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leviathan

International school FAQ - read first before posting

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I'm an international medical graduate who finished in 2012 and matched to a residency in Canada. I wanted to write this to give the realities about training abroad. While I'm an example of a "success" story, and the majority of my classmates made it through medical school and matched into residencies in Canada and the US, I wanted to give some basic information to paint a little more about the realities of going abroad for medical training. Please feel free to ask for further information, or to clarify things in this thread. 

1. What is the process of becoming a licensed physician if I attend a foreign medical school?
First, you have to obtain a medical degree from a school listed on a directory called FAIMER: https://imed.faimer.org/

Second, you have to obtain post-graduate medical training (residency training) in either a specialty or in family medicine. This can be either in Canada or in a country that has training recognized by the Royal College of Physicians of Canada or the Canadian College of Family Physicians. Without this residency training, your medical degree alone will not allow you to practice medicine. 

 

2. Once I finish medical school, how do I obtain a residency position?

This depends on the country you're looking to get your residency.

 

Most of Canada's residencies are reserved for Canadian and US graduates only. Canada has a limited number of spots dedicated for international medical graduates (IMGs), the number which is determined by each province, for which you are eligible to apply. Most provinces fund positions with an agreement that you provide service for a length of time in an underserved community. You can research each province via the residency matching system website (CaRMS). Most provinces do offer all unfilled positions in a second round to both IMGs and unmatched Canadian gradutes, though these are very limited. The IMG positions are also very limited in number, with very high competition (probably in upwards of 20-30 applicants per position).

 

All residency spots in the US are open to any medical graduate both domestic and foreign. There are far more spots than US medical students applying each year, so this is usually where most foreign graduates obtain their training. The spots left over for IMGs are usually in smaller community programs in big cities, or in academic /university hospitals in less desirable states/cities. You should look up on the National Residency Match Program to get the most current statistics on what percentage of IMGs are matching, and how many spots there are compared to US medical students, as the gap has been closing recently.

 

I'm not aware of other countries, but students in Australia, the UK, and Ireland may be able to seek post-grad training in those countries (need a reference/source from these countries to fill us in). Eastern European medical schools may also have residency positions, though I don't think any of these are recognized in Canada. 

 

3. What is the likelihood of me becoming a practicing doctor by attending a foreign school?

This is a very difficult question to answer as there are many factors that determine your chances.

 

First of all, you may have a difficult time graduating from medical school. The attrition rate can be quite high at some schools, especially those that accept applicants with much lower GPAs and MCAT scores. There are many reasons for failure. First, many are due to students having poor academic performance and inability to learn the enormous volume of material required in medical school. It may also be due to poor quality of education/instruction in these schools. Lastly, it may be due to schools having stricter requirements to pass the course material, and more difficult exams. 

 

Second, matching to a residency is another difficult process due to limited residency spots and very high competition in Canada and the US.  Looking at all-comers from foreign schools, the match success rate for IMGs in Canada varies from as low as 9% from Asian schools and as high as 63% from Oceania (likely Australia/NZ). The 2015 match rate in the US for IMGs was 50%. 

 

4. What factors increase my chances of matching?

The stats above are the overall average for all applicants. Things that may increase your chances would be graduating in the year of your application (vs someone who graduated many years ago and didnt match), having many rotations in Canada or the US (for each match) so the programs are familiar with you on a personal basis, having high board scores on the US and Canadian licensing exams, and having letters of recommendation from Canadian or US faculty. The first two factors are things that would be possible for you to achieve. It's impossible to predict if you could get the latter two factors, so you can't count on those. 

 

5. Is it worth attending a foreign medical school with the dismal match rates? 

Given that a medical degree without a residency is a useless piece of paper, you are essentially taking a $200-300k gamble and many years of your life with about 50-60% odds of success. If you feel medicine is truly the only career you could see yourself doing, the best option is still to reapply in Canada. A close second option is to apply for an American medical school, where it can be easier to gain admission, and a distant third option may be a US osteopathic medical school, which are even easier than US allopathic / MD schools. 

 

6. What are some career options I could pursue besides medical school?
If you really enjoy learning about medical sciences and enjoy patient care, you should strongly look into allied health jobs that pay well, and allow you to see patients with autonomy where you make your own decisions (which are reasons why I think most people want to be doctors over say nurses or other fields). 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 restricted procedures (intubation, surgical airways, defibrillation, giving cardiac meds, needle thoracentesis etc.). There are critical care nursing jobs where you work on long distance transfers / flight teams with MD oversight. There are also nurses who work up north and basically provide independent care for anything that comes through the door. Physical therapy and OT are specialized providers that are consulted by physicians to provide a unique knowledge and skillset that we don't have. There are so many options that fulfill the things people think they can only find in medicine, without the immensely long training commitment. Working the same hours as you would as a physician would also get you a very high salary, when accounting for all the overtime. In addition you wouldn't lose years of income earning potential, and go into hundreds of thousands of dollars in debt. 

7. 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 stranded and without recourse.

8. 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, as opposed to just having their own 'internal' accreditation by their host country. Some states license physicians if their school is on the FAIMER database, which simply lists schools that are accredited by the host 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. American University of Antigua 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 accreditation or even adopt the California / NY list (as many US states have done), and that could cause serious troubles for you if you attend these unknown schools. 

Edited by leviathan

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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).

 

Edited by leviathan

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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.

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