Friday, April 11, 2014

What are the residency prospects for graduates of offshore medical schools?

Note: I updated this information in a new post on 7/26/16.

A year ago in a post about law school applications decreasing, I speculated about whether a similar phenomenon would occur with medical schools.

In that post, I commented on the impending problem of too many medical school graduates and not enough residency training positions. I cited an article that appeared in the New England Journal of Medicine in 2011 in which the CEO of the Accreditation Council for Graduate Medical Education predicted that by 2015 or sooner there would be more graduates of US medical schools than residency positions leading to specialty certification.

The data for the 2014 residency match have not been released publicly so the outcomes for graduates of US med schools are unknown.

However, the Educational Commission for Foreign Medical Graduates says [here] that of the 26,678 residency positions offered, only 53% of US citizen graduates of offshore medical schools (US-IMGs) and 49.5% of non-US citizen offshore grads matched.

A look at the websites of two of the more prominent Caribbean schools, St. George's University and Ross University, shows that most of their graduates who matched ended up in non-procedural specialties like internal medicine or family medicine.

St. George's lists 760 graduates and Ross 783. [They take two groups of enrollees per year at different starting times.] St. George's matched 22 (2.8%) and Ross 18 (2.3%) in categorical 5-year general surgery positions. To look at it another way, of some 1200 categorical slots, 40 (3.3%) graduates of the two most well-known Caribbean schools are on track to become general surgeons.

Neither school listed the number or percentage of unmatched graduates.

The ECFMG pointed out an important fact which is that as of 2013, hospitals were forced to commit to either filling all of their residency positions via the match or none of those positions via the match. This has resulted in an increase of 2672 positions available through the match and implies that there were that many fewer positions available outside of the match this year.

The exact a number of US-IMGs and non-US citizen IMGs who obtained first-year positions in the 2014 post-match supplemental process or later is also unknown, but at least in surgery, about 450 positions that were available after the initial match results were released consisted of nearly all preliminary slots good for only one or in some cases, two years of general surgery training. That amount of training is insufficient for obtaining board certification, but some prelim residents do progress to 5-year positions as I noted in a recent post. 

A harrowing account of one US-IMG's quest for a residency position can be found here. He is fortunate to have obtained a preliminary surgery spot after both the main and supplemental matches.

Excluding ones in Cuba, there are about 40 medical schools in the Caribbean that cater almost exclusively to US citizens as well as some similar schools in Mexico.

Some key questions arise. How many international medical graduates, both US and non-US citizens, do not currently have residency positions? What will those without residency positions do to earn a living? How will they pay back their student loans if they are unable to practice as physicians?

If you go to an offshore school, the best case scenario is that you'll have about a 50% or perhaps slightly better chance of matching to a residency position in any specialty and about a 2.5% to 3% chance of matching in general surgery. These odds may be worse if you choose a lesser-known school.


Anonymous said...

Thanks for the stats. If these top 2 Carribean schools are churning out 750 grads a year each, then it is obvious they are diploma mills. Few US schools push out that many.

Are all these off-shore schools not private businesses? So at least a few people have done well.

Since few prelimimary surgery interns go on to a full surgery program, where do they end up? Anesthsiology and pathology are moderately competitive these days, and I assume internal med and ER programs would require them to start anew.

Anonymous said...

The pluses and minuses of off-shore schools are easier to assess now with all the online resources available. so I expect the number of applicants to decline. However, I don't think the number of grads to go down for a while. Some of these schools pay US hospitals big bucks to take in their students for clinical rotations, and cash-strapped inner city hospitals find the arrangement attractive.

The 50% chance of being a US doctor after spending 4years and 200k is prob. still attractive to many undergrads who all of course believe they are above average. nevermind GPA and MCAT. When young, we all live in Lake Wobegon.

Anonymous said...

I think although this is a good article to give many prospective students a reality check, it should not be used as a reason to NOT pursue ones dreams in the medical field via the carribean. There are a good amount of students in the carribean that are more than US medical school caliber, but due to unfortunate circumstances have had to turn to this route. Whether it was one college class that torched their GPA or due to the simple fact that the instate medical colleges surrounding their particular area were extremely competitive; there are more than enough examples and reasons.

At the end of the day, if you put in the work to get good board scores AND make connections, you will have a great shot at getting your residency choice. And if you talk to some of the top surgeons at hospitals, they will tell you the carrbibean surgery residents they do have are the hardest working because they know they are the underdogs.

Skeptical Scalpel said...

I'm not sure what happens to all the prelim surgery residents. I wish I knew. More of them than one might think find categorical general surgery positions because the attrition rate of GS residencies is about 20%.

I agree that there is big money to be made in the med school business and that I doubt applications will fall off much for a while. You have only to look at the third anonymous comment above to see that hope springs eternal in the human breast.

artiger said...

