can count on having at minimum, a decent, if not huge, income. Loans can be paid off. It's not like borrowing 100K for a partly-completed degree in English.

 

This is our plan. Even living at an increased standard of living than we are right now, we'll be able to pay off our $170,000 in student loans in 5 years or less. Med school loans aren't the end of the world if you are smart about it.

[StephanieZ]

A friend's husband went to med school in the Caribbean. Then he did his internship in the US. Then some sort of surgical residency. Then he wanted to be a neurosurgeon. He had to do at least 2-3 years of some sort of quasi-post-doc-waiting-extra-time-thing (at very low pay) trying and trying to get his neuro residency. By the time I met them, he was in his neuro residency. Now he's making $$$$$ as a neurosurgeon. SO, he got where he wanted to get, but it took a couple extra years, presumably in part due to the fact that he went to a less-than med school so had to work harder and longer to get into the very competetive residency he wanted. 

 

Note, that assuming he missed 2 years of earning 400-500k/yr (as he did his first year in practice), that's 1mil lower lifetime earnings. So, take that into account when looking at cost differences. :) 

 

In general, ppl go to the Caribbean schools who can't get into US schools. That's just the truth. If it were my kid, and it was human medicine (high enough likely salary to pay the debts), I'd encourage them to get into a US school and go there, and go to the one that was less expensive than most, and to live frugally. Then I'd just hold my breath until they were out of school and repaying those huge debts. 

 

 

[creekland]

Yeah, our plan, if Dh didn't get into me school the first year was to move to Texas and try again the next year because of the many options if you are a resident there.

 

I will say, $100,000 in debt is on the light side for medical school. The only people I know who are that low are military or their families helped. We did a great job at keeping the debt under control (state school, extreme budgeting, etc.) and are worse off than that. Just trying to be realistic.

 

Hadn't thought of encouraging him to move to TX!  He's at the point now where I've no doubt he'll get in somewhere... so I suppose that idea is a little late.  I've just been contemplating the family budget for the next few years - getting youngest out of college and thinking about that looming med school bit a year from now (more or less).  Receiving the flyer in the mail opened a path to think about and I presumed I could get some really down to earth thoughts from the Hive.  It seems I was correct on that last bit at least!

 

Many thanks for your thoughts.

 

I'd research it a bit on the student doctor forums. They are like the wtm forums of medical training,and would likely have lots more insight.

 

He's on that site.  I stay off of it.  I'm purely looking at nuts and bolts (costs) and wanted to know what I thought about the Caribbean option if/when it comes up - even in joking conversation with him.  After reading the flyer, I realized I didn't really know much of anything about it.

 

Yup. I found it valuable when Dh was first applying for med school, then when he was applying for residency, and now fellowship. Dang, this road is long... (dd7 wasn't born yet when Dh decided to go to med school and will be almost 12 when he's done with training.)

 

See... this is another thing I should have thought about long ago.  If I had graduated him upon his completion of 4th grade, he'd have been done somewhere around now.  I really wasn't looking ahead.  I could have been.  He announced to the world he wanted to be a doctor in 3rd grade... ;)

 

As you know I'm a veteran of the American system, and despite considerable free help with scholarships and grants, I graduated in 1990 and promptly married someone who also had huge educational debt!  Between the two of us, we owed about $130,000.  In 1990, that was enough to purchase a nice house in our area.  And despite my chronically working part time, and his choice to be an academic (less $$) in a low-paying specialty, we paid off our debts at an accelerated rate before we'd been out of residency for 5 years.  Yes, it meant living like students a little longer, but was more than worth it.  My point is only that doctors can count on having at minimum, a decent, if not huge, income.  Loans can be paid off.  It's not like borrowing 100K for a partly-completed degree in English.  

 

I don't know much about the Caribbean medical schools, but I will say that I've never once regretted the money I borrowed for a good, private secondary and professional education.  When I was a medical student, it was assumed that students did not go to the Caribbean unless they failed to get into an American school, and the few people I knew in that category reinforced that idea.  Things obviously could have changed since that time, but IMO, it's a professional liability that he would have to overcome forever.  

 

Thanks for your BTDT thoughts.  I hadn't really considered the professional liability part of it, but it's a good point.

 

This is our plan. Even living at an increased standard of living than we are right now, we'll be able to pay off our $170,000 in student loans in 5 years or less. Med school loans aren't the end of the world if you are smart about it.

 

I think I'm going to have to refuse to look at the numbers involved...

