As a national physician shortage looms, a 33-year-old Chicago entrepreneur has come up with a business designed to help applicants who are shut out of traditional medical schools find a way to become doctors.
Dr. Mark Kaushal, who grew up in Deerfield and earned his own medical degree in Hungary in 1999, has hatched a program called Source America, under which U.S. students can go to Eastern Europe and become an M.D. in six years.
“There are lots of smart, highly motivated kids out there who don’t get the chance to be doctors–either because they couldn’t get into med school or they can’t afford it,” Kaushal said. “Meanwhile, we have an aging population and American medical schools that can’t produce enough docs. I’d like to change that.”
In this era of managed care and skyrocketing malpractice costs, the competition to get into medical school remains as fierce as ever. At the University of Chicago, for example, some 7,520 students applied for admission to the Pritzker School of Medicine. Only 289 were accepted, of whom 112 will enroll this fall.
Cost is a barrier as well, with students graduating with a mean $115,218 of debt in 2004. This shuts out plenty of viable candidates with potential to be excellent healers, Kaushal said.
For the past two decades the number of medical students has remained relatively steady.
But now, Baby Boomers are hitting the age where they need more care and doctors are nearing retirement.
The combination of those two trends will have a “profound impact” on access to quality care, especially in underserved communities, according to the Association of American Medical Colleges, which represents accredited U.S. and Canadian medical schools.
Recently the non-profit association called for a 30 percent increase in medical school enrollment by 2015.
But Kaushal is working on a solution right now. Two years ago he started by placing about 20 students at a medical school in Slovakia.
This fall he is moving the program to Bulgaria, where costs are lower and he will enroll an incoming class of 12 students. His goal is to have 100 students participating by 2007.
Tuition, room and board costs about $10,000 a year, a quarter of tuition alone at a private medical school in the U.S.
“We deny thousands of very good students admission [to medical school] . . . then we have such shortages that we need to bring in doctors from overseas,” he said. “It is my contention that rather than importing physicians, those can be American kids.”
Last year mainstream medicine weighed in on the overall topic of foreign medical schools and raised some concerns. The medical colleges association said the country has become “overly dependent” on foreign medical school graduates, who now account for about 25 percent of all physicians in training, according to the Chronicle of Higher Education.
That reliance will only increase with the growth of the over-65 population–which is one reason that the profession must take steps to alleviate shortages that are likely to worsen during the next two decades, said Edward Salsberg, director of the AAMC Center for Workforce Studies.
But that does not mean that the group embraces Kaushal’s concept. “Very little is known about the quality of international medical schools that cater to Americans abroad,” Salsberg said. “U.S. medical schools are held to well-known, high standards and are accredited by the Liaison Committee on Medical Education. In contrast, no standard regulatory oversight exists for foreign medical schools that educate Americans.”
Two choices
The Source America initiative works like this: Qualified students have a choice of two six-year options–either going abroad right after high school for the entire program or spending two years here taking the necessary pre-med courses, then transferring to Bulgaria for the remaining four years.
Some U.S. colleges and universities, such as University of Missouri-Kansas City, also offer a six-year option, combining undergrad with med school. But many schools that had six-year programs–such as Northwestern University–have scrapped them in favor of at least three years of undergraduate education, saying the extra year gives students more maturity.
Kaushal has agreements with Oakton Community College in Skokie and Lincoln College, which has two campuses, in Lincoln and Normal, Ill., to provide the science requirements, which will be transferrable to the three largest medical centers in Bulgaria, located in Sofia, Pleven and Varna.
His program differs from the “for-profit” schools that have sprang up in the Caribbean, he said, because the European schools arelong-established institutions offering a parallel track, taught in English.
These programs are subject to the same accreditation as the native programs and the medical curricula look identical to those offered by American medical schools, Kaushal said–including anatomy, biochemistry and pharmacology, as well as clinical rotations in surgery, pediatrics and obstetrics-gynecology.
Source America, located at 3302 W. Peterson Ave., leaves acceptances and rejections up to the Bulgarian schools. Kaushal, whom the students call “Dr. Mark,” makes money by charging a $12,000 consulting fee. The tab covers the initial college visit abroad, assistance cutting through reams of red tape–from procuring the necessary transcripts to renting an apartment–and having local staff available to navigate any problems during the school year.
“The idea is so new and so out-of-the-box that it’s a little bit scary,” he said, noting that a decade ago consumers felt the same way about yoga. “But I know we’ve hit on something.”
Ankita Shah, 22, is pleased with the results. On Tuesday she was scheduled to return to school for her third year in Slovakia.
After graduating from Niles North High School in 2002 the Morton Grove resident attended Oakton for two years, hoping to transfer to the University of Illinois at Chicago to study medicine.
Instead, when a blurb about SourceAmerica in the India Tribune caught her mother’s eye, she shifted gears.
“So far, it’s worked out really well,” said Shah, who will complete her studies in 2008 and is considering pediatrics as a specialty.
But it’s not for everyone, she said. “The first year was difficult. I was a little homesick and there was the language barrier. But the second year got a lot better.
“If you’re serious about studying, it’s the place to go because you get a lot of personal attention. There’s not a lot of partying–it’s a small town and very quiet–but we like it,” said Shah, whose classmates are a tightly-knit group from Illinois, Florida and California.
Avi Gandhi of Glenview will be part of the inaugural freshman class headed to Bulgaria next month. He is excited about living abroad–but not nearly as happy as he is about becoming a doctor.
He graduated from Niles West High School with a 3.8 average (out of 4.0) and a list of activities including the swim team and president of Students Against Drunk Driving.
But his ACT score of 21 virtually sank his future before it began, he said.
“This way, I don’t have to worry about the MCATs [The Medical College Admission Tests]. I decided to take the sure thing . . . the fact that this is cheaper and I’ll save two years of my life is a bonus,” he said.
Marybeth Kravets , a college counselor at Deerfield High School and a co-author of a book on admissions, is also enthused.
“The faculty is amazing,” said Kravets, who visited the Bulgaria campuses this summer and is now serving as a pro bono adviser to the program. “All the professors have medical degrees and many have post-doctorates. . . . The educational opportunity for U.S. kids is phenomenal.”
No guarantees
Still, many physicians are skeptical–particularly when it comes to assurances that foreign-educated graduates will be able to fulfill their residency requirements at American hospitals.
“Unfortunately, no such guarantees exist,” Salsberg said.
Before entering residency training here students must pass the same board exams as those taken by domestic medical students. Applicants are then evaluated on these and other criteria that help administrators determine their qualifications, said Salsberg, adding that AAMC is considering helping American students obtain better information about foreign medical schools.
Kaushal knows that one’s career path can take some unanticipated twists and turns. A “B” student at Northwestern University, he had his heart set on being a doctor like both his parents, but grades kept him from getting a coveted fat envelope from an American medical school.
Instead, he landed in Hungary–a route also followed by his brother. After returning to the U.S., he decided that medicine “was not for me.”
But he did have a knack for business, parlaying the knowledge gleaned from abroad to his own start-up. (His younger brother, though, is a physician in Chicago).
“There are so many excellent students, who might not test well on the MCATs but would still make excellent doctors,” Kaushal said. “I don’t believe tests or grades are a true assessment of one’s ability. They certainly don’t measure compassion or bedside manner.”
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brubin@tribune.com
