Medical school students in New York are having trouble finding available clinical clerkships because for-profit, offshore medical schools are paying up to $400 per week for a single slot, according to the Wall Street Journal.

American schools typically don’t offer money for clerkship slots, instead offering hospitals the benefit of being affiliated with their university in exchange for helping train students in their third and fourth years of medical school.  

In a letter to the Buffalo News, one medical school administrator estimated students from for-profit school have paid for “nearly 50 percent of the clerkship slots in the state.”

“At the University at Buffalo (UB), over 80 percent of students are New York State residents; they shouldn’t be displaced by international students,” said Michael Cain, MD, vice president of health sciences at UB and dean of the Jacobs School of Medicine. “We never wanted to ban students from for-profit, offshore schools; we only want to guarantee that our students get the clerkships they need.”

Cain added that the issue may become more pronounced as the number of medical schools enrollees grow. Within New York, Cain said schools have “expanded class size significantly,” while nationally, medical school enrollment hit an all-time high of 20,630 in 2015, according to the the Association of American Medical Colleges.

Administrators at offshore schools argued to the Wall Street Journal that it makes sense to pay hospitals when they’re offering important assistance to their students. The administrators only said the work their students perform benefits the state because graduates are more likely to work in underserved neighborhoods.

The offshore schools haven’t been able of buying additional slots at hospital since 2014, thanks to the New York State Education Department’s ongoing review, which the Wall Street Journal reports is expected to be completed in the next year.