Not for all schools. Current schools can and should be left intact.

As for allowing private, for-profit schools (and why they ought to be necessarily any better than any other model you’d have to explain), those seem to exist on nearly every English-speaking Caribbean island expressly for the purpose of supplying the U.S. practice market and so far..

I am suggesting for-profit schools, specifically, because of the attention they were given by Flexner when he suggested that such schools be shut down. By allowing for-profit schools, the state need not invest infrastructure funds to establishing new schools. Instead such schools (and their incumbent cost) would be borne by the private sector. The state could instead focus its funds on paying for the education of students that would most likely (given the reception to the idea that I have seen here) only be allowed to practice in their state of training. I am not suggesting that such schools would be better than any other model, however they would reduce the capital outlay of state funds while providing states with a ready supply of potential providers that would justify the risk of spending money to train them. As far as the foreign schools go… students from such schools still need to pass the same requirements as domestic students (and they are held to a higher standard in regards to the USMLE). Either the licensing standards are an objective ubiquitous standard for determining competency or they are not. We can’t have it both ways in claiming that they serve as a standard for domestic students but do not serve as a standard for foreign trained students.

If it were otherwise so compelling, where are the DeVry’s and University of Phoenix schools in this debate?

They are precluded from the debate precisely by the mechanisms enacted in the Flexner Report. I would suggest that readers make the simple effort of reading the wikipedia entry on the Flexner Report. It provides the basics and readily provides the answer to this question.

Law schools, in your example, are a poor comparison. Most nonprofit universities see their law schools as money-makers, since there is no large clinical or research enterprise required to support the educational mission.

I see it to be a perfect example (particularly in the manner that I used it in regards to Ca-only accredited law schools). When it comes to states investing money for providers for a particular field, the risk of the provider fleeing the state is minimized if they can only practice in the state in which the investment was made. The issue here is not one of producing research clinicians but of producing clinicians to meet to the basic healthcare needs of the communities in question. Again, I am not in any way suggesting the current training model be changed for current schools. I am simply suggesting that it be supplemented. Our friend’s provision of osteopathic schools, which I have now co-opted, goes to show that such a non-research affiliated model is capable of producing competent clinicians.

One would have to implement all or most of what I have suggested for the totality to work. Schools that produced providers that were not granted comity to practice anywhere else but who had the bulk of their educational expenses paid for by the state would have no greener pasture to go to if they wished to practice. In regards to the last sentence, I would agree if there were did not exist a mechanism to test for competency. If there exists a problem with the boards/residency system regarding testing of competency then we should never see these two touted as being indicative of producing clinicians that by virtue of having passed the former and completed the rather can be deemed competent. I opt for the view that these two do give some measure of determination of competency and would be sufficient to weed out the chaff if such were allowed. The final question that we should ask ourselves is from the perspective of the currently unserved. If the choice is between a provider that is 85-90% of the “best” (using whatever metric that one chooses to use) or to go without care… what would one choose?

As for allowing private, for-profit schools (and why they ought to be necessarily any better than any other model you’d have to explain), those seem to exist on nearly every English-speaking Caribbean island expressly for the purpose of supplying the U.S. practice market and so far, I don’t see that idea becoming anything other than a niche for applicants who are unable to gain admission to a U.S. mainland school. The whole idea of this kind of school smacks of the fly-by-night trade schools that look for “students” who can attend with their federally-guaranteed loan money, regardless of how well suited they are to medicine, academically or otherwise. If it were otherwise so compelling, where are the DeVry’s and University of Phoenix schools in this debate? My guess is that they already know medical schools are incredibly expensive money losers and not at all the kind of educational ventures a for-profit entity wants to go into. Law schools, in your example, are a poor comparison. Most nonprofit universities see their law schools as money-makers, since there is no large clinical or research enterprise required to support the educational mission.

People have to exercise a criminal level of negligience and incompetence to get canned from a residency and then can always find another. They all complete eventually as they are a source of cheap labor for the hospiitals.

Everyone passes liscensure exams eventually. Any imbecile can pass a test if he tries enough and preps enough. That doesn’t mean he actually has any sense or ability.

Boards are of some small use as a filter, but aren’t needed to practice and plenty practice without them.

None of that has anything to do with Hawaii. You could put a med school on every corner and still have the basic problem: a price regulated market that will not let the price adjust to economic realities in a high cost environment where the prices that the producer has to pay to live are in fact not regulated and are increasing. The inevitable result is a shortage of services.

Produce a million MD’s in Hawaii and the economics don’t change a bit. You may have more supply of MD’s but the capable will tend to melt off into greener pastures where there is more freedom to earn an income reglective of their ability. Any increase in supply will be accompanied by an decrease in quality.

The answer isn’t to beg for more reimbursement either. It is to cut loose from contracts that let others set fees. Every other business in Hawaii decides what it must charge to stay open and sets prices accordingly.

They already “allow” that. There is a private DO medical school opening in Colorado next year.

“and allow medical schools without coupling to large research institutions.”

They already “allow” that too. 90% of osteopathic medical schools have no connection to a large research university.

So are you gonna come up with somethning new or just keep repeating the same shit over and over again thats already being used in this country.

Don’t forget that other level that those unaccredited school graduates have to pass prior to become licensed. What is, or was when I took it, called the “baby bar”. Not because it was easy, but because it wasn’t the real one.

As for “crisis”, the problem with it is that there is no objective definition. It’s just a scare tactic.