Above Dr. Moazzum Bajwa meets with patient Jos Luis Garcia at the Riverside University Health System Medical Center.

MORENO VALLEY, Calif. Its easy to dismiss the for-profit medical schools that dot many a Caribbean island as scams, set up to woo unqualified students who rack up huge debts, drop out in staggering numbers, and if they make it to graduation end up with an all but worthless degree.

But the schools are determined to change that image. Many are churning out doctors who are eager to work in poor, rural, and underserved communities. Their graduates embrace primary care and family practice, in part because theyre often shut out of training slots for more lucrative specialties.

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And they just might help solve an urgent physician shortage in California and beyond.

The deans of two of the Caribbeans medical schools, Ross University School of Medicine in Dominica and American University of the Caribbean in St. Maarten, are on an aggressive campaign to improve their image. Theyve published a series of editorials and letters with titles like Why malign overseas medical students? and have hired the public relations giant Edelman to make the case that their humble, hard-working, compassionate students may be precisely the kinds of physicians that America needs most.

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Our students have persevered. They havent had all the opportunities in life and they still want to help people, said Dr. Heidi Chumley, dean of the American University of the Caribbean School of Medicine. Absolutely, we want to get our story out.

That story is unfolding on the ground in places like Moreno Valley, a city of about 200,000 in Californias Inland Empire, a former agricultural region just east of Los Angeles. Here, the Riverside University Health System Medical Center rises from a stretch of largely undeveloped land once slated for luxury housing. It acts as the countys public safety net for an ethnically diverse and mostly low-income population including patients like retired carpenter Jos Luis Garcia.

On a recent clinic visit, Garcia, 69, was following up on a urinary tract infection and his high blood sugar. He saw Dr. Moazzum Bajwa, 30, a second-year resident and graduate of Ross.

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Sitting eye to eye with Garcia, he spoke in a steady stream of Spanish. The visit lasted nearly an hour.

In an attempt to keep his patient off insulin, Bajwa had asked Garcia to improve his diet and to track blood-sugar levels after meals. Nmeros fantsticos! Bajwa exclaimed, looking at the folded sheet of carefully written numbers Garcia had brought to show him.

Bajwa, a former middle school science teacher, then spent 10 minutes drawing a careful diagram to explain to a rapt Garcia exactly why certain foods raised his blood sugar. He then examined Garcia and checked his medical records.

As the visit was ending, Bajwa asked Garcia about stress. Garcia said his wife had recently had surgery for glioblastoma multiforme, one of the most malignant of brain tumors. Wow, Bajwa said quietly as he scanned the medical summary Garcia had handed him. Wow. He sat down again on his low stool.

Lo siento mucho, seor, Bajwa said, clearly moved.

Then he gave Garcia a hug.

This is a very great doctor, Garcia said later, through a translator. Normally, I dont feel important.

Bajwa, a US citizen raised in Michigan and North Carolina, is the grandson of Pakistani Nobel physics laureate Abdus Salam and holds two advanced degrees, in neuroanatomy and public health. But he couldnt get into an American medical school. So he attended Ross.

It was the only school that gave me an opportunity, he said.

There are about 70 medical schools in the Caribbean, most of them established in recent decades and run by for-profit businesses that cater to Americans. These so-called second-chance schools accept students with lower grades and MCAT scores, or sometimes no MCAT score at all. Compared with US medical schools, tuition and dropout rates are higher and class sizes larger. Ross, for example, enrolls more than 900 students per year.

Graduates can practice medicine in the United States after passing their US licensing exams and completing a residency. But the schools have come under fire for generating a stream of students who dont end up as physicians, but do end up with crushing debt because they flunk out or dont win residencies.

One graduate of St. Georges University School of Medicine took a poorly paying job drawing blood to help pay off $400,000 in medical school loans. Another graduate of AUC entered nursing school after failing to get a residency.

Are Caribbean medical schools promising something they cannot fulfill? asked Dr. Glenn Tung, an associate dean at Brown Universitys Warren Alpert Medical School who has studied the schools. What Im concerned about is the cost to the students who dont make it and the cost to the American taxpayer when loans arent repaid.

Illinois Senator Richard Durbin has repeatedly introduced bipartisan legislation to strip the schools of Title IV federal funding for student loans. Three Caribbean medical schools Ross, AUC, and St. Georges took in $450 million in federal funding via student loans in 2012, Durbin said.

