What I Am Doing In The CaribbeanI have wanted for a long time to go to medical school. I applied to some U.S. medical schools, but I was not accepted. I had a GPA of 3.6 undergrad (for two bachelors degrees and almost a third in four years, which is not too shabby, I think) and 3.6 grad (which covered two masters degrees and a Ph.D.), not stellar, but not bad. Moreover, I scored a 30 S on the Medical Colleges Admission Test (MCAT), which is very good, especially for an admittedly middle-aged fellow (I am in my "extremely late thirties") who hadn't studied the topics tested in about 30 years. The MCAT is oddly scored. The three tests of academic skills are graded on a scale of 1-15, with those scores associated in a sliding fashion with percentiles. I scored 11 on the Verbal Reasoning Test (90th percentile), 10 on the Physical Sciences Test (85th percentile), and 9 on the Biological Sciences Test (70th percentile—it had a lot of organic chem questions, and I never liked organic chem much), and I scored an "S" on the test of writing ability (90th percentile), so 11 + 10 + 9 = 30 and S. For the writing exam, we wrote two essays, each on an appropriately bland and broad topic on which just about anyone should be able to write. We were given 30 minutes to write each essay. The writing test was graded on a scale of J through T, which looks like a mighty odd scale, indeed, until you figure out that if you assign the value 0 to J, 1 to K, 2 to L, and so on, you realize that it's just a barely disguised 0-10 scale, and I'm satisfied with a 9 of 10. I mention these facts not to brag but to suggest that I was well-qualified for medical school. Applicants to most U.S. med schools with a 30 S and a 3.6 GPA , especially applicants with two (and nearly three) advanced degrees, would likely be accepted. So I suspected something other than my ablities were in play. American medical schools say that they don't discriminate on the basis of age, but they do. I was told point blank that I was "too old to go to medical school" by the dean of admissions at one such school. Illegal? Yup. But it happened to me. I am, by the way, suing that school. But I digress. That was the bad part. Now comes the good part, which is much more fun, much more positive, and, well, good! So I said, "What the heck?" and decided to go to an off-shore med school instead. To be sure, Caribbean and other off-shore medical schools cater to a specific clientele, people who could not get into a U.S. medical school for whatever reason. Usually that reason is weak grades, weak MCAT scores, and the like, but those weaknesses don't necessarily make those folks bad candidates for medical school. Sometimes it isn't necessarily the students with the best grades who will make the best physicians. Sometimes it's the students with somewhat less than the best grades who should be admitted to med school, but they aren't. Many of those folks wind up going to off-shore med schools such as those in the Caribbean. Most of the folks I have known here are good people who want to become physicians, who will make good physicians, who should be in medical school, and came here because they couldn't get into a U.S. school. In my case, it was age that kept me out of U.S. med schools, but the effect is the same. Because I know I want to become a physician, because I believe that I will make a good physician, and because I believe that I should be in medical school, I, too, came to the Caribbean. Moreover, lest you think otherwise, be assured that the education at most off-shore medical schools is exactly the same as it is in U.S. medical schools. That is, we study exactly the same subjects because we have to know the same things. We are tested and licensed exactly the same, too. We are most definitely not discount doctors coming out of a diploma mill that grants dubious degrees, although, I grant you, there are some questionable off-shore medical schools of dubious quality, but my friends and I aren't at schools like that. Even though our alleged or apparent weaknesses kept us out of U.S. med schools, and even though these off-shore schools accepted us, that does not mean that the off-shore schools have lower standards, broader, no doubt, but not lower. As I said, with very few exceptions, the students I have met in the Caribbean will all be very good physicians, and it certainly will not be the fault of the off-shore schools in the cases of those few who turn out to be not so good physicians. It is rather short-sided on the part of medical schools, Congress, and policy makers to limit the number of entrants into U.S. medical schools as much as they have been for the past 30 years or so because we are experiencing a shortage of physicians in the U.S. now, a shortage that is likely to get worse over the next 20-50 years. Congress has held allocations to residency programs more or less level (in constant dollars) for many years because the alleged best minds thought