Do Caribbean Schools Have Lower Residency Match Rates?

Do Carribbean Schools Have Lower Residency Match Rates_

It’s no secret that U.S. medical schools are extremely competitive to get into. In fact, it gets harder every year.  For this reason, premedical students might consider other options, such as Caribbean medical schools. These schools seem to guarantee a route for people who want to pursue their dream of becoming a doctor.

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However, there is more to it than meets the eye. Although there are plenty of well-trained medical doctors who did go to a Caribbean medical school, you will have a tough time finding any who recommend it over the traditional route. The residency match rates are significantly lower for Carribean medical schools, roughly 30% lower. The article below breaks down the exact numbers. Also, we will delve into some factors everyone should be aware of while considering Caribbean medical schools.

Why Do People Go To Caribbean Medical Schools?

The motive to attend Caribbean medical school usually boils down to one of two factors: 1) misinformation or 2) necessity.

What do I mean by misinformation? There are many misconceptions out there that make Caribbean medical schools seem like an excellent first option. Although this is less common nowadays, it is still essential to go over.  

One of the biggest misconceptions that I’ve seen is that an MD degree is better than a DO degree. While it is true that MDs have historically had an advantage over their DO peers into matching into more competitive specialties, this gap is quickly closing. The stigma that osteopathic physicians have faced is slowly eroding.

What does this have to do with Caribbean medical schools? It turns out that many people buy into the idea that an MD degree is superior to a DO degree. According to this logic, it would be better to attend a Caribbean medical school (which confers an MD degree) over a DO school.

A quick look through the 2020 NRMP Match Results and Data can tell you everything you need to know about the disadvantages faced by international medical graduates (IMGs).

  • 93.7% of U.S. MD students matched
  • 90.1% of U.S. DO students matched
  • 61% of U.S. IMGs matched
  • 61.1% of non-U.S. IMGs matched

From the data above, you can see that there is a sharp drop off in match rates for international medical graduates.  

A look at the percentage of students who matched into their preferred specialties reinforces the disadvantages faced by IMGs. 81.9% of US MD and 76.4% of US DO students matched into their preferred specialties. However, 68.7% of US IMGs and 65.4% of non-US IMGs matched into their preferred specialties.

If you break it down further and take a look at the match results for students who only attempted to match into one specialty, the differences become more evident. Throughout the table, it is obvious that DO students have a clear advantage over IMGs. This is for both extremely competitive specialties such as neurosurgery and dermatology, as well as less competitive specialties such as family medicine.

See the table below.

Percent Unmatched for each specialty

Specialty US MD US DO US IMG Non-US IMG
Dermatology
11.0%
17.6%
57.1%
47.4%
Neurosurgery
23.0%
75.0%
55.6%
74.3%
Orthopaedic Surgery
18.0%
25.4%
66.7%
75.0%
Otolaryngology
22.3%
40.0%
50.0%
75.0%
General Surgery
10.5%
24.7%
47.6%
64.1%
Internal Medicine
1.8%
4.4%
36.9%
36.9%
Family Medicine
3.0%
4.6%
41.7%
48.1%
Emergency Medicine
5.9%
11.7%
37.9%
45.8%

The poor performance of IMGs boils down to several factors, such as the bias against IMGs and lack of support from the administration when applying. However, it is a noticeable trend that should sway anyone away from Caribbean schools as their first choice.

This brings me to point #2. There are people who are aware of just how much more difficult it is to match into a residency program, especially a preferred specialty, from a Caribbean school. Yet, they choose to pursue this pathway anyway as it still gives them a shot. These are usually people who have exhausted other options and are now willing to take a very high risk in order to achieve their dream of becoming a doctor.

For someone who has exhausted all options, such as applying multiple times in the US and applying broadly to schools from all tiers and geographical locations, the Caribbean medical school may end up being a necessity to pursue their dream.

 

The Schools and Their Admission Statistics

The admission standards for Caribbean medical schools are much lower than for US DO and Medical schools.  Some schools do not even require the MCAT and will also accept U.S. students straight out of high school.

 Also, instead of having one application cycle per year, Caribbean medical schools will admit students at multiple points throughout the year. 

Let’s start by talking about the “Big 4” Caribbean medical schools. These are St. George University (SGU), Ross, American University of the Caribbean (AUC), and Saba. These schools are informally considered to be the top Caribbean schools due to their relative success in training students.

Furthermore, these schools have accreditation and are recognized by some state education boards. While some Caribbean medical schools do not require the MCAT, the “Big 4” all require completion of this exam.

Caribbean School Information Applicant Statistics

School Bachelor’s degree required? Average GPA MCAT required? Average MCAT
Yes
N/A
Yes
496
Yes
3.27
Yes
496
No, but preferred
N/A
Yes
N/A
Yes
3.30
Yes
498

US MD
Yes
3.72
Yes
512

US DO
Yes
3.43
Yes
503

As you can see, US medical schools are far more competitive to get into, even when compared to the “Top 4” Caribbean medical schools.

Some Caribbean medical schools accept students straight out of high school. For example, Trinity School of Medicine has a 5-year pre-medical/MD program. SGU has 5,6 and 7-year programs.

Lower admissions statistics lead to a greater number of overall students. But how do these students fare once they start attending a Caribbean medical school?

How Good Are Caribbean Medical Schools?

The 4-year curriculum at Caribbean school is structured similarly to U.S. medical school curriculums. Usually, there are two years of preclinical education, followed by two years of clinical rotations. Typically, Caribbean students have to pass the UMSLE Step 1 exam before they can start their clinical rotations. This is similar to their US counterparts. 

