Trend of pay-to-play medical training worries critics

The breakup came unexpectedly and without explanation.

After years of partnering with Jackson Memorial Hospital, Miami Dade College was tersely informed that its medical ultrasound students would have to find someplace else to train. Jackson would no longer provide the hands-on instruction students needed to graduate.

Behind the scenes, Jackson was being aggressively courted by a fast-growing for-profit school: Dade Medical College. Dade Medical lacked MDC’s long track record and strong academic reputation, but it was willing to do something the public school could not: pay for access.

In 2010, Dade Medical and Jackson signed a deal that paid the hospital $7,500 for each ultrasound student training spot. To date, Dade Medical has paid the hospital more than $330,000.

As a state-funded community college with a tight budget, MDC couldn’t compete, said Medical Campus President Armando Ferrer — at least not without hiking tuition costs. A two-year ultrasound degree at MDC costs about $8,500. A similar degree from Dade Medical runs $47,050.

“Basically we cannot afford to pay for clinical sites, because we would have to pass that on to our students,” Ferrer said. “We try to maintain the lowest cost that we can, with the highest quality.”

MDC’s experience reflects an emerging education and healthcare concern: With a growing number of health-related colleges, many of them for-profit, competition for essential training spots has become increasingly fierce. In nursing, the Florida Legislature directly encouraged this heightened competition, thanks to laws passed in 2009 and 2010 that made it easier for colleges to get new nursing programs approved.

The new laws led to a huge increase in the number of for-profit colleges offering nursing degrees. Among all types of schools, Florida added 231 additional nursing programs in less than five years — more than doubling the state’s total, according to a Legislature report issued in January.

But the Legislature itself has begun to have second thoughts, as a growing number of nursing schools are on academic probation — most of them for-profit schools. Sen. Denise Grimsley, R-Sebring, filed a bill this year that would toughen standards somewhat, in hopes of weeding out what she called “bad players” who have jumped into the nursing education business.

At training locations such as Jackson, some industry experts worry that money — rather than academic merit — may increasingly become the deciding factor, with valuable hospital training slots going to the school that writes the biggest check.

The practice of paying for training spots is a relatively new phenomenon, according to Linda Quick, the president of the South Florida Hospital & Healthcare Association.

Quick said she’s not surprised that Jackson would look to make money from partnering with schools. At the time it inked its deal with Dade Medical, she said, the hospital was struggling with “significant financial difficulties.”

After losing the Jackson spots, MDC was able to place its ultrasound students elsewhere, but Quick said pay arrangements still set “a troubling precedent, because not all schools have the wherewithal to make contributions.”

Who pays?

For-profit colleges aren’t the only ones willing to pay. Jackson followed up its Dade Medical deal with a three-year, $90,000 training arrangement with Barry University, a private Catholic college. Then, last July, the for-profit Cambridge Institute of Allied Health & Technology became a third paying Jackson partner — at $3,000 per slot.

Asked about Dade Medical, Jackson Memorial spokesman Edwin O’Dell stressed that it was previous hospital leadership that approved the deal. But the hospital’s two subsequent paid “affiliation” agreements were signed by current CEO Carlos Migoya. Migoya also renewed Dade Medical’s contract.

“We have trained more than 3,000 public school students for free,” O’Dell said in a statement.

Beyond direct training fees, a number of colleges — including private and public universities — are generous donors to the charitable foundations of local hospitals. Florida International University, which is working to expand its medical school, ranked among the top givers, donating at least $1 million to Miami Children’s Hospital.

School and hospital executives deny that the donations amounted to a pay-to-play system.

“One thing had nothing to do with the other,” said spokeswoman Kerting Baldwin of Memorial Regional Hospital in Hollywood, which agreed to train Dade Medical’s students in July 2011. Two months later, the college pledged a $500,000 donation to Memorial’s Joe DiMaggio Children’s Hospital Foundation.

Dade Medical College has been particularly successful in landing big partnership deals over the past four years. Besides Jackson, the college’s hospital partners include Mount Sinai Medical Center, Miami Children’s Hospital and Memorial. The partnerships continue despite recent controversies involving the school and its founder, Ernesto Perez.

In October, Perez was arrested on charges of hiding his criminal past on government forms. Perez didn’t disclose a 1990 arrest for a sex offense involving a minor, or a 2002 aggravated battery charge. The perjury case against Perez, who stepped down as CEO after his arrest but remains majority owner, is still pending.

