By Dr. James M. Dahle, Emergency Physician, WCI Founder
There was an interesting article in the New York Times a while back called: “I am Worth It”: Why Thousands of Doctors in America Can't Get a Job.
The lead-in to the article involves a doc from Alabama who enrolled in a medical school in Barbados.
Then came an unexpected hurdle: A contentious divorce led Dr. Cromblin to take seven years away from medical school to care for her two sons. In 2012, she returned for her final year, excited to complete her exams and apply for residency, the final step in her training.
But no one had told Dr. Cromblin that hospital residency programs, which have been flooded with a rising number of applications in recent years, sometimes use the Electronic Residency Application Service software program to filter out various applications, whether they’re from students with low test scores or from international medical students. Dr. Cromblin had passed all her exams and earned her MD, but was rejected from 75 programs. In the following years, as she kept applying, she learned that some programs filter out applicants who graduated from medical school more than three years earlier. Her rejection pile kept growing. She is now on unemployment, with $250,000 in student loans.
Caribbean Medical School Residency Match Rate
There are apparently 10,000 “chronically unmatched” doctors in this country. While a 94% match rate seems really high, 6% of a large number of people is, well, a large number of people. But a 94% chance seems like a gamble worth taking.
Attending a medical school in the Caribbean is a different story for several reasons.
The average match rate there is approximately 61% according to the article, but that's 61% of those who graduate AND actually get an interview. Many students drop out along the way and there are plenty of those who don't even get an interview. Among graduates, the real match rate is only 50%. Among enrollees, it's even lower.
That's right. Even if you graduate from medical school, you have:
- A 50% chance of fulfilling your dreams and becoming a practicing physician AND
- A 50% chance of owing $250,000-450,000 and wasting 4-10 years of your life chasing a dream
That is one heck of a gamble.
Apparently, there are people attending med school in the Caribbean who were not aware of this gamble when they rolled the dice, so let's get the word out there. In the words of my partner who sent me this article:
IF YOU GO TO MEDICAL SCHOOL IN THE CARIBBEAN, THERE IS A 1-IN-2 CHANCE YOU'LL END UP $250K IN DEBT AND UNMATCHED!
The other problem with going to school at some Caribbean schools is that, even as an American citizen, you can't get federal student loans. You end up paying higher interest rates, you don't qualify for IDR programs, and the PSLF or IDR forgiveness escape hatch to fall back on in the event you don't match doesn't exist. Here is a list of schools eligible for federal loans.
At least if you go to Ponce (the Puerto Rico medical school) you can get federal student loans, but match rates are still substantially lower than you would see at a mainland MD school (82-89%). Speaking of Ponce, here's a heartbreaking story from a Ponce graduate who did not match either:
San Diego-based Seth Koeut was born to Cambodian refugees who came to the U.S. when he was a child and later pursued a medical degree in hopes of becoming a doctor. After he failed to obtain a residency role—a required part of the transition from medical school graduate to licensed medical professional—Koeut ended up working menial jobs before filing for chapter 7 bankruptcy in May 2012 while holding $440,465.66 in federally-backed student debt.
In 2015, Koeut filed an adversary proceeding to discharge his student loans as part of his bankruptcy. After the adversary proceeding was dismissed, Koeut filed an appeal in 2018. In October 2020, arguing against a discharge of the loans, the Department of Education (ED) contended that he had “not given his best effort to find better employment.”
Born in a Cambodian refugee camp in Thailand, Koeut came to America in the 1980s. His family “lived in extreme poverty,” the filing stated, “collecting cans from the trash to supplement the family income.” Koeut did well in school and earned a bachelor’s in marine biology and Spanish from Duke University in 2002 before moving to Bangkok to study clinical tropical medicine.
He did not earn a formal degree and began working part-time jobs in retail before attending the for-profit Ponce School of Medicine in Puerto Rico, finishing in 2010 and passing all the medical board exams. However, over the next five years, Koeut was unable to secure a residency placement. The loans he took to finance medical school, meanwhile, started coming due. Koeut selected an income-driven (IDR) program in October 2010 with a monthly payment of $0, according to an ED loan analyst who testified in his case. He also went back to working retail, including jobs at Bloomingdale's, Crate & Barrel, Banana Republic, and even as a dishwasher in a Mexican restaurant.
Koeut repeatedly deferred payments while unsuccessfully attempting to obtain a spot in residency. As of 2020, according to court filings, Koeut claimed that his total assets amounted to less than $5,000. Mr. Koeut's attorneys argued to the court that Koeut had applied to 5,000 jobs after graduating from medical school, trying in different fields using his language skills and even working unpaid jobs at universities and other organizations to improve his resume while living in his parent’s kitchen to avoid paying rent. And while ED contended he did not try hard enough to find employment, the court stated: “A medical school graduate who works as a parking attendant and dishwasher cannot be described as lazy.”
This story had a bit more of a happy ending than the first. Not only did this doctor qualify for $0 IDR payments, but he actually had his loans forgiven in a bankruptcy proceeding, a rare but increasingly common event despite the mostly true “Student loans don't go away in bankruptcy” dogma.
There are literally thousands more of these sorts of stories every year. Here is another from the New York Times:
At some point, Dr. Saideh Farahmandnia lost count of the number of residency rejection emails she had received. Still, she could remember the poignant feeling of arriving in 2005 at Ross School of Medicine in Dominica, thinking she was “the luckiest person in the world.” She had grown up in a religious minority community in Iran in which access to higher education was restricted.
After medical school, she spent two years doing research with a cardiothoracic surgeon at Stanford, thinking it would make her residency applications more competitive. But she applied to 150 residency programs, from rural to urban community hospitals, and received 150 rejections. She kept applying every year until 2015, when her mother died suddenly and she took a break to grieve. “You leave your family to follow your passion and promise you’re going to help the country that adopted you,” Dr. Farahmandnia, 41, said. “At the end, you’re left with $300,000 in student loans and a degree that took so much of your life and precious time with your mother.”
They're not all from Caribbean graduates either:
Dr. Douglas Medina, who graduated from Georgetown University School of Medicine in 2011 and has been unable to match, says he pays at least $220 each month in loans, though some are now paused. “Just a couple of weeks ago I tried to decide between student loans or a stroller for the baby that’s coming,” he said. “It’s not just our careers being ruined, it’s our families.”
But many of them are, and at some point, they all come face to face with this issue:
“When I graduated, I got the cold smack of reality that all my credentials don’t matter, because you’re not getting past that match algorithm,” said Kyle, an international medical school graduate who asked that only his given name be used because he is reapplying for residency after an initial rejection.
