International school FAQ - read first before posting

[leviathan]

International med school FAQ: This is a work in progress but hopefully it answers some of your questions. Hopefully other people can add their own information to it or correct me if I've made any mistakes. A lot of this is just a warning to those who wish to study abroad who may not realize the difficulties they will face. I hope people will do their due diligence and research facts on their own as well.

1. What are the chances of becoming a practicing doctor if I attend an international medical school?
To be a licensed physician requires not only medical school but post-grad residency training. The hard part is both graduating from medical school (failure rates are as high as 50% at the more rigorous Caribbean schools), and also matching into a residency. IMGs will only match to leftover positions that US grads don't take, and in the near future they predict a 1:1 ratio of US grads to available spots, leaving none leftover for IMGs (Source). In Canada, there are dedicated spots for IMGs with a return of service contract attached, but there are currently about 900-1000 IMGs applying each year (Source) for 254 IMG positions (Source). Residency positions are possibly also tight in Australia, although if you match there it is relatively easy to return to Canada after if you trained in family medicine.

2. Given #1 is it worth it to attend an international school?
If you have exhausted all other options and you are willing to take a $200,000-300,000 gamble on finding a job afterwards, then nobody is holding you back. As long as you are aware of the risks then we are willing to help answer other questions. We may be overreacting a bit with what is going to happen in the coming years, but the match rates have already started to drop over the last few years and everything suggests it is going to continue to go in that direction.

3. What are other options I can try before international schools?
International schools (for example those in Ireland, the UK, Caribbean, Australia, Eastern Europe etc) should be your last resort after taking several years off to improve your GPA, rewrite the MCAT, get life experience and things that make you competitive in Canada and the US. You should try Canada first, then the US MD schools, then in my opinion, US osteopathic (DO) medical schools. All of those routes will offer you a medical degree with almost guaranteed chances to match into a residency program and become a licensed physician. The DO degree is equivalent to an MD degree and is also now recognized in Canada, so you can apply for the same spots as CMGs and don't have to compete for IMG spots.

4. What are some career options I could pursue besides medical school?
If you are passionate about medicine and health care, look into allied health jobs that pay well, and allow you to see patients with autonomy, which are reasons why I think most people want to be doctors. There are nurse practitioners and physician assistants who see their own patients and independently provide assessment and treatment. Critical care and advanced care paramedics also have a broad scope of practice, assess acutely ill patients, and make their own decisions to provide treatments and perform procedures that are normally restricted to MDs. There are critical care nursing jobs where you work on long distance transfers / flight teams with MD oversight. Physical therapy and OT are specialized areas that are consulted by physicians to provide a unique knowledge and skillset that we don't have.

Many of these jobs are also pretty high paying with much less time commitment than medical school and provide a lot of the same things that make being a doctor rewarding. As an example: there are countless advanced care paramedics who easily make over $100,000 every year with a bit of overtime, probably similar or still fewer hours than you would work as an MD. Two, they did not have to drop $150,000 on med school and lose an extra 6-8 years of income to finish med school+residency. Three, all the grueling hours you put in medical school and residency working 80-100 hours or more per week could bank you even more income if you turned that into overtime hours at a job. Fourth, all of that income you make up front is subject to compounding interest, which goes a LONG way to establishing your net worth. Lastly, if you do go to an international school, you will be likely to match into a low paying specialty where earning potential is not that great. Bottom line if you're going into med school for the money, think twice about it as there are LOTS of other options out there!

5. If I really don't want to do anything besides medicine, and I can't get my grades high enough for any school in Canada or MD/DO schools in the US, where should I go?
Any of the medical schools in the UK,Ireland,Australia are excellent. Some of the Caribbean schools are also excellent, but you have to be careful to choose a Caribbean school that has been around for a long time, has a high pass rate on the USMLE, and has an excellent match success rate for its graduates.Every year there are dubious Caribbean schools that close down or go bankrupt leaving their students without recourse.

