A number of leading American medical schools have told the federal government they will refuse federal money to avoid being forced to waive regular admissions criteria and admit a quota of American students transferring from foreign medical schools.
"We're against the principle that usurps the private institution's right to determine who will enter," said Dr. Richard S. Ross, dean of Baltimore's Johns Hopkins Medical School. Hopkins could forfeit up to $700,000 for failure to comply with the new federal law.
Hopkins has formally advised the government that it will not comply with the law, as have such medical schools as Yale, Harvard, Stanford, UCLA and St. Louis University.
"Being told that you will accept students irrespective of their academic qualifications just doesn't seem to be the type of instruction that the faculty of a school of medicine will take very lightly," said Henry C. Meadow, senior associate dean for administration at Harvard Medical School.
"But that's exactly what the law says."
The legislation was the product of a House-Senate conference committee that last fall considered federal subsidies for U.S. medical schools.
When the measure emerged from conference, it contained a provision linking the subsidies to the admission of American transfer students from foreign medical schools, although that provision was in neither the original House nor Senate version of the bill. In the rush before adjournmenth for the November election, the measure passed.
The measure requires U.S. medical schools to accept as third-year transfer students as many American citizens as possible who have completed two years at foreign medical schools - if the American schools are to retain their eligibility for federal subsidies, which can be $1,400 per student.
To be eligible for admission, the transfers must pass part one of the Examination of the National Board of Medical Examiners, a standard test that generally is administered after the first two years of medical school.
The law, however, prohibits the medical schools from applying their own standards of admission. And many medical school admissions officers say this standard examination officers say this standard examination is an inadequate screening device.
An aide to Rep. Paul Rogers (D-Fla.), the prime supporter of the legislation, said the intent is simply to provide the best possible medical training for the thousands of Americans who fail to win admission to American schools and enroll abroad.
"We owe it to these kids. We're concerned that they're coming back here to practice medicine on our people," the aide said.
In recent years the highly competitive American medical schools have led increasing numbers of Americans to enroll in foreign schools in Europe, Asia and the Caribbean, most prominently at the University of Guadalajara in Mexico.
Some such schools apparently were organized specifically to accomodate the tide of American students. And the training at some of these institutions is less than adequate, said one medical spokesman here.
Families of many of these students have organized an intense lobbying campaign to allow them to enter Amercian medical schools as transfer students.
Many argue that the nation needs more doctors and that enrollment of transfers from foreign schools is one good way of getting them. Opponents, however, dispute the need for more doctors.
Proponents of the legislation also argue that the last two years of medical school, during which students receive clinical training, represent the weakest part of the foreign shcools' carriculum. Therefore, they say, it is at that point that American students should return home to complete their training.
There is no firm count on how many American students there are in foreign medical schools, but Dr. Clayton Rich, dean of Stanford's Medical School estimated as many as 1,500 might qualify for admission as foreign transfers under the new law.
Under the law, a pool of these students would have to be divided among the nation's approximately 100 medical schools in some proportionate manner, although specific guidelines for doing this have yet to be drawn up by the Department of Health, Education and Welfare.
Because of the complexity of this issue, the effective date of the legislation has been delayed until the 1978-79 academic year. In the meantime additional congressional hearings into the issue have been scheduled for next month.
But the applications for federal subsidies - which are called "capitation grants" because they are based on the number of students enrolled in the school - are due a year in advance, and some schools are filling out applications and adding a written advisory that they will not accept the transfer provision.
In virtually every case, the medical schools charged that the transfer provision violates their academic integrity, although some also said they simply do not have space to accept transfer students.