The financial lives of all of these doctors were completely ruined by going to medical school. What are the solutions to that problem?
What Happens If You Don’t Match
Four Solutions to the Unmatched Problem
What is the problem, really? Well, there are several, but the main one is the huge mismatch between medical school spots and residency spots. This is basically the same problem law school graduates face. There are far more attorneys than good lawyering jobs. For-profit law schools stuff their classes full and pump out graduates that nobody wants. It's not quite as bad in medicine, but it is increasingly becoming a problem. Medical schools are increasing class sizes and new, for-profit medical schools are popping up all the time.
And that doesn't even include the old, for-profit medical schools in the Caribbean. Every year there are more medical school graduates, but no more residency slots than there were the year before. There are four solutions to the problem, and each of them should be implemented:
#1 Stop Lying to People
Honestly, this is no different for pre-meds than it is for high school students. Too many guidance counselors and even parents are telling young people to chase their dreams without regard to the cost. Guess what? Going to a really expensive college and borrowing the entire cost of education to get a degree in English, journalism, or other fields that don't lead to high-paying jobs is not going to work out well financially. Sure, a few of those folks are going to go to medical school or law school or start a great business, but most of them are going to be in a middle-class job saddled with doctor-like loans and never really dig out. As a society, we need to quit giving such terrible financial advice.
When it comes to medicine, the problem is a little more hidden. Yes, we still have pre-med advisors, bloggers, podcasters, Twitter accounts, and college instructors encouraging students to go to medical school no matter their qualifications. They continually trot out somebody who struggled in college, got into a single Caribbean medical school, matched into neurosurgery, and is now a world-renowned surgeon who separated conjoined twins in a grueling 36-hour surgery and now the twins are both playing for the Mets! What they don't do, however, is give these students realistic expectations of what is likely to happen in their case.
We all know a great doctor who struggled with the MCAT or the USMLE or who had a relatively low college science GPA. We all know great doctors who are DOs, IMGs, or FMGs. It's no longer politically correct to say that standardized tests have any usefulness whatsoever. Certainly passion, compassion, hard work, and attention to detail are at least as important to a successful career in medicine as intelligence and raw ability. But we need to quit telling people that raw ability and intelligence don't matter at all.
Yes, some people are smarter than others. Just like we all know great docs who may have “lesser credentials,” we also all know some docs who just aren't all that bright and who we wouldn't let anywhere near our family members. Lower that bar too much, and there will be a lot more of those docs around.
Pre-meds also need to be aware that some steps in acquiring their dream career do not work the same way as getting into a college or even a medical school. Schools love to have diverse students with incredible background stories and a broad array of talents and interests. They have real motivation to demonstrate that they are accepting students with all kinds of gender, racial, socioeconomic, and academic backgrounds.
However, as you leave school, that focus changes. When you interview somebody for a residency position or a real job, you're trying to decide whether you want to work with this person day in and day out for the next few years or decades. You want to know they're not going to sign out a mess to you. You want to know they're going to take good care of your patients when you sign them out or they are on call for you. You don't want this person increasing your own medicolegal liability or requiring you to do a ton of extra “academic rehabilitation” work. Frankly, you couldn't care less if their family is from Cambodia, Nigeria, Guatemala, or Canada. Nor do you care whether they studied music or molecular biology in college.
I sat on a medical school admissions committee. I've served as faculty in a residency. I've been hiring attending docs for more than a decade. It's not unusual for us to have 50 CVs for a single position. Those CVs mostly all look the same except for the names of the schools, residencies, and publications. We may only interview four or five of those docs. Guess how we screen them? That's right, mostly on the perceived quality of the residency with a little bit less emphasis on the perceived quality of the medical school. We all know that the acceptance rate at a Caribbean medical school is 10 times higher than at a mainland MD school.
Residency programs have similar issues. They get thousands of applications. They have to cut them down somehow. What is the easiest way to do it? They screen by USMLE scores (although they soon won't be using Step 1 scores), by GPA, and by perceived quality of the school. There are hundreds of residency programs across the country that have never taken a Caribbean school grad and likely never will. The truth is that there are fewer open doors for you when you choose to go to school offshore. Pre-meds need to know that. They also need to know about the downstream consequences of owing $400,000-500,000 in non-federal student loans without a job that will ever pay them off. Even if they match, chances are good that they will have a higher student loan burden than most of their peers and they'll be matching into a specialty that pays less than average. You don't get a pass on math just because you're chasing your dream.
Not everyone agrees with me. More from the Times:
Dr. William W. Pinsky, the chief executive of the Educational Commission for Foreign Medical Graduates, which credentials graduates of international medical schools, said residency directors who down-rank medical students from abroad were missing out on opportunities to diversify their programs. “I understand program directors have to do what they have to do,” Dr. Pinsky said. “But if they put on a filter to leave out international graduates, they’re cheating themselves.”
Maybe the programs are cheating themselves, but Dr. Pinsky is asking residency programs to take a bit of a gamble that they don't have to take. For the most part, Caribbean students went to those schools because they couldn't get into a mainland school. So they started out a step behind. Then they often suffered through substandard preclinical education, being forced to teach themselves medicine and then prepare for Step I on their own. As 3rd and 4th years, they usually have to line up their own rotations, which often are simply not as good as the ones for students at a typical mainland MD school. So you're taking a less capable individual and putting them through an inferior process and then expecting someone evaluating them for the next stage of their career to somehow ignore all that? That's not very realistic, despite the fact that there are some incredible individuals who can become great doctors through this pathway. While it can happen, it isn't the way to bet.
#2 More Responsibility on Medical Schools
OK, rant over. Obviously, it is important for people to take personal responsibility for their actions. However, some of this responsibility also falls on the medical schools. They simply must maintain sufficiently stringent admission criteria that ensures their students can graduate and pass their boards AND match into residencies and get good jobs afterward. If they don't do this, they should pay at least part of the price. For example, if a student doesn't match within two years of graduation, perhaps the school should have to refund 1/4 or even 1/2 of the tuition paid. It wouldn't completely solve the students' financial problem, but it would certainly incentivize schools to be careful who they admit and to maximally support their struggling students. These sorts of incentives are even more important at schools with low match rates. I have no idea how this would be enforced on a school in another country, but perhaps the match could do so. It could simply not allow a school's graduates to enter the match until the school implemented this sort of a policy. Maybe that would do more harm than good, but how are these schools any different than other institutions regarded as predatory? Maybe we need to take a hard line against them.
