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Why I Won’t Apply to Caribbean Medical Schools

March 24th, 2013  |  Published in Applying to Medical School  |  17 Comments

 

Nijigahama Beach

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.

Residency Match

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

 

 

 

US MD IMG
Radiology 1.8% 44.5%
Ophthalmology PGY-2 PGY-2
Anesthesiology 1.9% 36.9%
Dermatology 8.2% 61.9%

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

 

 

 

US MD IMG
Family Medicine 1.8% 51.4%
Internal Medicine 1.9% 49.1%
OB/GYN 3.7% 44.4%
Peds 1.5% 31%
Psych 2.6% 54.1%
Surg 9.2% 62.1%

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)

BUT!

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.

Update

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!

Sources

image created by Konstantin Leonov
Match data from FSU and AUC was institution-reported

  • Tasha

    I have experienced the same thing. Medical school rejection was so heartbreaking for me that instead of telling myself I could do better, I took the easy way out and went to pharmacy school- regretting it every single day. I have graduated and fortunately working at a job I love, but I always think “what if.” I am planning on applying for med school next and plan to not take the easy road. I may be in my mid-30′s when I graduate, but the fight will be worth the time and pain. Loved your article!

    • http://www.goingtomedschool.com Jennifer Isaacs

      Tasha, thanks for sharing your story. I’m glad that you decided to finally find out “what if.” I have not given up on my decision to go to medical school and I’m still working on getting there! I’m going to apply in May 2014 for matriculation in August 2015. There are definitely many non-traditional students in medical school so I think you’ll be pleasantly surprised to find you are not alone. Keep me updated on your journey, and good luck!

      • bella

        Thanks for your thoughts on carribean med schools. Very insightful. Does anyone know anything about AUA in Antigua? I just got accepted there, but have been doing a lot of research and have lots of doubts about it.

        • http://www.goingtomedschool.com/ Jennifer

          In my opinion there is very little difference between these schools. You are going to be in an uphill battle and likely are already disadvantaged if you didn’t have the academic record to get into US schools. If you think you can dedicate yourself and work 2x as hard as you ever have, and if you can risk the loss of money and time, then do it.

  • Realitydude

    GOOD FOR YOU! DO NOT..I REPEAT DO NOT GO TO MED SCHOOL IN THE CARIBBEAN..
    The US has about 25,000 PGY 1 residency spots annually, and around 19,000 US MD and DO school graduates. The remaining 6,000 are filled with International Med Graduates, but as more and more US med schools are opening up(especially D.O schools) they are churning out more students. Every year there are hundreds more new Med school graduates than the previous year.
    The number of residency spots hasn’t gone up. I read some statistic that by 2017 the ratio of US Med school graduates to residency spots will be 1 to 1.
    I have friends who went to caribbean schools..SGU, Ross, St. Matthews, AUC, Saba and quite a few are having trouble matching into residencies.
    These students ARE NOT dumb, they went to UCLA, Berkeley, Michigan, George Washington, etc and other good undergrad schools. They passed Step 1 and Step 2 on first attempt but didn’t match into residency. Some wanted competitive fields, and such, but many are struggling. They will take any residency they can get.
    Most caribbean students end up in family practice, internal medical or psychiatry.
    Also, my friend from Ross said they started off with 400 in his class, and by the end of the 4th semester only 250 remained, a lot get weeded out.
    The caribbean was a great option in the 80s and 90s, but now its just too much of a gamble.
    The unrealistic optimism of many students is what gets people into trouble. They think they are special snowflakes and will be that top 1% of students who makes it, but many can’t hack it.
    It’s great that many people like to study medicine and help people, but med school isn’t for everyone. If you can’t get into a US MD or DO school after applying a few cycles, they pick another field in health care.

