STEVE BRAWNER

Arkansas natives Drs. Gail Brown and Thomas Rose are among many primary care physicians who attended medical school at an institution blacklisted by California's medical board and thus, cannot practice in Arkansas despite a shortage in their field

Dr. Gail Brown, a second-year resident family practitioner in Montgomery, Ala., spent most of her life in Arkansas and wants to return home to practice. She wants to bring her husband, Thomas Rose, also a second-year resident family practitioner, with her.

But following California's lead, Arkansas does not recognize their medical school, the Medical University of America on the West Indies island of Nevis, and so while both can continue to practice in Alabama and in other states, they can't practice here.

The Medical University of America is one of 53 medical schools in the world not credentialed by the Arkansas State Medical Board. Of those, two are in Africa, one is in Mexico, and the rest are in the Caribbean and Central America.

Those 53 schools failed to meet regulations passed in June that grant credentials based on information gathered by the staff and on the decisions of other state medical boards. Schools rejected by two other state boards and those that are Internet- and distance learning-based are automatically rejected.

It's a big job determining whether foreign and American students from overseas medical schools are qualified to practice in America. There are 1,800 medical schools in the world, and 25 percent of U.S. physicians received their training overseas. The Educational Commission for Foreign Medical School Graduates certified 10,172 international medical school graduates last year, one quarter of them U.S. citizens.

Faced with such a daunting task, Arkansas, like several other states, relies on the work done by California, which is large enough to perform extensive and costly site visits. Arkansas blacklists the 10 schools California has rejected as well as some of those that have never applied for admission, which includes the Medical University of America.

Cindi Oseto, associate analyst at the California State Medical Board, said the process for certification is involved and expensive. Materials are sent from the school to the board and then to a medical consultant familiar with academic and clinical medicine. A site visit funded by the applicant follows before a report is prepared by the board. Students from medical schools that have never applied for certification have the same chance of obtaining a license as those from schools that have been rejected – none.

According to Julie Carlson with the Arkansas State Medical Board, it just makes sense for a small state like Arkansas to follow California's lead. "California goes and makes site visits and has specific requirements, and that's just not feasible for our board, so we've adopted California's list and then just accept whatever their requirements are as ours," she said.

To Brown, that's bad policy in a time when the state desperately needs physicians of all kinds and family practitioners in particular. She said that while the living conditions in Nevis were less than luxurious, she received an excellent education during her two years on the island, where she met her husband, a pharmacist from Wyoming who, like her, was embarking on a second career. She spent her last two years of medical school in Louisiana as part of the Louisiana State University system and, with her husband, is now spending her second year of residency in Montgomery. Both have passed the first two steps of the USMLE exams.

Brown questions why the state has adopted California's list and points out that being certified is a costly process. Medical University hasn't been rejected – it just hasn't started the process in California, and it has gotten seals of approval elsewhere, including the World Health Organization and other states such as New York, which is considered along with California to have the most effective certification program. Its sister school, Saba University School of Medicine, has been approved.

Bill Trice, the attorney for the state Medical Board, said that it's important that the state have a consistent method of certifying medical schools in order to be fair to the medical profession and to potential students. He said legitimate medical schools should consider California's certification fees to be part of the cost of doing business. "I can't imagine not being credentialed if your purpose is to turn out students who can go work," he said.

Now 50, Brown chose Medical University for several reasons. She was working as a clinical social worker with a master's degree when she entered medical school at age 43, and she didn't want to retake her college science courses and thought being an older student would put her at a disadvantage gaining admittance to an American medical school. She was going through a divorce, and Medical University of the Americas was an economical choice.

Brown questions why she could practice at a Veterans Administration hospital in Arkansas or at the Little Rock Air Force Base with her education, but can't practice civilian medicine, and she says the medical board should be more flexible when it makes its decisions.

"They have pretty much made this a black-and-white thing," she said.