These for-profit Caribbean medical schools need to be accountable to their students and to US taxpayers, he said in a statement.

Dean Chumley and Dr. Joseph Flaherty, the dean of Ross, take exception to such criticism.

They acknowledge many for-profit medical schools arent doing a good job training and developing students. But they argue that AUC and Ross, two of the oldest Caribbean schools both owned by the for-profit educational juggernaut DeVry Inc. are creating successful doctors.

Obviously, brains help, but judgment, empathy, intuition, thats all part of it, Flaherty said. Our students are gung-ho.

Just 54 percent of US medical graduates who trained overseas are matched with a residency program in their first year of eligibility. Thats an abysmal record, compared with the 94 percent for graduates of US schools. But Ross and AUC say they have match rates higher than 86 percent. And they say a vast majority of students pass their step 1 licensing exams on the first try.

The schools are also controversial because they buy their way into hospitals to train students. In 2012, Ross inked a contract beating out rival St. Georges University School of Medicine of Grenada to pay $35 million over a decade to the cash-strapped Kern Medical Center in Bakersfield in exchange for the lions share of the hospitals roughly 100 rotation spots for third-year medical students.

Some critics fear such deals will squeeze American-trained students out of rotations; disputes have flared in New York, where St. George paid $100 million for rotation spots, and in Texas, where lawmakers attempted to ban Caribbean students from training in the state.

But Flaherty, Rosss dean, said such deals are a win-win. A struggling hospital gets funds. His school, which has no teaching hospital, gets a place to train students.

The doctors get to know our students and say, These guys are good, he said.

While their numbers are up, its still harder for international medical grads known as IMGs to get residency positions. Theyve heard all the jokes about studying anatomy on the beach with mai tais in hand. But when it comes to residency positions, they are deadly serious.

You have to apply very widely. Theres always a stigma that IMGs dont get as good an education. said Rina Seerke-Teper, 31, a second-year resident who has wanted to be a doctor since she was 6. She graduated from the University of California Berkeley and worked in stem cell research before attending AUC.

Many Caribbean graduates dont even apply to residency programs that are filled only with American trained students. Instead, they look for IMG friendly programs like the family practice residency here, run in a busy clinic housed within the county hospital. The program is highly competitive about 800 applications for 12 positions each year and of the three dozen current residents, 29 studied in a medical school outside the United States.

Competition for the coveted slots is likely to grow even more as California, which just got one new medical school and is slated to soon add another, starts spitting out more locally trained graduates.

California will need an estimated 8,000 additional primary care doctors by 2030. The United States as a whole is projected to need some 30,000 additional primary care physicians in the coming decades.

Dr. Michelle Quiogue works in one of the areas hit hardest by the shortage, rural Kern County. A graduate of a prestigious medical school Brown Universitys Quiogue has worked alongside many foreign-trained doctors and would never know what college they graduated from.

In her mind, the problem is not a lack of medical students but a lack of residency programs to train them. The governor has proposed cutting $100 million for primary care residency training, and her organization, the California Academy of Family Physicians, is scrambling to get it replaced.

I have never heard a patient ask where a physician is trained, said Carly Barruga, a third-year medical student at nearby Loma Linda University who said she is getting excellent training in her rotation here from Caribbean-trained doctors like Dr. Tavinder Singh.

Singh, 30, is chief resident here and a Ross graduate. Singh didnt apply to US medical schools because his MCATs werent as strong as they should have been. He didnt want to wait a year to retake them.

While Singh was once the one begging for a chance, the tables have turned. In a state hungry for family practice physicians, hes now fielding numerous job offers.

For now, though, hes just happy to be practicing medicine. He loves helping patients like Wendy Ocampo, a 19-year-old with limb girdle muscular dystrophy. During an appointment this month, Ocampo came in to see Bajwa with respiratory symptoms.

It was supposed to be a quick visit, but he ended up spending a half-hour with her once he discovered bureaucratic hurdles had left her waiting seven months for the wheelchair she needs for her job and college.

It burns me up that these things are falling through the cracks, said Bajwa, after taking a few minutes to compliment Ocampos impressive new shoes and ask if she was growing out her hair.

Though sick, Ocampo beamed. Honestly, hes great, she said. He calls me to check on me. I have, like, 30 doctors and none of them have ever done that.

See more here:

Caribbean medical schools get a second look - The Boston Globe