6. What are the "big 4" Caribbean schools? What does this mean?
These are schools that have been accredited by all 50 states in the USA. Some states simply license physicians if their school is on the World Health Organization (WHO) database, which lists schools that are accredited by their own countries. Because that database does not guarantee the quality of each country's own accreditation standards, some US states conduct their own accreditations of foreign schools. Only 4 medical schools in the Caribbean currently have accreditation by these states which are: St. George's University, Ross, American University of the Caribbean, and Saba University. One other school recently received accreditation by California, but still does
not have accreditation in many other states due to being less than 15 years old. Many other states are starting to adopt the accreditation lists of these 4 states, so the number of states you will be unable to practice in is slowly expanding. You could argue that Canada could start its own list, and that could cause serious troubles for you if you attend these less well-known schools.

7. What grades do I need to get into an international school?
This section needs to be edited for accuracy. My own understanding is that you need at least a 3.2-3.3 GPA and at least 27 on the MCAT for any of the schools in the UK,Ireland,Australia, and the top 4 Caribbean medical schools. Ireland may actually be a bit higher. I think DO schools are somewhere around 3.5 GPA, and US MD schools are probably 3.6 to 3.7. There are of course exceptions to this average for all schools in both directions of GPA, but this is just a general idea. There are shady schools in Eastern Europe and the Caribbean who would take you if you had a pulse and the $$$ to pay them, but if your GPA is any lower than what would get you into the reputable schools, you should question your academic ability to make it through any medical school program or pass the licensing exams.

8. What are the steps I need to take to get a residency in Canada?
You need to complete medical school, and write the MCCEE (Medical Council of Canada - Evaluating Exam). Then you can apply for any of the IMG-dedicated positions in the first round of CaRMS. Almost all of these positions come with a return of service agreement after you complete residency, where you will practice in an underserved community in the province where you do your residency. Manitoba and Quebec do not have dedicated IMG spots and do not require a return of service, except for a few remote positions. Saskatchewan also does not require a return of service for its urban family medicine positions. British Columbia and Alberta require you to take a special clinical exam and apply to an IMG program, which is often not possible without taking a year off due to time constraints.

9. What are the steps I need to take to practice medicine in Canada if I complete residency somewhere in the US or elsewhere?
There are two things you need to practice medicine in Canada:
1. Medical licensure - This is done on a provincial level. All provinces require the MCCQE/LMCC parts 1 and 2. BC and Ontario will also take the US exams (USMLE steps 1,2,3). You must also have graduated from an accredited medical school on the WHO/FAIMER list.

2. Board certification -For most provinces you must complete a residency and then pass the Canadian exam for that specialty. The exception is family medicine, which in Canada will recognize family med board certification from some countries such as the US, the UK, and Australia.

9a. If you completed residency in the US:You must write the MCCEE exam and apply for a statement of need from your province, which states your province requires doctors in your specialty and would like you to complete your training and come back. You take this statement to apply for a J1 work visa to complete residency in the US. After residency, you need to get a medical license in your province (see #1 above) then get certified in your specialty (see #2 above). Board certification in your specialty is harder, except as mentioned for family medicine. Many US residencies are 1-2 years shorter than their Canadian counterparts. For other specialties you may have to complete extra years of training, take the Royal College board exam for your specialty, work under supervision for a certain number of years, etc. For other countries the same problem applies.

9b. If you completed residency elsewhere:As mentioned, family medicine training is recognized from certain countries. For all other specialties, it becomes too complicated to mention here but the rules are similar to the US. You have to apply to the Royal College and seek equivalency for your training, and write the board exam for your specialty.

[Robin Hood]

Sorry to sound pessimistic, but I think, if you can't get into any North American MD or DO school, then you are better to forget medicine, unless you want to ruin your life with a 300,000$ debt that you can't repay (unless your parents are super rich).

Originally Posted by leviathan

International med school FAQ: This is a work in progress but hopefully it answers some of your questions. Hopefully other people can add their own information to it or correct me if I've made any mistakes.