 

A friend's husband went to med school in the Caribbean. Then he did his internship in the US. Then some sort of surgical residency. Then he wanted to be a neurosurgeon. He had to do at least 2-3 years of some sort of quasi-post-doc-waiting-extra-time-thing (at very low pay) trying and trying to get his neuro residency. By the time I met them, he was in his neuro residency. Now he's making $$$$$ as a neurosurgeon. SO, he got where he wanted to get, but it took a couple extra years, presumably in part due to the fact that he went to a less-than med school so had to work harder and longer to get into the very competetive residency he wanted. 

 

Note, that assuming he missed 2 years of earning 400-500k/yr (as he did his first year in practice), that's 1mil lower lifetime earnings. So, take that into account when looking at cost differences. :)

 

In general, ppl go to the Caribbean schools who can't get into US schools. That's just the truth. If it were my kid, and it was human medicine (high enough likely salary to pay the debts), I'd encourage them to get into a US school and go there, and go to the one that was less expensive than most, and to live frugally. Then I'd just hold my breath until they were out of school and repaying those huge debts. 

 

Holding my breath... closing my eyes... all about the same, no?

 

Again, thanks for sharing your knowledge.  It's very much appreciated.  He's a good kid (ok, not really a kid any longer since we made him wait until 12th grade to graduate from high school).  I'm sure he'll do well.  We'll just support him as best we can and not mentally calculate how much he could end up with in loans.

 

We have, however, warned him that we'll be living in his basement for our retirement years.

[Jane Elliot]

I think loans should not be a consideration when you're choosing a medical school. (I would not say this about anything else except dental school.) There are so many great ways to get them paid off. Dh's clinic is approved for federal loan repayment because we're in a rural/doctor shortage area. He hires on doctors and mid-levels looking to get their loans repaid quickly. We went that route when dh got out of residency in '95, and there are even more options available today than there were back then.

 

And to answer your initial question: Several med students and residents per year rotate through dh's office for training. So while he did graduate med school years ago, he is still very much part of that world. He says the Caribbean schools are considered inferior and that those graduates have a harder time getting into a residency. 

[creekland]

I think loans should not be a consideration when you're choosing a medical school. (I would not say this about anything else except dental school.) There are so many great ways to get them paid off. Dh's clinic is approved for federal loan repayment because we're in a rural/doctor shortage area. He hires on doctors and mid-levels looking to get their loans repaid quickly. We went that route when dh got out of residency in '95, and there are even more options available today than there were back then.

 

And to answer your initial question: Several med students and residents per year rotate through dh's office for training. So while he did graduate med school years ago, he is still very much part of that world. He says the Caribbean schools are considered inferior and that those graduates have a harder time getting into a residency. 

 

This is really good to know - thanks!  Last I knew my guy was more interested in rural and/or shortage types of areas.  He also has an affinity for overseas medical missions having been on one and planning another.

 

I'll admit with the financial part I was wondering if taking on major loans would hinder him from considering these options if he still wanted them at the end - if it would force him to work for years in a job he didn't really like in order to earn enough to pay back the loans.  

 

It's possible he won't continue with that path if he changes his mind or gets more into research, but then again, if accepted to the research part, med school is paid for so loans won't be an issue.

[MotherGoose]

My sister is a MD and she says that those schools are somewhat looked down upon and make it harder to get accepted to a residency for the rest of your training.  

[creekland]

My sister is a MD and she says that those schools are somewhat looked down upon and make it harder to get accepted to a residency for the rest of your training.  

 

That seems to be the general consensus.  I had a vague idea that they weren't usually a first choice, but never really looked into it as to why.  The cost difference made it worth asking.  I'm still not all that thrilled with the idea of anyone having such high debt (what if something goes wrong in their lives?), but I guess that's a risk most take if coming from a less-than-wealthy heritage.

 

I'll admit I'm really hoping he gets an MSTP position... just to avoid the issue.

[MotherGoose]

That seems to be the general consensus. I had a vague idea that they weren't usually a first choice, but never really looked into it as to why. The cost difference made it worth asking. I'm still not all that thrilled with the idea of anyone having such high debt (what if something goes wrong in their lives?), but I guess that's a risk most take if coming from a less-than-wealthy heritage.

 

I'll admit I'm really hoping he gets an MSTP position... just to avoid the issue.