#3 Increase Residency Slots
This mismatch between medical school graduates and residency positions has always been around, but in recent years it has worsened. There is a doctor shortage, particularly in primary care (although maldistribution appears to be the larger problem). So more schools open up and more students are enrolled. But that wasn't the bottleneck. The rate-limiting step was residency training. Without more slots for residents (primarily paid for with federal Medicare dollars) you might get more doctors, but you don't get more practicing physicians. Boosting this funding solves both problems.
Some doctors are actually against opening up more residency slots. They want to control the number of practitioners entering their field to keep incomes high. Fine. Then just increase residency slots in the specialties where there are shortages. Right now APCs like PAs and NPs are plugging holes in the system, mostly in primary care fields. Doctors wring their hands about this encroachment and the loss of turf battles in state legislatures. But lower cost/higher profit isn't the only reason APCs are hired. They're also hired because a doctor can't be found.
The article says this process has begun:
The pool of unmatched doctors began to grow in 2006 when the Association of American Medical Colleges called on medical schools to increase their first-year enrollment by 30%; the group also called for an increase in federally supported residency positions, but those remained capped under the 1997 Balanced Budget Act. Sen. Robert Menendez, Democrat of New Jersey, introduced the Resident Physician Shortage Reduction Act in 2019 to increase the number of Medicare-supported residency positions available for eligible medical school graduates by 3,000 per year over a period of five years, but it has not received a vote. In late December, Congress passed a legislative package creating 1,000 new Medicare-supported residency positions over the next five years.
But let's be honest: It's too little, too late. A thousand spots isn't even close to what is needed to solve this problem. It's off by an order of magnitude.
#4 Assistant Physician Legislation
One of the best solutions is the concept of an Assistant or Associate Physician. This is a medical school graduate who has not completed (or even started) residency training. Two states (Arkansas and Missouri) now offer this licensing, but legislation has been introduced in Georgia, Virginia, Utah, Kansas, Oklahoma, Washington, and New Hampshire, as well. An assistant physician, like most Advanced Practice Clinicians (APCs), practices under the supervision of a licensed physician. However, despite having twice the training (and training at a higher level) of an APC, they make half as much. At least, though, the APCs are getting some valuable training out of it that will soon lead to the “big bucks”. That's not the case for an assistant physician. In fact, assistant physicians should probably qualify for a PA license if nothing else.
It has often been said that medicine eats its young. Medicine also eats its wounded. We need to quit ignoring the unmatched doctor problem. Changes need to be made at the individual level and college level (better education about the costs and financial risks of attending medical school), at the medical school level (balancing the need for training competent doctors with developing a compassionate, diverse workforce, and limiting enrollment until more residency positions are available), at the federal level (more residency positions), and at the state level (assistant physician licensing). As practitioners, we need to consider converting what are traditionally APC slots into assistant physician positions. As things stand now, you get twice the training at half the price.
What do you think? What do you see as the solutions to the problem? What advice do you have for Caribbean graduates struggling to match? Comment below!
Do you have similar thoughts on for-profit US allopathic medical schools? Are most osteopathic programs for profit as well?
Other than the one mentioned in the article, what for-profit, US, allopathic medical schools are there?
California Northstate was the first for profit US based MD school to open. Some of the new MD schools might be for profit but its not clear on their website
Thanks. I’d never heard of that place. It looks like they were established about 6 yrs ago, which is probably why.
I don’t think they’re the huge gamble you’re taking as an IMG, but I’m not a huge fan of for-profit schools just because tuition tends to be higher and the schools tend to be newer and less established. It seems to me there are far more for profit DO schools than MD schools, but I don’t have exact numbers. Are most DO schools for profit? I’m not sure, but I would guess more than half are. There are state DO schools too, particularly in the Midwest.
Our new local College of Osteopathic Medicine (ACOM) “is a private, non-profit medical school” started/ run by our local medical center (one of two hospitals in town) which means they have the same drive for money as our non-profit hospital administrators all have. No shareholders, but folks with salaries plus a hospital happy to work med students in their wards (though many later rotations are done out of town). Tuition ’20-’21 $55K. Friend moved from federal jobs to being a clinical instructor there and is quite happy for that halfway to retirement job; another friend is a patient model for the students. Good deal I figure for HPSP students, but wonder if HPSP successful applicants can also get in somewhere cheaper/ longer established.
A small minority of DO schools are for-profit.
What % of those opened in the last 10 years are for-profit? My impression is nearly all.
Some of the newly opened MD schools have lower acceptance standards (GPA and MCAT) than the older, “more traditional” and well known MD schools. Also, look at the lower acceptance standards of the lower 1/3 tier of MD schools and some state MD schools as compared to the top 15–20 MD schools…….they are lower than some of the DO medical schools. The training/residency programs of these lower 1/3 tier MD schools are not of the same caliber as those of the top 15–20 medical schools. Also, the primary care specialties (FP, IM, Peds and ER Medicine) are not as competitive for residency positions as the surgical specialties and still take a healthy number of acceptances yearly. That is why in some areas of the country (large cities), the job market does not have to be competitive with the salaries with these doctors.
First time I’ve seen someone consider EM primary care. OB/GYN sometimes gets thrown in there, but usually not EM. EM is about mid-tier for competitiveness.
Thank you Dr Dahle for an honest opinion on this topic… since I got matched in 2006 – it’s been harder and harder for international medical graduates to secure residency spots.. I was fortunate to have gone to a medical school in the Philippines who my residency program has recognized well due to prior alumni… in fact, IMGs and FMGs who graduated from other countries fared better on getting matched or prematched than someone who graduated from a carribean medschool when I was researching this back in the day… I do find it quite odd but your article sheds light on this issue…
I don’t know that I’ve seen the data on IMGs from the Caribbean vs other countries. Do you have a link?
I am presuming that US citizen IMGs are mostly from Carribean Med schools and non-US citizens aren’t.
Still holds true today almost 7000 matched over 5167
https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2020/07/Charting-Outcomes-in-the-Match-2020_IMG_final.pdf
I do not know the denominator of people who are applying to those positions…while there will be US citizens doing medical school in China or the Philippines perhaps or any other country – it’s most likely they have roots there…. Non-US citizens will not be able to afford carribean medical school tuition fees so my analysis and presumption on this may hold more truth than not
Interesting stats in that link. Just looking at my specialty of EM:
The overall match rate was 2665/3115 = 86%
For US IMGs it was 151/270 = 56%
For Non-US IMGs it was 28/65 = 43%
For US grads, it was (2665-151-28)/(3115-270-65) = 89%
89% vs 56%. 89% feels like an “almost sure thing”. 56% feels like a big gamble to me, especially when paid for with debt.