1. What are the chances of becoming a practicing doctor if I attend an international medical school?
I put this first because it's the most important point people may not realize. To be a doctor you cannot just graduate from medical school. You also need to do a residency. Both Canada and the US have a finite number of residency training positions for medical graduates, and their domestic graduates generally get all those spots first. International medical graduates (IMGs) are left to fend for the leftover spots. Due to the recent expansion of med school enrollment in both the US and Canada, the ratio of residency positions to students is dropping to near 1:1. In other words, the extra spots for IMGs are rapidly falling every year and things are not looking optimistic. In Canada, there are dedicated spots for IMGs; however, the number of Canadians studying abroad has skyrocketed to 3500 in recent years. Competition for those Canadian IMG residency positions has always been difficult and I predict it will get even more difficult in the coming years.

2. But I finished medical school and have an MD - Can't I find work without residency?
No. You need at least one internship year of training after medical school to get a license to practice. In almost every state and province you also need a full residency and board certification in family medicine or some specialty to practice. In other words, your MD is virtually useless without a residency position.

3. Given #1 and #2 is it worth it to attend an international school?
I don't want to discourage people from pursuing their dreams, but I also don't want to encourage people to attend an international school, end up $200,000 or more in debt, and be unable to find a residency. I don't know what the consequences of that would be, but I'm guessing one would be forcing them or their loan cosigners into bankruptcy, and losing their homes or other collateral equity. As long as you are aware of the risks then we are willing to help answer other questions. We may be overreacting a bit with what is going to happen in the coming years, but the match rates have already started to drop over the last few years and everything suggests it is going to continue to go in that direction.

4. What are other options I can try before international schools?
I think international schools (for example those in Ireland, the UK, Caribbean, Australia etc) should be your last resort after taking several years off to improve your GPA, rewrite the MCAT, get life experience and things that make you competitive in Canada and the US. You should try Canada first, then the US MD schools, then in my opinion, US osteopathic (DO) medical schools. All of those routes will offer you a medical degree with almost guaranteed chances to match into a residency program and become a licensed physician. Going elsewhere will get you a medical degree, but will leave you struggling to find any residency program. Even after exhausting all those routes, I think you should only attend foreign schools if you truly can't see yourself doing anything else for a career besides medicine, and accept the serious risks involved.

5. What are some career options I could pursue besides medical school?
If you are passionate about medicine and health care, look into allied health jobs that could offer exposure to patient care with autonomy, which are reasons why I think many people want to be doctors. There are nurse practitioners and physician assistants who see their own patients and independently provide assessment and treatment. Critical care and advanced care paramedics also have a broad scope of practice, assess acutely ill patients, and make their own decisions to provide treatments and perform procedures that are normally restricted to MDs. There are critical care nursing jobs where you work on long distance transfers / flight teams with MD oversight. Physical therapy and OT are specialized areas that are consulted by physicians to provide a unique knowledge and skillset that we don't have.

Many of these jobs are also pretty high paying with much less time commitment than medical school and provide a lot of the same things that make being a doctor rewarding. As an example: there are countless advanced care paramedics who easily make over $100,000 every year with a bit of overtime, probably similar or still fewer hours than you would work as an MD. Two, they did not have to drop $150,000 on med school and lose an extra 6-8 years of income to finish med school+residency. Three, all the grueling hours you put in medical school and residency working 80-100 hours or more per week could bank you even more income if you turned that into overtime hours at a job. Fourth, all of that income you make up front is subject to compounding interest, which goes a LONG way to establishing your net worth. Lastly, if you do go to an international school, you will be likely to match into a low paying specialty where earning potential is not that great. Bottom line if you're going into med school for the money, think twice about it as there are LOTS of other options out there!

6. If I really don't want to do anything besides medicine, and I can't get my grades high enough for any school in Canada or MD/DO schools in the US, where should I go?
Any of the medical schools in the UK,Ireland,Australia are excellent. Some of the Caribbean schools are also excellent, but you have to be careful to choose a Caribbean school that has been around for a long time, has a high pass rate on the USMLE, and has an excellent match success rate for its graduates.Every year there are dubious Caribbean schools that close down or go bankrupt leaving their students helpless.