My sister looked into military and decided she didn't want to do that. So she has loans, don't know how much. One thing I've heard Dave Ramsey say about med school loans is that if the new dr will continue to live like a med student with dr wages for a couple of years and devote excess cash above student lifestyle to the loans you can get rid of them quickly. Don't know how many people actually do this (not my sister), and it's hard because you are usually 30 plus by the time you are done depending on specialty, that you are DONE living like a student and want a real house and some real furniture, and many docs, males at least, have picked up kids and a wife by then too.

[Jean in Newcastle]

Not about your original question, but about loan repayment options.

 

http://www.usnews.com/education/blogs/medical-school-admissions-doctor/2012/02/20/explore-new-options-to-repay-medical-school-loans

Edited April 10, 2016 by Jean in Newcastle

[Ottakee]

Can you convince him to go into pediatric psychiatry......and move to West Michigan?  We are very sadly lacking in pediatric psychiatrists in our area.  

[creekland]

Not about your original question, but about loan repayment options.

 

http://www.usnews.com/education/blogs/medical-school-admissions-doctor/2012/02/20/explore-new-options-to-repay-medical-school-loans

 

That was an encouraging article.  Thanks for sharing it.  I'm pretty sure he wouldn't want to commit up front, but toward the end when he has a better idea of what he wants to do, the loan forgiveness part could be helpful if he heads on that path.

 

Can you convince him to go into pediatric psychiatry......and move to West Michigan?  We are very sadly lacking in pediatric psychiatrists in our area.  

 

Well... considering our ages in another decade, we've been trying to sway him toward geriatrics and having a house overlooking big water (assuming we're living in his basement). :closedeyes:  He replies to us that he's going to head toward pediatrics and stay in the snowy north (probably NY vs MI though), but I like to think he's just playing with us.  :tongue_smilie:

 

In reality, he seems to still be toying with what he really wants to do.  He's shadowed a few specialties now and loves his linguistics/brain studies & research (with young kids) in general, but six/eight/ten years from now?  Who knows?  I'm sure if he gets MSTP (research), that will play a big part.  

[kitten18]

My BIL paid off his (approximately) $200,000 loans in less than 5 years after finishing residency.

It really wasn't a hardship. He's kind of a tightwad anyway and he just continued to live the way he (we) had been raised.

[raptor_dad]

Here is an article on US-IMG match rates for residency, http://skepticalscalpel.blogspot.com/2014/04/what-are-residency-prospects-for.html

 

Here are new 2016 stats, http://www.ecfmg.org/news/2016/03/30/img-performance-2016-match/

 

TL;DR: The Caribbean schools have a 53% success rate of matching students into residencies. 4th year med students at allopathic(md granting) med schools successfully match at a 93% rate. Thats matching into any residency. Matching in to either competive residncies or competitive sub specialties is going to be nearly impossible. The listed match rate for surgery was 3.5%... derm, radiology, optho, etc are probably as low or lower.

 

ETA:The domestic osteopathic med schools(DO granting) matched ~80% of their grads in 2015. Though there you may have licensing issues outside the US. 

Edited April 11, 2016 by raptor_dad

[StephanieZ]

FWIW, I am all about not having my kids go into debt for schooling.

 

However, there's no way I'd be footing the bill for med school unless I already had my own retirement very well funded (as in 2-3 million cash on hand). Loans for med school are readily available. Medicine is lucrative. Kids shouldn't go into a field requiring that huge investment unless they plan to work in the field enough to pay the loans back. (I.e., no, you can't take 10 years off full time to have babies . . . So plan to work PT to pay back the loans even if you have babies. . .  Medicine isn't a good field to take a complete time out from anyway.)

 

So, anyway, dh and I have a set dollar amount we have committed to providing to each kid for undergrad +/- anything that is leftover can be used to offset grad school. And, if one chooses to go to med/grad school in our university town, we can even offer nice free housing. (A 1000 sf deluxe inlaw apartment or a 1100 sf 3BR trailer of their own that wouldn't even be near our home but would be within 15 min of the hospital). So, those are things we can do and will do to help . . . But, med school full funding isn't going to be happening. It's totally reasonable to pay back 200-300k on a 200+/yr salary. 

 

Just saying . . . I wouldn't sweat the med school budget. I'd leave that to my adult child to figure out. I might offer to pay for a couple hours with a financial planner while s/he was in the decision making phase!

[Frances]

Graduating with more than $100K in debt but with a degree that almost guarantees a well paying job is really not that bad. Almost all of my husband's PharmD classmates, except those with working spouses, had that kind of debt, but they all had jobs that paid more than $100K at graduation. And many medical professionals receive signing bonuses and partial loan forgiveness. My husband received both and that cut our debt in half. The rest was easily paid off in four years, and it only took that long because paying it off earlier would have made us lose some of the employer loan payments.