Oops I guess the denominator is there.. table 1 yep. Well I guess I could infer that there are more Non US citizens applying than US citizen IMG so the percentage of non US citizen matching is lower but they still take a higher number of positions compared to a US IMG.. maybe the bias of their specialty selection etc
Would it be possible for residency programs to offer unpaid positions? Or lower the pay and have more spots? Or heaven help us residents pay for the experience slots? What bars are there to that?
That’s what dentists already do. Many dental specialist residents PAY tuition.
Yup. My program costs about 40k a year as a resident. It is extremely painful to pay $$ after going through 8 years of schooling.
“We all know of D.Os, IMGs and FMGs that are great doctors “. Really?
Maybe I shouldn’t have said “all” if you don’t know any, but I certainly know plenty.
You had me up until that comment. With the exception of around 200 extra hours of osteopathic training, there’s virtually no difference in medical education from DOs and MDs. To compare DO education to IMG education shows that you are holding onto an old view of DO vs MD that the majority of practicing MD and DO physicians have long since moved away from. Although it’s nice to hear that you find some DOs really great doctors, you will find that the majority of your colleagues (and all those who are DO) would take issue with the way you phrased this comment. Consider removing the DO from this statement. It’s both insulting and highly inaccurate to suggest – however indirectly – that a good DO physician is the exception to the rule. (And like you, I also have experience screening many many people – for me it’s at a competitive program in a very competitive specialty. DOs and MDs are treated equally in the application – because, newsflash, they just are. We do not accept international graduates regardless of their scores as we consider their training subpar.)
I’m not going to spend much time on this soapbox since I don’t feel all that strongly about it and you clearly do. I’ll simply point out the facts:
1) The average matriculant to a US DO school has a lower science GPA and MCAT score compared to the average matriculant to a US MD school.
2) The match rate in the MD match is significantly higher for a graduate of a US MD school than for a graduate of a US DO school.
3) A US DO student is far more likely to have to line up their own 3rd and 4th year rotations (and thus often ends up with inferior rotations) than a US MD student.
4) Even though you do not, there are many residencies, fellowships, and jobs that prefer an MD grad to a DO grad (for whatever reason) and very few that prefer a DO grad to an MD grad. Thus, getting a DO instead of an MD will close at least a few doors to you. You may never want to go through those doors, but they’re still closed.
Now I think your main point is that the difference between an MD and a DO in all these things is very small and the difference between a US DO and going to a Caribbean school is very large, and I will agree with you there. But to pretend those other issues do not exist is just sticking your head in the sand with wishful thinking. Current trends are such that perhaps in a few years these differences will not exist, but to say they don’t exist right now is just plain wrong.
for those who believe that DO’s and MD’s are (or are close to becoming) equivalent, I tip my hat. However, if you still think that Caribbean doctors are not equal, you still have some eye opening to do. It is true that more are accepted to these schools with a lower score in either the mcat or gpa. However, those that ACTUALLY MAKE IT THROUGH and become doctors, aren’t those people. The people that make it are the smart, determined, self-taught fighters who are crushing it. And frankly, probably would have excelled in a U.S. medical school however had something in life that happened to them that knocked them out of an algorithm.
Outside of standardized tests which have their issues, I’m not sure there’s any data to prove that either way so I’m sure opinions about it are colored by personal experience.
Small fact check: Certain Caribbean schools are eligible for Fedloans and PSLF. I know Ross is because I graduated from there.
In the coming years I expect match rates from the better schools (Ross, St George) to get worse now that Step 1 is pass fail. From the moment that we started we knew that a high step 1 score would open a lot of doors, and in my case is probably the reason I’m a surgeon.
I refer to these schools as the better ones (small bias) because the curriculum matches US schools and for the most part all clinical rotations are in the US and arranged by the school. Having worked with a number of US schools I do not see a huge difference in training or quality of grad when matching for grades. What applicants need to know is that doesn’t matter because residency programs will still screen by medical school.
The difficulty that I saw while a student is that all Caribbean students tend to have some weakness in their resume that caused them to go the IMG route. The students that recognized the weaknesses AND corrected tended to do well, but their residency application had to be good- high scores, good grades no long gap in training.
I could write an entire book on this but I’ll finish by saying that $250k is on the low end for Caribbean dept.
Do you have a link to a list of the ones that are eligible and the ones that are not?
I agree the better schools line up your rotations for you at US institutions. In that respect, many DO students are getting worse rotations than some Caribbean schools. But it doesn’t seem to hurt their match rate nearly as much.
I agree the change to a Pass/Fail Step I hurts those from schools without a big name. The problem with the test is that it isn’t designed to show how good of a resident you will be. It’s always been a pass/fail test, they just happened to give you a score and residencies just happened to use it to screen applicants. But that isn’t what it was ever designed for.
Looks like someone got you the link.
In regards to USMLE, there is correlation to board pass rate
https://www.journalacs.org/article/S1072-7515(21)01922-0/fulltext
I don’t think scores are the only metric but they certainly help.
For sure. I definitely lean more toward reporting USMLE scores (I figure more information is better than less), but plenty of reasonable people disagree with me and I’m not in control of it anyway.
I recognize the high attrition rates and match difficulty of Caribbean grads but I’m surprised to see such a narrow view.
Caribbean medical school are a fantastic option for late bloomers. These schools give you a chance to prove yourself as worthy medical-student-material in battle while legacy US schools bottleneck you out of the game at the start using undergrad pedigree, GPA, MCAT and whatever characteristic that’s currently in favor in your teen years. We all believe that merit should be proven vigorously for the aspiring physician but theoretically you are getting a more battle tested medical student going into residency from a carib school due to the alternative structure of the admission process and aggressive attrition rates—ONLY THE STRONG SURIVE. Alternatively, legacy schools allows for an early bloomer with a perfect resume and high standardized scores to skate on by during medical school and maybe use the American pedigree to skate on by in residency. We’ve all seen it.
As far as the predatory aspect of the financial relationship you seem to have insinuated. Give me a break! You of all people Dr. Dahle should realize that every investment requires diligent research and personal risk assessment. All this data you are quoting is widely available and most of the time even published on the university portal. In addition, most( the good ones) will fail you out early and it’s for your own protection. At worst, if you prove incompetent you will only owe a couple semesters worth of tuition.
Lastly, unless things recently changed there are multiple Carib med schools eligible for US federal student aid.
https://studentaid.gov/understand-aid/types/international
Do your own research. Pick a good Carib program(Big 4). Be honest with your capabilities and understand failure is not an option if you start this path.