    • http://www.goingtomedschool.com/ Jennifer

      I agree with you on basically all of this. I feel like since I struggled some in undergrad I can’t just believe that getting into a medical school program will make me a doctor. Unfortunately there are many competent persons that don’t match and there is negative stereotyping about Carib doctors. I’m not sure if it will ever change. I do have a few friends going to the Carib right now, and I hope that they match successfully!

    • Chris

      1) The weeding out is a good thing, not everyone should/can be a doctor. The Caribbean schools do not screen them out, the curriculum does. That’s why they are in the Caribbean in the first place.

      2) The competitive specialties are competitive because they take the best of the best… If your friends were the best of the best they’d have gotten into US schools. I question how smart they were if they went to a Caribbean school and applied to highly competitive specialties w/o a back up. That doesn’t sound smart to me.

  • Nova

    What about St. George’s University? Is there anything that they might be hiding as is the case with Ross? I too might be older by the time I graduate med school but perhaps a DO program would be better.

    • http://www.goingtomedschool.com/ Jennifer

      My friend went to SGU and wasn’t happy about it. From what she told me, they admit more students for the first year then they have clinical training spots available…not everyone admitted is going to make it to third year, either by virtue of the school expecting a certain number of students to fail, or by weeding out students so that would happen. I would just be careful and yes, a DO program is a much better choice for non-traditional/older students.

    • Chris

      SGU has the best match rate of all Caribbean schools. Now whether that’s because they weed people out or because they have the best clinical infrastructure, I don’t know. I can say I’ve met many SGU students during my Clinicals and they seem to be happy.

      I can tell you their island is the best followed by AUC on St. Maarten. SABA and Ross have terrible islands.

  • Chris

    I went to AUC. I am at the end of my 4th year and I am currently applying to residency. I have had good success obtaining interviews to residencies and that is considering that I am in the couples match with my wife who I met at AUC. I know many current residents all of who also had great success in matching last year despite being Caribbean students. I want to make a few comments in regards to going to a Caribbean med school and your chances of getting a job:

    1st… This article is fairly accurate but I have to say that I still would take the plunge if you’re a self starter and have people skills. The students I see that are not getting interviews are the ones who are rude, weird or not personable simply because your attending physician evaluations during Clinicals are paramount to your passing your Step exams. If you have a hard time communicating or think you are very awkward in social situations, stick to US schools where they are more stats based. The comments about you in your evaluations as well as your letters of recommendation and your personal statement all have to be stellar.

    2nd… Even though AUC was relatively unsupportive of my 3rd and 4th semesters (referred to as Clinicals), if you fight to get what you want and are smart about not going to ‘easy’ clinical sites like England for Clinicals, you can get interviews based on evaluations from you attendings as long as you do well on exams. These schools will not hold your hand through your 4 years, no matter where you go. If you were a poor student in undergrad, you will probably be a poor medical student no matter where you go to school.

    3rd… Stay away from Caribbean schools that are not AUC, Ross, St. George or Saba as your chances to land clinical rotations in the US and subsequently match diminish greatly. Those 4 schools all had above a 50% match rate and the other schools fall off the charts with below 50% match rates. This is where the 49% statistic comes from in the above blog. The data was published by ECFMG beginning this year. They break it down by island but it’s obvious which school is on that island. These stats are available online, just google ECFMG.

    4th… Be realistic. If you think you want to be a world class heart surgeon or a dermatologist coming out of the Caribbean you’re barking up the wrong tree. The fatal flaw I see out of my classmates, outside of not being personable, is aiming way too high and not having back up plans. Your best bet to have a job after med school is to stick to primary care specialties especially if your scores are not astronomically high.

    I do agree that going to a Caribbean school greatly diminishes your chances of getting a residency but if you think you are can truly assess yourself and your abilities and feel as though you can endure the long lonely road of a Caribbean school, go for it. Just be careful that if you are not 100% motivated and/or unsure of yourself, you might find yourself straddled with a huge loan with no way to pay it back if you fail. These schools are second chances for the motivated and smart, not gateways to being a doctor for the lazy and dumb. The problem is that these schools accept both types of students.