7. What are the "big 4" Caribbean schools? What does this mean?
These are schools that have been accredited by all 50 states in the USA. Some states simply license physicians if their school is on the World Health Organization (WHO) database, which lists schools that are accredited by their respective countries. Because that database does not guarantee the quality of each country's own accreditation standards, some US states conduct their own accreditations of foreign schools. Only 4 medical schools in the Caribbean currently have accreditation by these states which are: St. George's University, Ross, American University of the Caribbean, and Saba University. One other school recently received accreditation by California, but still does
not have accreditation in many other states due to being less than 15 years old. Many other states are starting to adopt the accreditation lists of these 4 states, so the number of states you will be unable to practice in is slowly expanding. You could even argue that one day Canada may adopt its own list, and that could cause serious troubles for you if you attend these less well-known schools.

8. What grades do I need to get into an international school?
This section needs to be edited for accuracy. My own understanding is that you need at least a 3.2-3.3 GPA and at least 27 on the MCAT for any of the schools in the UK,Ireland,Australia, and the top 4 Caribbean medical schools. Ireland may actually be a bit higher. I think DO schools are somewhere around 3.5 GPA, and US MD schools are probably 3.6 to 3.7. There are of course exceptions to this average for all schools in both directions of GPA, but this is just a general idea. There are shady schools in Eastern Europe and the Caribbean who would take you if you had a pulse and the $$$ to pay them, but if your GPA is any lower than what would get you into the reputable schools, I highly doubt you have the academic ability to make it through any medical school program, much less pass the licensing exams.

9. What are the steps I need to take to get a residency in Canada?
You need to complete medical school, and write the MCCEE (Medical Council of Canada - Evaluating Exam). Then you can apply for any of the IMG-dedicated positions in the first round of CaRMS. Almost all of these positions come with a return of service agreement after you complete residency, where you will practice in an underserved community in the province where you do your residency. Manitoba and Quebec do not have dedicated IMG spots and do not require a return of service, except for a few remote positions. Saskatchewan also does not require a return of service for its urban family medicine positions. British Columbia requires you to take a special clinical exam and apply to an IMG program, which is often not possible due to time constraints.

10. What are the steps I need to take to practice medicine in Canada if I complete residency somewhere in the US or elsewhere?
This is constantly changing and will need revision and updates. For the US: First you still must take the MCCEE exam and apply for a statement of need from your province, which says your province requires doctors in your specialty of interest and would like you to complete your training and come back. You have to take this statement of need to apply for a work visa to complete a residency in the US. After completing residency, you need to first get a medical license in your province and then you have to get certified in your specialty. Medical licensure is currently pretty easy for BC and Ontario, where they will accept your American licensing exams (Steps 1-3) as equivalent to the Canadian licensing exams. Board certification in your specialty is harder as many US residencies are 1-2 years shorter than their Canadian counterparts. In Family Medicine it is actually 1 year longer, and you can currently become certified with the Canadian College of Family Physicians (CCFP) very easily if you are certified by the American Board of Family Medicine. For other specialties you may have to complete extra years of training, take the Royal College board exam for your specialty, work under supervision for a certain number of years, etc. For other countries the same problem applies. Certain countries like Australia and the UK have equivalency in Canada for their family medicine training, but unfortunately I don't think their medical licensing exams (for the actual MD license) currently are considered equivalent.

[piazzolla]

Re: Sorry to sound pessimistic, but I think, if you can't get into any North American MD or DO school, then you are better to forget medicine, unless you want to ruin your life with a 300,000$ debt
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"forget medicine" does indeed sound pessimistic.

How about: "change your approach"?

leviathan's FAQ is chock full of practical info on this, especially if you don't have a "Bank of Mom & Dad" to fall back on. (See #5: What are some career options I could pursue besides medical school?)

Many people who are drawn to clinical medicine would not feel out-of-place/unhappy pursuing an allied health degree.

I've run into people with nursing, doula, respiratory therapy & paramedic backgrounds who subsequently went into medicine in Canada--including one who only did nursing school partway (as a 2nd degree), b/c of entry into medicine.

Smart folks. Who, by the way, were far from being in debt during medical school.