And there are other problems: The nursing programs at two Dade Medical campuses are on state probation because of low passage rates on the required licensing test. In December, Homestead’s increasingly disenchanted city council backed out of a planned land sale to Dade Medical.

In the world of hospitals, Dade Medical became a major donor — spreading at least $1 million among Miami Children’s, Memorial Regional and Mount Sinai. In addition to paying Jackson’s training fees, the college also contributed $50,000 to Jackson’s charitable foundation in 2012.

In a written statement, Dade Medical’s new co-CEO, Raul Mendez, said there is “categorically NO correlation” between donations and acceptance of his students.

“Foundations are autonomous, and no direct relationship exists between the clinical decision makers and the foundation,” Mendez said.

Many donate

Memorial spokeswoman Baldwin said the hospital’s foundation has received donations from various community partners, including “educational institutions.” But besides Dade Medical, she declined to identify other schools, saying the list was “private.”

At Miami Children’s, six other schools donated besides Dade Medical, including public, private and for-profit schools. Miami Children’s did not reveal how much each college has given, but it said FIU has been the most generous — having donated at least $1 million.

FIU officials stressed that the bulk of the donated money came from students, not the university’s administration. For 17 years, students have held a “Dance Marathon” fundraiser that benefits the hospital, raising more than $727,000 in total. The event is popular at many other colleges.

In recent weeks, FIU announced that its College of Medicine, in partnership with Miami Children’s, will be opening an on-campus pediatric surgical center in 2015. Previously, Miami Children’s says it held “preliminary discussions” with Dade Medical about opening a hospital-affiliated urgent care center in Homestead.

A 2011 press release from the hospital put Dade Medical’s donation at $250,000. Miami Children’s began accepting Dade Medical students the following year, according to the hospital.

In a statement, the hospital said the donation “did not have any effect or influence in the hospital’s decision-making process to offer clinical training spots.”

Mount Sinai Medical Center, which said no other partner schools wrote charitable checks, also began its Dade Medical partnership in 2011 — three months before receiving a $250,000 charitable gift. A hospital spokesperson said it chooses partner schools based on the “community need” for additional nurses and other healthcare professionals. The hospital insisted it gets “no financial gain” from partnering with schools.

“In fact, Mount Sinai invests over $20 million annually to train tomorrow’s generation of doctors, nurses, and allied health professionals,” the hospital said in a statement.


For colleges that offer health care degrees, hospitals and other hands-on training sites are critical both for teaching students and maintaining good standing with accreditors

And for rapidly growing Dade Medical, the need for training sites was acute. In less than 15 years of operation, Dade Medical has expanded to six campuses and more than 2,000 students. Together, the four local hospitals Dade Medical secured have trained nearly 1,700 students in areas such as nursing and ultrasound.

The training programs, known as “clinical rotations,” give students direct interaction with hospital patients. When dealing with patients, students from all schools usually work under supervision.

But even then, an unqualified or poorly trained student could be a potential risk to patients, said Barmak Nassirian of the American Association of State Colleges and Universities. Safety could be compromised, he said, by clinical spots being “auctioned off to the highest bidder.”

Hospitals and schools all defended their student oversight. Memorial’s Baldwin responded that safety is one of the hospital’s “institutional pillars” and she said students working there follow “numerous safety procedures.”

Dade Medical’s Mendez defended the quality of his college’s programs and said students have trained for 15 years in the community without causing a single patient safety issue.

Beyond Miami

The issue of colleges paying hospitals is not limited to South Florida. Bloomberg reported in September that a Caribbean for-profit medical school based in Dominica, Ross University School of Medicine, paid hospitals in Connecticut and Michigan to provide training spots to its aspiring doctors. The highly expensive school caters to American students who have been rejected by traditional medical schools.

Ross is owned by DeVry, the nation’s third-largest for-profit college chain. DeVry also owns a second Caribbean med school, American University of the Caribbean School of Medicine, which also pays hospitals for training spots. Bloomberg reported that the payments from AUC ended up leading to a reduction in available spots for students from Stony Brook — a state university in New York.

The American Medical Association opposes such payments from offshore medical schools and is pushing for legislation at the federal and state levels that would ban it.