that there would be a surplus of physicians in the U.S. They were wrong. Moreover, keeping the number of physicians artificially low raises the cost of medical care by making it scarcer, but that's a discussion in populist economic and political theory that I shall hold off on for another time. There have been but a few medical schools open in the U.S. in the past few decades, and enrollment in U.S. med schools has not increased much in those years, either, and that's why we need off-shore med schools and their graduates to fill the gap. Without foreign-trained physicians, that is, U.S. citizens that go off-shore for their medical education as well as foreign physicians who come to the U.S. to practice, the U.S. would be in big trouble. And I am glad to be here. It makes no difference to me where I get my education as long as I get it. (Moreover, I get the added benefits of living in a different country and a different culture, learning about them, expanding my understanding and my horizons, things I have always wanted to do.) The bottom line is that off-shore med schools and foreign-trained physicians practicing in the U.S. are both good things. I am, however, a little concerned that foreign physicians are deserting their own countries to come to the U.S. for a better life. That's a reasonable personal or family goal, but those physicians have a responsibility to their own people as well. If there is a physician shortage in the U.S., and there is, surely there is an even greater shortage in other countries, especially so-called third world countries. I am talking here about citizens of countries other than the U.S. who were trained as physicians at med schools in their own countries or elsewhere, and who then come to the U.S. to practice instead of practicing in their native countries. I am not talking about U.S. citizens who come to the Caribbean or elsewhere to attend a medical school with the intent of returning to the U.S. to practice. Those folks are, after all, practicing in the U.S., their home country. I think physicians should practice where they are needed, and I think their first responsibility is to the place where they grew up if that place has a need for physicians. Lovely Central Illinois does, so that's where I want to return to practice, though I wouldn't be averse to practicing elsewhere in the Midwest or Great Plains states. I reject, however, the idea of moving to a big city just because of its cultural advantages and because physicians can in general earn more money in big cities than they can in small towns and rural communities. I'll go where God sends me, and right now I hear God telling me to go back to a small town in Lovely Central Illinois. Would I rather be at the Urbana-Champaign branch of the U of I College of Medicine? Sure. The Urbana-Champaign/U of I community was my home for 33 years, and I miss it. However, it is also possible that the change of locations is good for me. Were I still living in U-C, I'd likely spend some of my time at my fraternity; at the Krannert Center for the Performing Arts; at films shown for classes and by local film societies; at the UIUC library (which is the third-largest academic library in the U.S., fourth largest over-all, truly one of the great research libraries in the world, where I have spent countless Saturdays and Sundays researching and reading whatever interested me at the moment); at IMPE, the campus rec center; at football games, basketball games, wrestling meets, gymnastic meets, track and field competitions, and the like; and ... well, you get the picture. I don't have those distractions here, so I probably get more work done here than I would were I back there. I applied to the American University of the Caribbean on the lovely island of Sint Maarten, as it's known on the Dutch side, which is where the school is located. It's the same island as Saint Martin, as it's known on the French side. I was accepted into AUC, and I left for St. Maarten on 30-APR-05. I was glad, indeed, overjoyed to be there at first because being there meant that I was finally on my way to becoming a physician. I thought I would be happy and productive at AUC, but that turned out not to be the case. While I understood the material quite well, I couldn't understand the questions on the exams because they tended to be not so much questions on the material that we had studied and learned but rather misguided journeys into deciphering how the minds of the professors worked, or, more often, didn't work as it turned out, tiny minds of petty people intent upon bullying med students and venting their own frustrations. That kind of mind, that kind of behavior has nothing to do with education. (Mind you, not all the professors were that way, but about half were.) That kind of person has no business in education. So I transferred. As God is my witness! As God is my witness! I'm never going to be hungry or answer stupid questions on stupid exams