Quite true Scalpel. I transitioned from a prelim to a categorical spot. In my categorical program, there were two guys who said "Enough" a few months in their second years. Although they looked great on paper and were conscientious physicians, they both said that they simply could not hack it (back then the call ranged from every other to every third night, depending on the service). Grades and test scores aren't everything, so if the desire is truly there, the prelim route is about the best shot. If time and money are not factors (not sure who would fall into that category), one could do a residency in, say, internal medicine, then reapply for a categorical position. I know that every day I wished I knew more medicine.

I still think the best thing would be to have everyone do a general intern year, rotating through the basic services, and then deciding near the end on a specialty. I know, not going to a happen.

Anonymous said...

Re Anon 3:

Working hard is good in any field. But....

The top 2 Caribbean schools graduate 750+ *each*, while no American MD school even puts out 250 a year.

Although it does not come up in polite conversation, it is a given that an off-shore grad is a result of not getting in any one of
thousands of American MD and DO spots. Contrary to popular opinion, it is not all that difficult to get into medical school
The current acceptance rate for MD schools is around 40-50 %.

If you didn't get into an AmericanD or DO school, a prospective student should just go do something else and get on with life. There are plenty of financially comfortable,
rewarding careers ourside of medicine.

Anonymous said...

For anyone interested, I think this is the data:

As a brief summary:

Total surgery (categorical) positions offered: 1,205
Total US Seniors: 1,274 applied / 922 matched
Total Applicants: 2,382 applied / 1,198 matched

For the international scene:
Total US-IMG applicants: 5,133 applied / 2,722 matched to a PGY-1 position though no data is given regarding whether these were categorical or prelim positions

CB said...

^^lol just stepped in on this convo and that was quite a ridiculous comment. Not everyone can afford to apply to all these schools you speak of. Most students I know in the Carribean tried their luck at the few local schools they thought they had a shot at and if all else failed, went offshore (since theres even less of a chance out of state). While there are many failures, there are also many success stories from offshore grad students, all you have to do is look.
I hope the ones you refer to as needing to just go get on with life are the same students who outperform you in the future sir.

Skeptical Scalpel said...

Artiger, thanks for illustrating the point that it is possible to transition from a prelim to a categorical position in surgery.

First anon, your comments are a bit harsh. It's OK for people to pursue their dreams as long as they know what they are getting themselves into.

Second anon, thanks for the link.

CB, there are many success stories, but I think it is useful to be aware of the odds.

-STEPHANIE said...

Anon: As the wife of an off shore grad, I can personally attest to the fact that some students that are plenty capable of being great physicians just don't get accepted to US med schools. Your comment seems a bit harsh and I doubt that all the physicians out there practicing that attended off shore schools would appreciate hearing that they should have "just gone on with life" after not being accepted in the US. However, as the author stated, students who attend offshore schools should be aware of the odds and the fields in which most off shore applicants end up in so as not to be shocked by the reality and stigma of being an IMG.

Skeptical Scalpel said...

Stephanie, thanks for commenting for writing the post about the difficulty your husband overcame to eventually secure a surgical prelim spot.

Anonymous said...

I tried my best to provide some specific information from my small corner of the world for neurosurgery applicants. Perhaps the general approach (and some of the suggestions) are relevant to your general surgery readers as well ...


Skeptical Scalpel said...

Thanks for the comments and the link. Most of what you wrote is applicable to IMGs wanting to be general surgeons too except for your suggestion that a year of research might help an IMG who didn't match. That may be true in neurosurgery, but I don't think it will work for general surgery. A year away from clinical medicine doesn't enhance a GS applicant's chances in most places.

Anonymous said...

I completely agree, generally, regarding the limited value of research. But there is a paucity of alternatives.

The challenge is how to become a "known quantity" in a program once one has failed to match. Since we do not have preliminary spots, and since most of our "pre-residency fellowships" are disappearing (and of dubious value), I don't know of any way other than research. I completely agree that doing clinical work is superior - but only a few general surgery programs will allow preliminary residents to rotate on neurosurgery, and only for a limited time.

Another option, which I did not think of earlier, would be to backup or scramble into a related specialty (radiology, neurology, even anesthesia) which requires a separate preliminary year. Then if one could do the preliminary year at a university hospital with neurosurgery residents, perhaps a highly motivated applicant could maneuver to have a month on the service and attempt to parlay that into a job if one were to open up at that program. Quite a few "if's"...

Either way, the path from FMG/IMG to neurosurgery (and, as you mentioned, general surgery) is too tenuous. My best advice is that one should work tremendously hard early on to gain admission to a US MD medical school if one wants to be a neurosurgeon in the United States.

pamchenko said...

