Letter: Medical hustle and flow in the Caribbean


Dear Sir:

After graduating from college, I made a trek to the Caribbean islands to accomplish a goal of getting an MD.

Medical schools in the Caribbean use a "cumulative and segmented learning" system. The first part involves a rigorous 16 months of basic sciences on a Caribbean island usually taught by a non-US international faculty. The ensuing 4-7 months and most critical phase, usually somewhere in the US, includes self-preparation for a board exam and an introductory course in clinical medicine. The final 72 weeks of school involves clinical training throughout several hospitals in various cities.

So the overall path is clear but, as with each island, each school offers a unique experience. And unlike with US medical schools, which can be systematically ranked for prospective students, ranking the nearly 30 Caribbean medical schools is a bit more challenging. Instead, many students use a logical, but informal method to tier schools based on where they provide clinical training and graduates can get licensed.

The overall journey can be humbling but, for many students, it will be a mentally and financially draining process. A medical degree from one of these offshore schools will cost at least $80,000 and upwards for a US student, with the added bonus of having no federal loans available. And not to make things too easy, but health insurance, books, housing, food, and other administrative fees are not included. Also, since many of these offshore schools are not recognized by the US Department of Education, acquiring a student status for loan deferment purposes or other things is next to impossible. This also creates a very gray area for students because there is no governing body in the US to help regulate these schools in any sort of way. This is Caribbean medicine.

Even later down the road after graduating, the average salary for a hospital resident can range from $30,000 to $60,000 per year, and for most doctors, who have loans, will have to defer paying off the principal resulting in an accruing interest. So a medical school graduate with a five to six-figure debt could have monthly payments ranging from $1,000 to $2,000 after residency training, depending on the repayment plan. And when you venture out on your own, there are the issues of getting licensed to practice, malpractice insurance premiums, Medicare reimbursement for physicians, and the cost of running an office and other practice expenses.

Over the years, there have been countless articles and online blogs with perspectives from intelligent students, physicians, and professionals alike on the topics covered here. And despite all the information out there, offshore schools continue to sustain with new cohorts of island bound students every four months. So the conclusion is quite simple, a lot of people will do almost anything to become doctors and fortunately, there are business savvy minds out there creating paths to allow some achieve that goal.

And the point here is not to paint an unflattering picture about becoming a doctor because it can be a very noble profession. Hopefully though, it is clear that the journey of becoming a physician when traveling "Caribbean Air" requires a lot of grit and determination. And some tolerance to a little Caribbean hustle and flow would not hurt either.

Mahesh Yaragatti



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