 

Looking at things from a different angle might also help to put the potential large amount of medial school debt in perspective. If he does do an MSTP, he will likely forego more in MD income during the years spent earning the PhD than he would have paid for just the four years of medical school and living expenses. But I'm guessing he's not pursuing MSTPs for financial reasons.

Edited April 11, 2016 by Frances

[creekland]

Here is an article on US-IMG match rates for residency, http://skepticalscalpel.blogspot.com/2014/04/what-are-residency-prospects-for.html

 

Here are new 2016 stats, http://www.ecfmg.org/news/2016/03/30/img-performance-2016-match/

 

TL;DR: The Caribbean schools have a 53% success rate of matching students into residencies. 4th year med students at allopathic(md granting) med schools successfully match at a 93% rate. Thats matching into any residency. Matching in to either competive residncies or competitive sub specialties is going to be nearly impossible. The listed match rate for surgery was 3.5%... derm, radiology, optho, etc are probably as low or lower.

 

ETA:The domestic osteopathic med schools(DO granting) matched ~80% of their grads in 2015. Though there you may have licensing issues outside the US. 

 

Thanks for those.  They were quite useful to look at.  I definitely wouldn't want him to choose anything limiting his possibilities for the future.

 

But I'm guessing he's not pursuing MSTPs for financial reasons.

 

No, definitely not.  He loves research as much as he loves the medical field.  Those he's been researching with have been trying to get him to head into research instead of med school, so I suspect he's good at it.  MSTP would combine both of his loves.  If he has to choose, he's decided he still wants med school.  His apps will be sent in with the masses on June 1st.  By this time next year we ought to have an idea of what will be happening.

 

I still have the Caribbean flyer to take to him this weekend (along with his other mail that has come here), but I'll be sure to mention these other details when we give it to him.  He may know them already.  I'll find out.

[Bluegoat]

It might be interesting to look at Cuban schools, which might be more of a possibility now for Americans.  They are from what I understand considered to be very good, and the practice of medicine in Cuba is quite interesting in itself.

[creekland]

It might be interesting to look at Cuban schools, which might be more of a possibility now for Americans.  They are from what I understand considered to be very good, and the practice of medicine in Cuba is quite interesting in itself.

 

I suspect not being fluent in Spanish would be a huge con to this idea though. ;)

[Bluegoat]

I suspect not being fluent in Spanish would be a huge con to this idea though. ;)

 

I am not sure, I know the Cuban government has offered some scholarships every year to American medical students, so they may be set up to manage it.

 

My English speaking only cousin went to a French-only grad school.  He came out billingual with a PhD in biochemistry.

[creekland]

I am not sure, I know the Cuban government has offered some scholarships every year to American medical students, so they may be set up to manage it.

 

My English speaking only cousin went to a French-only grad school.  He came out billingual with a PhD in biochemistry.

 

Interesting.  I still doubt that will appeal to him TBH.  I'm not sure Caribbean in general is something he was even thinking about.  I just wanted to increase my knowledge on the subject in case it comes up - spurred by that flyer coming in the mail. 

 

I kinda like the Caribbean (in general) and if/when we planned visits, well...  :coolgleamA:  (Then there was that cost thing.  :glare:  Lower cost could have meant more visits.)

[raptor_dad]

It might be interesting to look at Cuban schools, which might be more of a possibility now for Americans.  They are from what I understand considered to be very good, and the practice of medicine in Cuba is quite interesting in itself.

 

I don't know much about the Cuban schools per se, but they are really a completely different proposition than the other Caribbean schools.

 

The Caribbean med school model is that you take your first 2 years of classroom instruction down there and then do you last 2 years of clinical rotations at hospitals mostly in NY-NJ-CT. You prep for and take the USMLE and come out with US doctor recommendations for residency... So you look similar to a US grad but weaker.

 

In Cuba, you are going to do your clinical rotations in Cuba. You aren't going to get support for USMLE prep and aren't going to have US docs writing recommendations. You will present to residencies like a true foreign medical grad. What the outcomes will look like for those kids is speculative, but I think it is certainly riskier at this point. I think Cuban schools could be a great option for primary care folks, especially the rural track family med programs, but it is just to early to say how that'll work out.

Edited April 11, 2016 by raptor_dad