An intriguing article in the NY Times highlights major potential trouble for Caribbean medical schools. The jist: The for-profit, often unaccredited Caribbean medical schools pay hospitals in New York state to allow their students to complete rotations in the American hospitals. This has upset the deans of NY medical schools, who argue that the Caribbean students create competition for training spots in hospitals, limiting their ability to increase enrollment. A proposed solution is to outlaw, or at least make it very difficult, for students at Caribbean schools to do rotations at New York hospitals. This could devastate the Caribbean schools and students, who rely on American hospitals for clinical training opportunities. Though the focus is now on New York, other states could follow New York’s lead, especially as competition for training spots intensifies as medical schools throughout the country ramp up enrollment in response to enormous predicted physician shortages.