That being said. I’m a carib grad. Used US federal aid for all 4 years. Very expensive but it was the best 4 years of my life. 2 years in paradise learning from some of the best professors you’ll ever meet from around the world followed by 2 years in mud training in NYC hospitals. Competitive residency match on first try in 2015. One of the best fellowship programs in the world for my specialty. Started my dream my dream job last year. Many friends and friends of friends with similar stories. Incredible incredible experience.
I disagree this is a “fantastic option” or that I’m taking some “narrow view.” I’m just presenting the statistics. The statistics make it pretty clear that going there, especially with borrowed money, is a huge financial gamble. You had better be completely convinced that you’re going to be on the winning end of that gamble before taking it. You might feel that coming out of an IMG program shows that you are strong, but that doesn’t mean that residencies will share your opinion. In fact, it appears to me that there is pretty strong data showing they do not feel that way at all.
Is it predatory to saddle 1/3-1/2 of your class with hundreds of thousands in debt knowing they won’t be able to get a job that allows them to ever pay it back? I think it is. Obviously others view it as “just giving everyone a chance.” Liberty vs paternalism I suppose and reasonable people can disagree.
Glad it worked out for you and thanks for passing on the advice to others.
I graduated from St. George’s in 2003 and matched into a very good Obgyn program and my exam scores on steps 1 and 2 were pretty good. I will tell you that many colleagues in my class did very well and placed as well, I really don’t know many people who didn’t match. If they didn’t match it was more of a character/personality flaw which was obvious to others . One of the most intelligent guys in our class was almost genius but you could tell he was never going to be a great people person but ended up doing research and eventually found his niche. Another of the guys in my class actually had one of the highest step 1 scores in the country. Most of us ended up with great jobs and yes student loans were close to 200k but I am still paying back and owe about half now but at a very low interest rate it’s not worth paying them off so quickly. I hear people graduating from dental school in the US having loans greater than that. So I am appreciative of the experience I got there and the people I met which will be an experience I will never forget and I have zero regrets.
Yes, you won the gamble. Doesn’t mean it wasn’t still a gamble though. I’m surprised you didn’t know very many who didn’t match. The statistics are pretty significant. But it’s probably because people don’t talk about it much. I have a friend I went to med school with who didn’t match. I didn’t know it for years afterward. He did a year of research and then matched the next year.
And thanks for the link. From there I found a list of Caribbean schools eligible for federal loans and added it to the post.
What about corporate jobs? I have seen medical graduates without residencies join consulting companies or financial companies for medical adjacent firms (like medical device companies or Med tech companies). You don’t need a residency for that. I think this should be more widely advertised as a potential option.
A doctor who has finished medical school, finished residency, and practiced for a couple of years is VERY valuable to pharma and other corporate jobs. One who only finished residency is significantly less valuable. And one who only finished med school is even less valuable than that. Mostly, medical school teaches you what you need to know to start residency, not enough to go do something else. So are there jobs that would want an unmatched MD/DO? Sure. Are there enough of them? Not even close. And I highly doubt any of them pay enough to justify the cost of borrowing to pay med school tuition.
This post strikes a little close to home.
I graduated from a Caribbean medical school in the mid 2000’s: one of the “good reputation” ones. I checked the match spots for graduates and they seemed to place in a variety of specialities. They also had a very high first time pass rate for step1.
With Step 1 going to pass/fail and the increasing number of candidates the carribbean schools accept, I would not recommend this route for anyone…unless they could pay cash for the education.
The residency matching has focused mostly on a few non competitive specialties. That’s to say nothing of those who dropped out, took extra time to finish their degrees, or who go chronically unmatched for a residency.
For those who want a career in medicine but can’t get into medical school, other options such as an APC should be seriously looked at.
Regards,
Psy-FI MD
I’m a former employee of Penn State College of Medicine – Hershey. I worked in clinical simulation, which was a wonderful professional experience for me personally. Of note, our fellowship program attracted many IMGs – Caribbean, South American, Central American, Eastern European, African, during my tenure. I don’t know how to measure the success of this(as it wasn’t part of my job description), but during the years 2017-2021, three of our fellows matched, all having long post-med school graduation gaps. The matches were in Anesthesiology, Family Medicine, and Pathology. Two matched at Penn State and the other with a different system within PA. For a tiny program, I’d deem it a bright spot. The shortage of residency slots available is definitely a huuuge problem.
One route I’m surprised more of these people don’t take is going to PA school. Obviously this means more loans and more schooling, but they’ll make a good living, better money than they currently are making. I’m sure a program in the US would love to take a student who is an MD to their program provided they graduated in good standing. There just seems like if they get in this bad situation they need to look at alternatives that, while not ideal, are ways to earn a good living in medicine.
This is ridiculous.
PA school is just as rigorous if not more competitive and expensive.
Why not tell someone to just go and get their MRS degree.
Wrong – show me a PA school with less than 10-15% acceptance rate. PA schools are far easier to get into than US based MD or DO programs. How do I know? I am a PA who was unable to get into medical school. Glad I did the PA route, but your post is ridiculous.
I’m arguing they shouldn’t have to go to PA school. They already did 4 years of training. PAs only do 2. They should automatically become PAs.
So you’re basically saying PAs are rejected MD students? Don’t you think they should at least sit in the PANCE to see if they can pass that exam?
No, not exactly.
I’m saying MDs that don’t match into residency have already had twice as much education as a PA and presumably were taught at a higher, more comprehensive level.
I don’t think it’s unreasonable to make them pass an exam though, but presumably these folks are already passing the USMLE Steps 1-3, which, again, should be more difficult than the PANCE.
Wait…why should people that made poor decisions get to automatically displace PAs that successfully chose to go that route?
I say that as a PA that is applying to [non-Caribbean] medical schools.
The question could be reversed. “Why should a PA get to practice medicine when there are people available with twice the education who cost half as much?”
Let’s make it fair all around and have it go both ways. Let PAs challenge the USMLE and apply to residency. Let MDs/DOs that fail to match or choose not to pursue residency sit for the PANCE and become PAs.
I don’t have a problem with making them sit for the PANCE. You seem to believe it is a harder test than the USMLE Steps 1-3 for some reason. That seems unlikely to me, but I admit I haven’t taken the PANCE.
Do you agree that medical school covers all the material that PA school covers and then some? If not, what does PA school cover that med school does not?
