WATERLOO - Dr. Gregory Neyman is by all accounts an overachiever.

As a medical student, he scored exceptionally well on the United States Medical Licensing Examination, passing one part of the test most students don't even attempt until after graduation.

And while most medical students receive a doctor of medicine degree after 48 months of intensive training, Neyman did it in just 27 months. During that time, he spent only three months on his medical school campus and worked part-time as a chiropractor.

Honored as medical student of the year at his January graduation, the new doctor eagerly anticipates the start of his residency training July 1 at Northeast Iowa Family Practice Center.

"I'm just ready to get started with residency so I can learn more," he said in a telephone interview from his Garland, Texas, home.

Training questioned

The state of Iowa issued Neyman a resident physician license in April, but some states wouldn't have issued him a license at all.

At least two states have serious questions about the quality of the education Neyman received at the University of Health Sciences of Antigua, in the West Indies, partially because the majority of his coursework was completed over the Internet.

The California Board of Medical Examiners and the Indiana Health Professionals Bureau of Licensing have barred graduates of the Antigua medical school, and several other offshore institutions, from attaining either a residency training or medical license.

Lisa Hayes, executive director of the Indiana bureau, said the state's medical licensing board disapproved the school in December, citing "continued questions" over the school's curriculum. California lists the University of Health Sciences Antigua as one of eight offshore medical schools disapproved for licensure in the state.

"(Antigua school officials) just have played games with us. They have refused to fill out the paperwork answering our questions about governance, resources, curriculum and admissions," said Patricia Park, foreign schools liaison for the California medical licensing program.

Deficiencies noted

A serious concern for Park is the USHA's lack of an entrance exam. United States medical schools require prospective students to take the Medical College Admission Test. No such exam is required at many offshore medical schools.

"Your entrance exam is your checkbook," Park said.

The American Association of International Medical Graduates lists the Antigua institution as one of 10 medical schools with "multiple, serious deficiencies."

The organization's complaints against the school include its distance learning curriculum via the Internet, a part-time attendance curriculum and its practice of giving advanced placement to allied health professionals, such as chiropractors, nurses and nurse practitioners.

Park said no medical school in the United States grants advance placement status to incoming medical students.

"They make you start from day one," she said. "The people attracted to Antigua are the ones looking for shortcuts."

Neyman, a chiropractor since 1998, was given advance placement, circumventing months of basic science courses students in United States medical schools are required to take. It's the reason he chose the Antigua school, rather than a stateside institution, noting he had already taken all the basic science courses to become a chiropractor.

"I could get done a lot sooner that way," he said.

Dr. Ellen Sakornbut, residency program director at Northeast Iowa Family Practice, defends Neyman's choice.

"There was concern, but at this time there are many things being done in the area of basic science training," she said.

"There are a number of med schools where students work without sitting in a classroom. There are lots of ways people learn. Some learn through lectures, others through books and articles or Internet research. The point is do they master the curriculum? In the United States we would tend to be more comfortable with people sitting in a classroom, yet we have not found those who don't are less prepared to take exams."

Iowa law silent

Kent Nebel, legal affairs director for the Iowa Board of Medical Examiners, said the issue is relatively new.

Distance learning and Internet curriculums have popped up in the past few years, and there is no data to support Park's and others' claims offshore schools like UHSA aren't producing quality physicians.

"Even scholars have not reviewed whether this (distance and Internet curriculum) is an appropriate form of study and what the outcomes are," Nebel said. "Right now Iowa law does not address that issue. I think it's something the board needs to look into."

Current Iowa law states that to be eligible for a resident physician or physician license, an applicant must hold a medical degree from an institution approved by the board. Institutions approved by the board must be fully accredited by the Liaison Committee for Medical Education. Applicants with a degree from a school not accredited by LCME, such as the Antigua school, must be certified by the Educational Commission for Foreign Medical School Graduates.

To be eligible for this certification, an applicant must be a graduate of a school listed in the International Medical Education Directory, said Nebel. To be listed in the directory, a school must be recognized and approved by its own country's health organization.

Park of California said, however, the directory basically amounts to a phone book of medical schools.

"Some government official reports a school exists and it's printed. It does not apply any standard. Of course a government is going to approve their school. These schools bring in money and become a large part of a tiny island economy," she said.

Trained in U.S.

Although Neyman did basic medical school coursework over the Internet, his clinical rotations all took place in the United States under the watchful eyes of board-certified physicians. His residency will take place under the same scrutiny.

"These individuals are going into very structured, educational programs where they will be monitored very closely," Nebel said. "That's what a residency program is intended for. Whether they're U.S.- or foreign-trained, that process will determine whether they are in a position to practice medicine beyond a residency program."

Sakornbut of the family practice residency program agrees.

The process by which a doctor is chosen for a residency program is a competitive one, she said. Every applicant must submit all necessary documentation, including their scores from the U.S. Medical License Exam and medical school transcripts. References are checked, and interviews are conducted to make sure the resident is a good fit for the program.

Proof in the practice

Neyman did a clinical rotation at Family Practice in February, and it was then that Sakornbut saw his dedication to patients.

"I think Dr. Neyman is as dedicated and hard working as anybody I've met. He has an excellent work ethic and good attention to the human aspects of medicine, as well as good common sense. You can't necessarily assess that from a test score or piece of paper," she noted.

"My anticipation is he will come and work hard just like our other residents," she added. "I feel comfortable that he will provide a level of service that will be a benefit to this community."

Neyman has considered practicing medicine in Iowa after his three-year residency training is up. If he stays, he'll join the ranks of dozens of other foreign-trained physicians in the area.

"There are numerous physicians in this community who were trained in another country, and we are lucky to have them," Sakornbut noted. "The human body is the same in India and Antigua as in the United States."