    • http://www.goingtomedschool.com/ Jennifer

      Chris,

      Thanks for your contribution to the discussion. I agree with everything that you said. I’m happy to hear you’ve made it successfully through med school.

      One note is that the 49% unmatched IMG applicants refers to anyone who didn’t go to a US school…that means Caribbean+France+Egypt+Afghanistan, etc.

      I’m glad you were able to provide realistic advice from the perspective of someone who has been there!

    • nitab

      Hi Chris,

      Would you mind elaborating on how AUC was relatively unsupportive during your clinical years? A good friend of mine is applying right now and the AUC staff and all the blogs I’ve read have painted a VERY rosy picture implying no issues whatsoever and that the school has everything set up for you. I really want to hear from someone who has had first hand experience and isn’t also trying to sell the school. Thanks!!

  • Lolek

    This is part of the problem: Michael Uva, a 2010 graduate of St. George’s University in Grenada, sits for a photograph in New York, on Aug. 19, 2013. Uva has $400,000 in medical school loans and currently earns $30 an hour overseeing a blood donation clinic in New Jersey, where he also draws blood (after 2 failed attempts at residency)

    Here’s the link: http://bangordailynews.com/2013/09/18/opinion/contributors/subpar-not-caribbean-medical-schools-or-their-students/

    This is the biggest problem – you have graduates, burdened with great loan who cannot get into a residency (remember Caribbean IMGs are not the only ones – plenty of hard working med grads from all over the world – Pakistan, India, Nigeria, Germany, UK, etc…. and many of these don’t have a pressure of something like $400K in student loans)… This reflects fundamental problem – education is way too expensive, regardless if it is here or at the Caribbean – I do not think that it is this expensive anywhere in the world and US ranks as #30 in terms of the quality of medical services (believe France maybe #1 and their grads don’t have any or minimal student loans)…

  • Lolek

    as a caution to anyone considering going to St. George’s University in Grenada:
    DO NOT DO IT… If you do here’s what to expect:
    Crowded classrooms, subpar PBL group leaders (some of whom are SGU grads who apparently could not get matched into the residency so are spending a year or two teaching-feel for those people)… Most TAs are actually med graduates from places like Cuba, Egypt, Jamaica so SGU gets their major instructional work force for free… You have to take your own laptop to take an exam and go through the whole security protocol before you take an exam – and hope internet doesn’t go down before you get cleared to take the exam… Lack of study space – every spot is pretty much packed, it’s humid, if you get caught at a hall studying with a soda you will get a ticket from a uniformed police officer… and yes, you are running a chance of ending up like Michael Uva, SGU grad with $400K in debt, no residency and drawing blood… as I say there are many more like him – some of them work for SGU (why would one want to work for for-profit institution that burdened you with so much debt and hasn’t helped you enough with residency match is beyond me)… No dream is worth this – you’ll anyway wake up to reality that medicine like anything else is just a job and big business… wearing stethoscope and giving physical exams gets old pretty quickly… Just go to US school, if you must go abroad go to England or Ireland or Australia… if you speak Spanish go to Cuba and get medical education for free… otherwise just enjoy life and go and study something else… in the end it’s all the same… don’t put yourself in a position where you find yourself in a self-made mess that is huge debt, sickly competitive environment and no guarantee of residency… Future anyways will belong to nurse practitioners who will also be called doctors (Doctor of Nurse Practice or DNP starting next year every NP program will be DNP – so longer and puts Family Med docs out of business more or less)… AGAIN, DO NOT do it, unless you’re OK with incredible humidity, overcrowded courses, “factory/mill educational institution” that’s trying to produce robots who, only allows students who pass their comprehensive exam to sit for the USMLE (so that they can report high USMLE first time pass rates)…. The whole thing is less and less about true education and more and more about profit, percentages, scores, etc… so not worth it… If you do go – good luck, you’ll need it!!!