I am one of those medical school applicants that has a low science GPA (2.54) and fairly decent MCAT (30T). Naturally, my application is not competitive at US medical schools. After a slew of rejections during the Summer 2012 AMCAS application cycle, I began to review the pathways I can take to pursue my dream career. After much research, I have decided that I am not going to apply to the Caribbean medical schools.
First of all, I want to point out that Caribbean medical school are legitimate institutions which produce graduates which can practice in the United States after passing the licensing exams (USMLE) and completing a residency (graduate medical education) program in the US. I am not concerned that I would be incompetent if I graduated from a Caribbean medical school. There are many accomplished persons who graduate from Caribbean medical schools! These are the reasons I will not apply:
The Comp Exam
The NBME Comprehensive Basic Science Examination is a test that Ross University requires its students to take and pass before sitting the USMLE Step 1. This test is supposed to be reflective of Step 1. You would think that passing would be no great challenge since you would be preparing for Step 1 anyways. This blog says that only 30% of students in Fall 2011 passed the Comp exam on their first try. That certainly explains Ross’s touted 95% first-time pass rate for Step 1 in 2012!
Similarly, students at the American University of the Caribbean must also take the Comp exam in their 5th semester before being certified to take Step 1. There, 60% of students pass the first time and they have a 96% first-time pass rate for Step 1 in 2012.
To be eligible to practice medicine in the United States, you must secure and complete a residency program in the United States. Graduates from the various Caribbean medical schools apply for residency programs through the National Resident Matching Program. An applicant (medical school graduate) is matched with a residency program using an algorithm which considers the program’s rank of the applicant and the applicant’s rank of the program.
In 2012, MD graduates from US schools had a 95.1% match rate; DO graduates from US schools had a 74.7% match rate (they have their own “DO” match, in addition to NRMP); US citizens from international medical schools (that includes the Caribbean and all others listed here) had a 49.1% match rate. The numbers speak for themselves, but like any reader of Freakonomics will know, statistics are not as they seem.
Overall, 56.5% of MD graduates from US schools were matched with their first choice program. At American University of the Caribbean, only 42% matched with their first-rank program.
There are many considerations to take when applying for residency programs and many ways to stand out as an applicant. But can attending a medical school that is not in the United States hinder your success? Take a look at the ROAD specialties for example. This whole post has been discussing PGY-1 placements so I am omitting ophthalmology from the table.
This table shows the percentage of applicants who chose this specialty as their only choice and were unmatched.
Percentage of Unmatched Applicants
Note that US MDs were less likely to be unmatched than the IMGs (international medical school graduates—this includes the Caribbean!) Of course these are very competitive programs so let’s look at primary care specialties. This is something I considered, as I want to practice primary care. There are many different opinions as to which specialties are in primary care, so let’s just assume these ones below are in this category.
Percentage of Unmatched Applicants
The percentage of unmatched candidates who had chose only one specialty is not any better for the primary care specialties. But, keep in mind that the IMG category includes all of the international medical school graduates, not just those from the Caribbean.
Where do the graduates end up and how many of them?
At the American University of the Caribbean in 2012:
- Radiology–Diagnostic: 2
- Anesthesiology: 6
- Dermatology: 1
- Family Medicine: 50
- Internal Medicine: 57
- OB/GYN: 8
- Peds: 20
- Psych: 6
- Surg: 3
Let’s compare this to the residency placements of Florida State University in 2012.
- Radiology–Diagnostic: 1
- Anesthesiology: 8
- Dermatology: 1
- Family Medicine: 15
- Internal Medicine: 22
- OB/GYN: 17
- Peds: 16
- Psych: 1
- Surg: 8
The distribution is fairly similar. But for some, where they go for residency will play a large role in their career development.
Clerkships (rotations during M3 and M4)
In some cases, medical students will choose to do an elective clerkship at a facility where they wish to do residency. This allows students to “audition” for the position before they apply and get a feel for the program and location. All clerkships/rotations during your 3rd and 4th year of Caribbean medical school take place at other institutions. Also keep in mind that as a Caribbean student you need to apply for the clerkship locations on the list; at Ross, this happens on a first-come first-served basis. Just another uncertainty to add to the Caribbean mix! Now, if you wish to do an “away” clerkship while at a Caribbean medical school (and by this I mean you want to go to a facility that is not on the list) you have to send a request form. The Caribbean medical school has to pay the facility to accept you for their training, and if the cost is higher than the school deems valuable, you may be rejected. Not to mention, that some schools like University of Louisville, do not accept Caribbean students to do away rotations there. (But, despite this, some students from AUC matched with Internal Medicine programs at University of Louisville.) Currently, I cannot forsee the need to do an away clerkship, but I know if I went to a Caribbean medical school I would want to audition at a facility in Texas since that is where I currently desire to reside long-term. If attending a Caribbean medical school eliminates that flexibility, I do not want to attend.
Still not applying despite these good things
Monthly, weekly, and sometimes daily, I flounder between feeling confident that by repairing my GPA I can get into medical school and feeling hopeless. With no other career path on my mind that I would find as satisfying, I do consider the pros of Caribbean medical schools.
- living in an exotic place for two years (although I would likely have little time to see the sights)
- early patient exposure (at some schools)
- would likely be accepted and be able to get a medical degree (and perhaps return to the US to practice)
- tuition is cheaper than that of some US medical schools for out-of-state students (for some schools)
This journey of going to med school is not about being accepted to medical school and being able to frame a medical degree. My immediate goal is to begin a career as a physician; after that I am sure that my goals will change based on the opportunities before me and how medicine will have changed by the time I do become a physician. I cannot risk attending a Caribbean medical school and wondering if I will be one of the lucky medical students that gets to participate in a residency program, that I will not be one of the ones that will breakdown and flunk out or get tossed out during the pre-clinical years…. I need certainty.
Currently, I have begun plotting my journey as a post-bacc premed. Business degree in hand, I am trudging back to undergrad to pursue a second bachelor’s degree in Biology—a lovely, but expensive means of passing time during this overly massive gap year. Then, I will apply to medical school during the summer of 2014, with allopathic and osteopathic US medical schools in my sight.
Since writing this, I decided to attend a premedical post-baccalaureate program at VCU. This was based on feedback I received from the medical schools that rejected me. You can read that feedback, here. I also want to clarify that my wish for “certainty” wasn’t a wish for a golden ticket to doctor-hood, but rather certainty that I can survive the rigors of medical school. Fortunately the postbac program is giving me a small taste of what that might be like and allowing me to cultivate the skills I need to succeed. There were a lot of negative responses to my wish for certainty because of misinterpretation of my meaning–my own fault from poor writing. I switched over to a Disqus commenting system and have yet to add my Facebook comments into Disqus and in doing so the negative comments were lost. I have to import the Facebook comments manually, but once I have time I will do so. Let me know if you have any questions about my decision to not go to the Caribbean!
image created by Konstantin Leonov
Match data from FSU and AUC was institution-reported