This post seems to have turned to an anti-PA, which unfortunately is very sad. There are a lot of PA who went to PA school because they didn’t want to go to medical school, not because they couldn’t get into medical school. To question them why they should be allowed to practice medicine because one made the decision to be an IMG and couldn’t land a residency is idiotic. Many PAs decided to pursue that career for various reasons; whether they were medic first and didn’t want to go to medical school since they’re not a traditional student, didn’t want to spend all those years and accumulate much more debt or wanted to start a family earlier. This post make it seems that everyone who became a PA did so because they couldn’t get into medical school or if an IMG failed to land a residency spot should automatically gain the right to be a PA. Entitlement at its greatest.
Nobody is saying people go to PA school because they can’t get into medical school. Lots of reasons people go to PA school but it’s still pretty tough to get into.
Step out of your PA shoes for a minute and look at this objectively. I’m neither an IMG or a PA so I think I can be a bit more objective here.
I’m not really making any sort of an argument to get rid of APCs here. I’m trying to figure out how to eliminate the massive waste that is throwing away the career of doctors who did not match but otherwise finished medical school in good standing and passed appropriate licensing exams.
If two years of education and passing a test is enough to allow someone to practice indefinitely in a supervised manner, then why isn’t four years and passing a test? Logic would dictate that it should be enough. Yet only in a couple of states can it even be done and those docs are paid half as much as PA. Not exactly fair to them wouldn’t you say?
Now, let’s say you’re an employer. You have a choice of paying an associate physician (if that’s what we’re going to call these docs) $50K (or even $100K) or hiring a PA for $100K. Which one are you going to choose? At a minimum, it makes sense to at least look at these associate docs if state licensing and hospital credentialing issues can be addressed. That’s what I’m arguing for.
Now, you and I both know that some small percentage of these docs are lousy docs and are not going to be as good as an average PA. But on average? That seems unlikely.
So if they pass USMLE 1,2,3 but cannot get into or complete a residency they should automatically be eligible to take the PANCE? Why not allow them to take any medical professional licensing exam that takes fewer years than MD or DO? With that logic why not make them automatically eligible to take board exams to be Pharmacists, RNs, RTs, Nurse Anesthetists, PAAs, perfusionists, Paramedics, etc?
Physician Assistant and MD/DO training is comparing apples to oranges. Scope of practice is different. FMGs should not and will never be eligible to take PANCE unless they complete an accredited PA Program.
I’m very curious as to what you think is taught in PA school that is not covered in medical school. I always viewed PA school as the same subject matter taught at a lower level, as opposed to NP school which has a significantly different curriculum. That is one reason I always preferred PAs to NPs as APCs. Here’s one PA curriculum I found online:
Anatomy and Physiology 1
Physical Diagnosis and Patient Evaluation 1
Pharmacology 1
Principles of Medicine 1
Principles of Psychiatry
Health Care Delivery
Anatomy and Physiology 2
Physical Diagnosis and Patient Evaluation 2
Pharmacology 2
Clinical Lab and Diagnostic Methods
Professional Issues for Physician Assistants
Principles of Medicine 2
Clinical Neurology
Principles of Pediatrics
Principles of Medicine 3
Principles of Obstetrics and Gynecology
Principles of Orthopedics
Principles of Surgery
Aspects of Primary Care
Emergency Medicine and Critical Care
Aging and Rehabilitation Medicine
Research Design
I see MAYBE one class that isn’t completely covered by medical school, and I’m guessing it’s the least difficult one there. What do you see?
And no, I don’t think an associate physician should need to pass Step 3 to take the PANCE. That’s usually taken after internship. If they had finished internship and taken and passed step 3 they could just go practice as a licensed physician. Steps 1 and 2 should be adequate to show mastery of the medical school curriculum. I looked up a few sample PANCE questions and got them all right. Wouldn’t you be worried if I didn’t?
I fail to see how your suggestion of allowing all foreign medical graduates that passed USMLE 1 and 2 be grandfathered in and eligible to take the PANCE and practice as certified physician assistants does anything to address the physician shortage in the United States. Your opinion that these individuals will be more qualified to practice as APCs compared to individuals that completed a rigorous master’s degree to specialize as an APC is also subjective. PA programs are highly competitive, in many cases more competitive than many US medical schools, and certainly more competitive than foreign medical schools. The only thing that would be accomplished by allowing all FMGs to practice as PAs is effectively shutting out an entire profession of competent hardworking professionals. You said yourself; APCs are plugging primary care holes not currently filled by physicians. Now you want to advocate for undercutting PAs with FMGs simply because they can’t make the cut in the flawed US residency system? Your other suggestion of opening up more residency spots nationwide seems the most important piece of the problem.
First, shortages come and go. EM no longer has one for instance.
Second, the shortage is more a maldistribution than a true shortage.
If we’re short doctors, we should get more doctors. Not train more APCs. If we don’t need doctors and need APCs, then train APCs.
You may not like to hear it, but I think a med school graduate can make a very good case that he or she is better educated/trained than a PA school graduate. Does that mean every single doc is a better clinician than every single PA? Of course not. But more generally = better.
“If we’re short doctors, we should get more doctors. Not train more APCs. If we don’t need doctors and need APCs, then train APCs.”
I agree, more residencies=more doctors
More APCs by allowing FMGs to take over APCs space does not equal more doctors
Again, your assumption that a FMG is better at being a PA than a PA graduate is subjective and I respectfully disagree.
I agree that neither an associate physician nor an APC is a doctor.
Not all associate physicians are FMGs/IMGs. Only 93% of US MD school grads match in any given year. Assuming about half match the next year, that leaves about 3% a year who do not match. That’s about 570 docs a year.
All else being equal, which would you prefer, someone with 4 years of school or someone with 2? I’d take the 4. Now all that needs to be determined is whether all else is equal. Probably not.
But I’d still rather have the bottom 3% of med school grads than the bottom 3% of PA school grads. Why should those PA grads be able to get jobs when the med school grads can’t? That’s what this article is about.
PA school grads get PA jobs. Med school grads get residencies and much higher paying physician jobs than PAs. Just because some med school grads can’t get into residencies doesn’t mean they should automatically qualify then to become PAs despite not going to PA school. If they want to be RNs after not getting into residency, go to RN school. If they want to be pharmacists after not getting into residency, go to pharmacy school. If they want to become business professionals after not getting into residency, go get an MBA. Becoming a PA after not getting into residency is no different. I really don’t think this is a strange concept to grasp. There are more than 175,000 certified PAs in the United States that got accepted into/completed highly competitive and rigorous programs and work as effective midlevel healthcare providers. What you are suggesting would open the floodgates to any foreign medical graduate to come to United States, potentially barely pass TOEFL, and completely choke out the PA profession with many subpar PAs. I have friends that are FMG graduates that couldn’t get residencies, and it really sucks. They’re hard workers and are now stuck with astronomical student debt with no end in sight. I hate it for anyone in this position. But completely undercutting the PA profession is not the answer to this dilemma; opening more residency positions is.
