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Ross University School of Medicine, in Dominica

If medical school students at Ross University were expecting to study on the beach, their plans changed in September when Hurricane Maria slammed into Dominica, the Caribbean country that hosts the for-profit institution.

Currently, students find themselves studying on a cruise ship. Their next stop? Knoxville, Tenn.

The university is relocating more than 1,400 students, faculty and staff to Lincoln Memorial University, a private, nonprofit institution, after the fall semester aboard the cruise ship wraps up. Regulatory approvals are still being finalized, Ross spokeswoman Nicole Pride said via email, and although Ross will being using Lincoln Memorial's space and anatomy lab, it will continue teaching its own curriculum.

Autry O. V. DeBusk, chairman of the LMU Board of Trustees, said that the Ross students would be on campus for approximately a year and that getting them a temporary space was the right thing to do in the wake of a disaster.

“It is the right thing to do to help these students, and we are confident that the people of Knoxville will welcome them with open arms,” he said in an email.

The arrangement makes for an odd pairing -- a nonprofit and a for-profit medical school teaching side by side -- but it’s indicative of for-profit medical schools’ expanding presence onto the U.S. mainland after a long practice of accrediting regulations exiling them to foreign shores, often in the Caribbean.

Rocky Vista University College of Osteopathic Medicine’s 2007 opening in Colorado is credited as the first for-profit medical school established in the U.S. in modern times, reversing a century-long drought of the institutions. Ross’s relocation -- though temporary -- is the latest.

Since 2007, a handful of for-profit medical schools -- both ones that grant doctor of osteopathic medicine degrees and others that grant traditional doctor of medicine degrees -- have popped up in the U.S. Critics have shunned their corporate structures, academic rigor and debt loads that graduates sometimes incur. Advocates, on the other hand, say they provide a market need where others don’t -- or won’t -- invest, especially in rural areas that are facing physician shortages. Colorado Northstate University School of Medicine and Burrell College of Osteopathic Medicine, in New Mexico, are two such examples.

The trickle of for-profit medical schools was made possible because of a 1996 legal ruling against the American Bar Association opened up the possibility of accreditation for for-profit law schools. With that legal precedent looking like it might favor for-profit medical schools as well, medical school accreditors soon abandoned similar policies that previously made forming a for-profit medical school a nonstarter.

Still, the number of for-profit medical schools launching in the U.S. has looked like a trickle since the 1996 ruling, rather than an opening of the floodgates. Some of this is due to stigma and some of it is due to the investment risk, said Eli Adashi, a professor of medical science at Brown University’s Warren Alpert Medical School, who along with two co-authors wrote about the resurgence of for-profit programs earlier this year in Journal of the American Medical Association.

“The stigma [surrounding for-profit medical schools] exists, this is true,” he said. “Whether it’s warranted or not is another question.”

Adashi said many of the stigmas surrounding for-profit medical schools are based on institutions that operated in the U.S. more than a century ago. Additionally, he said, an institution being organized as a nonprofit doesn’t guarantee success or rigor by itself.

More importantly, though, having medical schools -- which have small classes and need expensive equipment -- rely solely on tuition can be a risky business bet, which makes starting new ones in the U.S. difficult, Adashi said. Most nonprofit medical schools have major research operations, landing grants that help finance the institutions.

“Not everybody sees this as a tremendous investment opportunity,” he said.

Still, he thinks it’s possible for for-profit institutions to find a place in the medical school market. For-profit medical schools, he said, are often similar to nonprofit schools that aren’t affiliated with large universities.

“The Harvards of the world can do a whole lot more. And for some people, that would be important, and a preferable route,” he said. “There is room for both.”

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