There is a lot of variability between schools, professors, and curriculums between schools, both in the US and in the Caribbean. As far as the actual classrooms, it is possible to learn just as much as what a US medical student would learn in their school.

The huge difference comes down to the structure and support that these schools offer students. One reason that medical schools have high admission requirements is because they know the curriculum is challenging. US schools try to weed out people before they become financially committed to medical school. Caribbean schools do the opposite and accept a large number of people, then weed them out during medical school.

The class sizes at Caribbean medical schools are significantly larger than their U.S. medical school counterparts. For example, St. George had a total of 482 people enter their Granada campus in Spring 2019. In contrast, Thomas Jefferson Medical School, which has one of the largest class sizes among US medical schools, enrolled 270 students for the entire year.

With huge class sizes, competition is inevitable, and the stress that already comes with medical school is magnified even further.  According to some former students, they literally had to compete for physical seats in a class

Caribbean schools also keep an eye on their statistics and do not grant all students permission to sit for the USMLE exam. This means that the STEP 1 pass rate is artificially inflated and that a significant number of people are held back and prevented from taking the exam.

All these lead to a high attrition rate. SGU was the only school I could find who addressed this and provided information about their attrition rate. They estimate it is “usually” between 7-12%.   

In contrast, the AAMC states that the national attrition rate of U.S. medical schools has been around 3.3% for nearly 20 years, and drop out typically is due to nonacademic reasons.  Keep in mind, SGU’s estimate is from their own website, and even though it comes from a biased source, the attrition rate still ranges between higher 2-4x than the US average.

Since these schools don’t publish their attrition rates online (which is a red flag by itself), it can be hard to estimate precisely how many people drop out. This information must be determined informally, such as by this survey from Med School Tips, where they reached out to students and alumni and asked them to estimate their school’s attrition rates. 

Respondents estimated the attrition rate to be between 20-40%. These numbers can obviously be inaccurate, but it does give a sense that attrition rates can be quite high at Caribbean medical schools. 

What this means is that these schools will accept students who are likely academically unqualified, receive their tuition payments, but then not provide them with the resources to succeed. Instead, it essentially boils down to “survival of the fittest.””. 

While the four-year graduation rate for MD/DO students is > 90%, the rates for the top 4 Caribbean medical schools are reported to range from 66%-80%. More specifically, the on-time completion rate ranges between 52%-83% for Caribbean schools, whereas it is 90 to 95% for US MD and DO schools

To summarize, these schools admit a high number of applicants that commit to paying tuition, yet do not provide adequate support to make sure every student succeeds. A certain portion of students are allowed to advance forward, while the rest are held back or drop/flunk out. These students then go on to complete clinical rotations back in the United States. They often have to travel to different sites around the country and work/live in non-ideal conditions. 

Upon making it through all these hurdles, they then go on to apply to residency programs. However, the system is biased against them. This means that a significant portion of students do not match into their desired specialty or even match at all.

The STEP 1 dilemma

With the recent news that STEP 1 is now a pass/fail exam, the odds are going to be stacked against IMGs now more than ever. The STEP 1 exam offered IMGs an opportunity to prove their merit with extremely high board scores. The change to a pass/fail exam places a degree of uncertainty on the whole process.

The consensus is that there will be a far greater emphasis on school prestige and opportunities, such as research. This will likely hurt Caribbean-trained IMGs even further.

Should You Go To a Caribbean Medical School?

Despite everything I have said up to this point, I want to make one thing clear: Just because you go to a Caribbean school does not mean you will be a poor physician. I personally have friends and family members who took this route. These people are some of the brightest and most passionate people I know, and I hope to one day be a doctor with the intelligence and bedside manner they have.

There are also many Caribbean medical school graduates who matched into extremely competitive specialties and are now successful neurosurgeons, dermatologists, orthopedics, etc.

But the route they took was an extremely difficult one. The odds were stacked against their favor. These people had to move to a remote island over the first two years of medical school, where conditions were not always ideal for studying. Then during their 3rd and 4th years, they rotated all across the US and then applied for residencies.

Some of these people made it and are now full-fledged doctors. Unfortunately, in my experience, this is not the norm. I know more people who did not match than those who did. 

Those who did not match still spent the time and money to become doctors. They are brilliant people, but unfortunately, they are not able to practice medicine and ended up pursuing other careers. Yet, they are still burdened with $150k-$200k of medical debt, with nothing to show for it.

Hopefully, this informs you of the perils of going to the Caribbean school. It should only be done as a last resort once you have exhausted every other option possible. You should only consider these schools if you are not able to match into a U.S. MD or DO school even after multiple attempts at applying broadly.

If you end up deciding to pursue this path, then realize that you will need to work extremely hard and probably work harder than any US MD or US DO student to compete for the same spot. In the end, you may have a fantastic CV and academic scores, but still, be unable to match into the specialty of your choice.

Essentially, if you go to the Caribbean, you should realize that while you have a decent chance of becoming a doctor, it may not be in the specialty or residency program that you would ideally like to attend.

If that is okay with you and your end goal is to become a doctor rather than specifically a specific type of doctor, the Caribbean route can make sense for your situation. At the end of the day, the odds will not be in your favor, and there is a considerable risk that you will spend a lot of money and time with nothing to show for it. But the Caribbean medical school route at least gives you the opportunity to earn an MD degree and have a chance at becoming a doctor.

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