Keck and Reed Respond

We are glad that Levy agrees the experiences of Cuba’s National Health System offer some lessons for us in the United States as we struggle with health system reform and improving health professional education. Space limitations precluded a description of the direct contribution Cuba is making to the education of US medical students through the Latin American Medical School (ELAM), and the impact Cuban-trained American physicians may have on medically underserved populations in this country and the newly forming Accountable Care Communities described in our article. ELAM, established in 1999 and located in a former naval academy near Havana, Cuba, provides scholarships for poor students from around the world to study medicine with a curriculum based on social accountability—addressing priority health needs with a particular focus on the medically underserved. Since 2005 the school’s more than 12 000 graduates from 65 countries will undoubtedly help mitigate the shortage of physicians worldwide, particularly in developing nations.1,2 Little known is the fact that some 200 US citizens are enrolled in or have graduated from ELAM.1 These are young people principally from low-income families and minorities underrepresented in the health professions. They have the intellectual ability, but not the financial resources, to go to medical school in the United States. In return for their scholarships, they promise to practice in distressed or shortage areas in the United States—much like the communities they call home. Medical education in publicly supported US medical schools carries a hefty price tag at about $50 000 annually.3 Thus, provision of 200 scholarships for US students may be viewed as a $40 million contribution by Cuba to our efforts to rectify disparities in access to care. An added bonus is that these physicians are well trained in prevention-oriented primary care and are fully bilingual in English and Spanish—Spanish being the language for medical instruction in Cuba. This is quite remarkable given the level of political enmity between our two countries. Many of these US ELAM graduates have already passed their US Medical Licensing Examinations, and some have already matched for residency placements across the country. We believe communities and institutions interested in improving services for the underserved and building an Accountable Care Community consortium may do well to seek out these returning physicians for primary care residencies and eventual employment. They have the potential to be excellent role models and thoughtful leaders, as more responsive and effective health services delivery evolves in the United States

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