Both doctors and clinical residency slots are in short supply in Texas. Thus, a Caribbean medical school’s proposal to send more students on clinical rotations in Texas has been drawing criticism over fears that these transplants could take slots currently occupied by Texas students.

The for-profit American University of the Caribbean School of Medicine, based in St. Maarten, hopes to send some twenty students a year for clinical training in Texas, and Texas’s nine medical schools are none too pleased about the plan, reported Ralph K.M. Haurwitz of the Austin American-Statesman.

This is because residency spots are hard to come by, even for those in the state’s medical schools: “Currently, many graduates who would prefer to do their residencies in Texas are forced to leave because no slots are available. The shortage is nationwide — this year, about 30,500 medical students competed for about 25,500 residency positions — but about 45 percent of Texas students leave the state every year for residencies elsewhere,” the Houston Chronicle‘s editorial board wrote in a 2010 editorial.

Medical school leaders maintain that “an influx of students from foreign schools could displace students at Texas medical schools from required training slots,” Haurwitz wrote. “In addition, they say, the Texas schools could wind up having to pay more to hospitals for additional slots or engaging in a bidding war with the foreign schools, with higher tuition to cover those expenses a likely result.” (Texas med schools currently pay hospitals $17,000 per year per clinical position.)

These criticisms have burbled up despite the fact that a number of checks (suggested by Higher Education Commissioner Raymund Paredes) would be put in place on the program. These include only allowing Caribbean students who graduated from Texas high schools to participate and sending clinical interns to high-need areas.

After hearing debate on the issue, Texas Higher Education Coordinating Board voted 6-2 in April to have Texas Attorney General Abbott weigh in on whether the board even has the legal authority to hand out a “certificate of authority” to a school based abroad.

Thanks to rapid population growth, Texas’s need for more doctors is acute. “Texas ranks 42nd out of 50 states and the District of Columbia in the ratio of doctors to population, and is last among the country’s most populous states,” according to a report from the University of Texas System. In a move to address this shortage, the University of Texas System hopes to open new med schools in Austin and the Rio Grande Valley.