So you don’t think there should be any way for a med school grad to become a PA other than applying to, being accepted into, and graduating from PA school and passing the test? Is that correct? Seems a tough position to defend given the overlap in curriculum, but whatever.
So the workaround is to do what other types of APCs have done and go to the legislators and create a new type of APC, an associate physician. i.e. someone who is a med school grad and can practice in a supervised manner indefinitely, similar to a PA. It’s already happened in MO and should probably happen everywhere. Then employers and patients (aka the market) will decide which type of APC they prefer. Either way, there will be the same effects on PA job availability whether PAs or APs.
I am a Foreign Medical Graduate. I think that rigorous standardized testing is the best and perhaps the only tool that a FMG can use to his own advantage. In the race to secure a residency position a FMG starts already from a disadvantaged position. What if the competition is for a high paying, sought after specialty? How is a FMG going to differentiate herself/himself from the rest of the crowd? I think the standardized testing is probably the only viable tool. I am sorry to see USMLE step 1 scores gone. With out the presence of rigorous testing an already disadvantaged group gets kicked even further behind. Just one man’s opinion.
Wow…did not hear that USMLE step 1 is going pass/fail. Granted, I went to a med school that was strictly pass/fail grading the first two years, then pass/fail/honors for clinical rotations.
Feel like the old guy saying this but wow is the world going soft…..pass/fail part 1 is the nail in the coffin for IMGs. How is Harvard going to select their undergrads now with optional SATs….LOL.
No.
Harvard allows only privileged and legacy students in. It’s already a done deal.
Very spot on article. There is simply an element of risk going to a foreign medical school (particularly as a US-IMG) obtaining a US residency match. Residency match committees are risk averse by nature so many will not even consider applicants from medical schools they don’t know. I had IMG’s and DO’s in my residency program, but they all went to med schools that had previously sent successful residents to the program so their experience was a known quantity. Applicants from unknown schools typically were not considered.
I agree that expanding the pool of residency slots, especially for primary care makes sense as a long term investment in the country.
With Step 1 pass fail, we are simply going to require a Step 2 score to be considered.
I know many outstanding International graduates. These are people who grew up in another country and went to medical school there. They either trained in their country, then came to the US, or did med school at home and trained in the US. Good US programs are magnets for top foreign grads. I can think of many outstanding people from Switzerland, Germany, Israel, France, Canada, Ireland, the UK… There are great people like that all over. At least in the more metropolitan areas.
On the other hand, I have encountered very few Americans who went to foreign medical schools. They are almost unheard of in our residency or on faculty. I don’t know whether we interview any such people. We do not seem ever to match them. I agree that going to those schools is a big gamble.
The concern about these people is so severe that the many residencies that cannot fill their programs at all still turn down many such Caribbean grads. These tend to be small programs in low paying fields and rural locations. One might think they would take anyone they can get, but they turn down this large group of students.
I have not worked with many DOs but the ones I have encountered were the same as the MDs.
The move to expand medical schools was simply insane. More grads with no more slots to train them does not increase the number of physicians. I stopped listening to predictions of the number of physicians we will need in the future. Years ago the “experts” predicted a major glut of doctors and advocated cutting the number produced. The cuts never happened. Years later the SAME PEOPLE were still predicting the number of docs needed, now they claim it will be a shortage. I think I could better predict the level of the S&P 500 10 years from now than they can predict the number of docs we will need.
I understand the stats you presented look bad, but people need to be smart. Much like with law, if you don’t choose the right school you likely won’t make a decent income. As has been established by others, several Carribbean schools can offer federal student loans which means they have been through a process of demonstrating a similar education and educational standards (not selectivity) as US medical schools. Next, these quality Carribbean schools place their clinical students in a hospital training program that has at least an accredited family medicine residency program (green book Rotations). This cannot be said for most osteopathic schools who place their students in individual physician outpatient offices for FM, IM, OBgyn, etc rotations. That’s awful. These schools should never be accredited. Real hospital experience, working with multiple attendings who teach and with residents cannot be matched. Taking overnight call, being drilled for answers, writing reports and making presentations offers unmatched learning. How do the good offshore schools get these rotations? They pay WELL for them, from student tuition. Additionally they offer a clinical didactic curriculum, shelf exams, etc to guide clinical students information and keep them on track. Again, if osteopathic schools don’t have their students in real rotations they should not exist. The numbers look bad in general, but not even close to as bad if students choose wisely, work their rears off and have realistic expectations for specialties.
I do think the end of Step 1 score reporting is a problem. I think this may mark the end of DO students getting allopathic residences or DOs getting into competitive specialties and will pose a challenge to IMGs.
I agree rotations are a big issue and I’m glad to see someone is paying for them. I keep getting people calling me up and asking to rotate with me for free. First, it would be a lousy academic rotation. Second, why isn’t some of that $60K a year they’re paying coming my way if I’m doing the teaching?
Via email:
Foreign grads can apply to residency programs in commonwealth countries if they prefer English, or any number of Spanish speaking ones throughout the world. The USA is best for money maybe, but not necessarily practice satisfaction or lifestyle. The US system has been turning out some pretty marginal product due to entry criteria that focuses on rote memorization rather than character imo.
I’m not a doctor, but the general takeaway I’m getting out of this is don’t chase a career just for the money. Chase it because you *really* want to do it and have the aptitude for it. I doubt people would go off chasing degrees in these less than ideal circumstances if they didn’t think they’d bring in serious dough in the future.
You might be surprised. Something like 1/4 of practicing docs say they had no idea what the average income in their chosen specialty was prior to graduating medical schoool.
Sure, but I’m willing to bet they knew they were going to be making “doctor money”. Anecdotally speaking, people I knew who went to med school in the Caribbean did so because they fully expected to make doctor money in the future. Furthermore, they expected the prestige of being a doctor.
Where I’m from, you had to take biology in high school in order to be eligible for med school. There was so much pressure on me from my parents and relatives that I caved in, took biology, and started dreaming of walking around in a white coat and driving BMWs. Luckily, the subject made me wanna vom, so I threw a tantrum and convinced my Principal to let me switch electives. Ended up in engineering, have no regrets. That’s the background I’m coming from when I made the comment.