again! I'll go back to Tara! After all, tomorrow is another day! I am now a student at The College of Medicine and Health Sciences, where I am remarkably happy and doing rather well. I transferred here in January 2007. The educational philosophy here is completely different. Although the professors set very high standards, the questions that they ask on exams are perfectly reasonable, questions that actually reflect what we have been studying. So I am happy, I am doing well, and I feel for the first time that I am actually learning the material, relevant material, things that I'll actually need to know as a practicing physician, not just cramming details that aren't worth learning just for the sake of an impenetrable question on an infathomable test on irrelevant topics. I am so much happier. I shall be here about another 8 months finishing up my basic medical sciences: Anatomy, Behavioral Science (that is, medical psychology), Biochemistry, Cell Biology, Embryology, Genetics, Histology, Neuroscience, Pathology, Pharmacology, and Physiology. I took some of these classes at AUC, but I am retaking those I have already taken as well as taking those that I have not so that all my coursework and grades will come from one medical school. Because I am taking all the courses in a shortened time-frame, I am overloading a bit, but I am doing well, partly because I've taken some of them before, but mostly because of the change in educational philosophy. The courses make sense, and more importantly, the tests make sense. We also have an Introduction to Clinical Medicine course where we learn to take vital signs, make basic physical exams, take patient histories, that sort of thing. We also have problem-based case studies wherein the professor will give us the chief complaint of the presenting patient, along with the patient's history, vitals, and lab results. Based on that information, we are supposed to figure out what medical problem or problems the patient manifests and suggest a course of treatment. We also spend some of our time in the final semester at dedicated study for the United States Medical Licensing Exam Part I. Med students take this exam after two years to determine if they are allowed to go on to the two years of clinical training. I anticipate no difficulty in passing. So that's the short of it. That's what I'm doing in the Caribbean. I am a medical student who is trying to become a physician, I am happy, and I am doing well. Some folks told me before I left that I couldn't do this, couldn't be a med student, couldn't suffer the rigors of med school, couldn't become a physician. They said that I was a fool for trying, that I was wasting my time. They said that most of my friends and schoolmates up through my college years were thinking about retirement, and that I should be thinking of retirement, too, and not thinking of starting a new career, a tough career, a career in medicine, of all things. I appreciate their concern. I realize that they are only expressing their opinions because they think they understand me and what's best for me better than I do. But they don't. They don't understand what I want and what I need; they don't understand my goals, my desires, my heart, my soul, and my mind. Those are the same folks who don't understand why I and other folks, for that matter, run as much as we do, run marathons and even ultra-thons; who don't understand why I bothered finishing my Ph.D. dissertation after having let it lie fallow for so long (1985-1997—the answer, of course, was to finish it because I wanted to, and there need be no other reason); who don't understand why I bothered to earn a second masters degree; who don't understand why I can't be satisfied with a safe but unchallenging job; who don't understand that I realize that being a medical student, becoming a physician, being a physician takes a great, huge, whole lot of time, and that I'm willing to make the sacrifice; who don't understand that even though I've made that sacrifice, I still do most of the other things I want to do—things such as writing—and that I have willingly, temporarily scrunched those activities into a tiny handful of minutes every day, but that I'll get back to them later, that I'll finish all my projects, jump all my hurdles, cross all my finish lines, and achieve all my goals eventually; who don't understand that I want to get married again and become a father and a dad (which are two entirely different jobs); who don't understand that I don't feel "too old" to do anything. Most importantly, they don't understand that I never give up. And when I think about what I want to do, I don't hear the reasons why I cannot or should not do what I want to do. Instead, I hear Frank Sinatra and Eddie Hodges singing "High Hopes" in the 1959 film A Hole In The Head:
Next time you're found with your chin on the ground
I'm moving the darned rubber tree plant, and ain't nuthin' and ain't nobody gonna stop me. |