But don’t chase it if it will bankrupt you to do so! I’m one of those bad moms- steered my kid away from acting, even music- do it all you want as a class, extra curric, secondary major or a minor. But plan on teaching it for lower middle class income if that’s all you do, don’t bank on being the next Meryl Streep or Yoyo Ma. Get a nice upper middle class job and bet you can be in a lot of amateur theatricals especially if you donate to the theatre group. And take expensive art/ creative classes in school so you don’t end up like so many bored folk owning rarely used spinning wheels or woodworking tools or even a kiln and floor loom.
And despite my own son-in-law being an example of a potential pro athlete- but he had a college scholarship for his sport, and still decided he didn’t want the risks (mostly financial- soccer not football) of that as an occupation.
I’ve mentored IMGs with some success.
Some practical advise for FMG/IMG:
Unfortunately, the odds are against you – programs have an aboudance of applicants without the extra vetting they feel they need to do. An average program director is looking at 10-50 applicants per slot (or more). It’s easy to have the computer cut that in 1/3. The only way to make up for that is face-time.
– Pick your specialty carefully. Dermatology might not be a realist aim.
– You need to work in a center capable of hiring you or with enough contacts to get you a spot somewhere else. This may be 1 to 3 years of research in the department. It may be your second job – these positions are often unpaid. This provides you with a 1 year interview – you will need to be aggressive and pursue projects with key staff members.
-You may also need to do an uncategorical internship somewhere then apply for a residency. You may need to do more than 1 of these internships.
It is not impossible. But it will take time and work.
I am not sure how much of the difference between US grads and Caribbean grads relates to ability to practice medicine. They clearly differ in their ability to absorb and repeat information on a test. US grads are great at that. Had to be to get in med school. MCATs predict Board scores but they do not predict residency rating of the quality of trainees. Of course there are problems with the precision of those resident ratings and restriction of range but there is not great data that someone with a top score on the MCAT will be a better doctor than someone who just squeaked into a US school.
I think many Caribbean grads would have done fine if they had gone to a US school. Having gone to a lesser school, they appear to have received a lesser education, which is why so many residencies will not touch them.
There is the famous case where the legislature abruptly raised the class size of a Texas state med school after the admissions process was complete. The school had to go back to people they had waitlisted or rejected to fill the class. Many of them had already accepted offers elsewhere, so the school had to go fairly far down the list. They then studied the performance of the two groups. They found that those who made the first cut did no better than those who came in the back door. Whatever they had selected for did not predict how people did once they enrolled.
Much of being a good doctor revolves around being careful, thorough and responsible. Doing that all the time. Even at the end of a busy day. Even when distracted and overwhelmed. Staying up to date in the field. Conscientiousness is somewhat reflected in college grades and MCATs because that sort of behavior helps learn the material. But it is more the conscientiousness than the knowledge that makes people better doctors.
Medicine is probably boring for brilliant people. There is too much rote repetition. Dull, but necessary. We have many magnas in our med school classes but far fewer summas or Marshall scholars. To the extent that such people go into medicine, they focus on research or policy rather than being full time clinical docs. Practicing medicine is just not intellectually challenging for them.
I don’t credit admissions committees for med schools with doing a great job of picking people in the margins. It is too hard to predict. I am sure that many people who did not get in on the first try but do get in when they apply do just as well as the first group. But once rejected twice, the odds on having a career in medicine plummet. I agree that those people would be better off in other lines of work, than going into debt and blowing 4 years of their lives trying to get into US medicine via the foreign schools.
There are other careers. In healthcare and outside of it.
It was a massive risk. I was a non-US citizen.
I did an undergraduate degree at a prestigious university and if I have gone “home,” I will have to repeat couple years (6 years medical school). I grew up in an extremely competitive society where young children got IQ tested, personality/ aptitude tested and nationally graded. I was not It was not paradise for the 2 years of basic sciences. It was kindness in other physicians who ended up mentoring and wrote letters, in addition to working our hardest and getting the highest marks in clinical rotations (along with Ivy Med students: JHU, Cornell, etc) and high USMLE scores. My boyfriend and I prematched to a university program who had never accepted our school graduates. We worked our hardest and ended up as chiefs. We both matched to cardiology fellowships, waived our j1 visas and offered faculty positions at prestigious universities in highly desirable VHCOL cities. My husband student loans was paid off in first couple years of attending jobs. Since we are private practices and I have been investing aggressively, we have been fat FI for several years. I agreed it was a huge risk and lots of luck and chances in the processes. At this time, I have continued investing aggressively and expanding to investment in different space. My husband is in the tech space (AI, machine learning) and has been co-founding several tech companies; this is his passion in addition to practicing. His future pay out will be in the 8 figure range. Would you be happy to not take the risks and be mediocre. If you are happy to be …, then good for you. If not, take the risks, touch the sky, you can’t be successful if you don’t fail.
I would say WCI post above is true. We knew many who failed to graduate or to match.
This is my experience, similar to Maria’s below. I graduated from Ross University in 2008. My class matched into a mix of both noncompetitive and reasonably competitive specialties. There was a decent number of EM and general surgery with several matching in radiology and orthopedics. Of course, a good chunk of us did IM, FM, Peds and Psych.
In the end very few of my colleagues that made it to the match had a problem getting into a residency program. I honestly can only think of one in my class, and that’s because he took 3 attempts to pass step 1.
The numbers of students that failed out of our school… particularly in the first 2 years… was probably close to 50%, maybe more. This unethical practice of the Carribbean school experience still upsets me every time I think about it.
I guess what drove me to proceed with doing Caribbean medical school despite the numbers is that I learned at the time that St. George and Ross University had much more favorable numbers than the general “Caribbean IMG” match stats revealed. Was it comparable to what US students saw? Heck no, but much better than the general stats being thrown around.
If you went to Caribbean schools 15 years ago , I would say if you picked St. George or Ross your odds were pretty good at getting into a non competitive residency…with a decent shot at even achieving moderately competitive residencies if you busted your butt a bit more. In 2021 is that still the case? I doubt it.
Remember the numbers now are worse than they used to be. There are more US MD and a lot more US DO graduates now, so even the “good Caribbean” schools are likely seeing a drop in match rate.
You also have to remember that there may have been people who wanted to do orthopedics but didn’t because they were worried about their competitiveness coming from a Caribbean school. That person technically matched, but perhaps not in their # 1 specialty. Can’t ignore that factor. And you mentioned, of course, the fail out rate which is dramatically different than any US school I know of.
It would be interesting to see the actual numbers for each school though. Know a link?
Another solution might be for the Caribbean schools to issue a physician assistant degree along with the doctor of medicine degree. This way if the graduate fails to match residency, they can take the physician assistant licensing test and practice as an advanced practitioner.
ARC-PA won’t go for that.
I like it.