Since going thru residency, I've worked with a lot of prelims. I give them all the same advice which is to seek opportunities outside surgery. Still a lot of them insist on pursuing "the dream."
that kid with the wife blogging for him still has the deck stacked against him. What he doesn't realize is that he will be competing in the match again nxt year against a brand new set of American medical school grads. he doesn't realize that there is a stigma against even American school grad prelims. Its like marrying someone with kids. another reason he's in a bad position is that he will have difficulty getting meaningful letters of recommendation or more importantly a phone call. the most important/influenential people will be working with chief residents. its not like in medical school where you can tag along with one chairman/chief of division and suck up all day to get a letter. his job as an intern will be to do mindless paperwork, discharge summaries, blood draws and basic floor management. intern work = PA level work and its hard to assess who will be a good surgeon from that level. granted you can tell about someone's work ethic, level of drive, ability to eat s**t which is important. another important thing is the ABSITE. interview offers are given before the absite is even taken. absite performance is crucial. he will be competing with indian kids (see AIMS) and foreign practice surgeons who are bred to take tests.
he is happy to gotten this prelim spot? its not really a blessing. I see it as very high risk.
his likely outcome will be fighting for a prelim two spot. he can always hope that one of his co-residents leaves for research (as long as one isn't slotted to come back). then again, he will need to have the best absite score/work ethic. after the prelim two year you are looking at research years which are by no means guarantee into surgery.
and the better of a surgeon he wants to be, the less he is going to see his wife and kid. he will be staying late to finish up tasks. he will be fudging workhours to show desire. he will be studying and reading for the ABSITE instead of spending time with his family.
ultimately he's playing catch up. you gotta pay the piper at some point. he went to St George's which had lower standards of admission. he needs to demonstrate that he's as good as a kid from AIMS with a 99 absite and ridiculous work ethic or a kid from an American medical school who just didn't match ortho.

Unknown said...

Who is their right mind would want to go to any med school today. Just have a peek at the website which shows what your physician gets paid from medicare. For example if you bill for say a pneumonia patient- 250 office visit, 90 bucks for IV rocephin, 65 bucks for EKG, 85 bucks for chest x ray, 45 bucks for oxygen therapy, 45 bucks for nebulizer treatment, 100 bucks for IV s and monitoring, 35 for pusle ox , time spent on patient 4 hours. 35 bucks for cbc with diff, 125 bucks for CMP. total billed- 1610. Now lets see how medicare rapes you..Office visit level 4 reimbursed 124 bucks, iv rocephin 1 dollar, EKG 12 dollars, chest x ray 12 bucks, O2, pulse ox and neb treatments, iv fluids, 0 bucks, cbc 12 bucks CMP 3 bucks for drawing and handling, total reimbursement- a big 164 bucks. Their you go guys. Not even close to covering your overhead. The dwindleing reimbursements will become the norm in the future. the cheaters seem to be the only ones that get paid well. Anyone that has gotten paid well is under investigation and will probably be moving into a jail cell. The students/grads that don't get a residency may be the lucky ones.

Skeptical Scalpel said...

Pamchenko, you have said it a little more explicitly than I. It is indeed a tough situation. Most of the prelims I know who have moved into categorical slots have been very lucky. Some do make it. Your advice about working hard is correct.

Scott, I agree with much of what you said. Here's an interesting statistic from October of last year. The number of applicants to med school in 2013 was the highest it has ever been. I think that they just don't know what they are getting into. They will find out.

Skeptical Scalpel said...

I meant to include the link to the story about med school applications. Here it is

pamchenko said...

as a surgeon I really don't rely on luck. I try to bet on likelihoods and weigh the pros and cons of every kind of decision I make. he's more likely to get a spot outside of surgery than a categorical position in surgery. ultimately that prelim needs to ask himself what is most important. most likely having a family, paying for wife/kids/home/lifestyle/kids sports/kids college/keeping up with the jones will be more important than whatever career he does. I know that's what's happened to me. you do what you need to do to pay the bills and take care of your family.
the smart thing to do would be to use that hard work ethic and try to get an anesthesia or radiology spot where he can get the money he needs to pay for his family. my friend in IR makes double my salary.
he continues to chase this dream, it will cost years of earning potential.
at least once a month I seriously regret being a surgeon and wish I was in finance.
if he is lazy or doesn't pan out, he can always go into PM&R and then match some noncompetitive pain fellowship and do injections all day, make surgeon type money and have a much better lifestyle where he can watch his kids grow up.

Anonymous said...

@scott. Almost all physicians still earn 6 figures, and some make 7 figures every year, as detailed in recent NYTimes articles.

@pam. Wow. Some surg. prelims do make it to a full residency, usually when some junior in their progam drops out late in the year. I agree that anyone starting a prel.year should immediately start looking into other specialties.

But, what are the numbers? How many prelim. GS get into a full residency in GS or ENT or urology or ortho?

What other specialties would accept a surg. prelim as a full year in their requirements? Anesth and path, maybe radiology, are the only ones that come to mind.

Regarding neurosurg, I have worked with many IMG neurosurgs. including an American Carribean grad. It may be tough, but it is doable. Isn't neurosurg a less competitive residency than ortho. rays. ENT, urol and derm? I don't know anymore since leaving academics 10 years ago.

Anonymous said...

@pam. That's kind of cruel.

Yes, general surgeons are poorly paid, but it is still 200-400 k for most. Radiologists earn more, which is prob. why it is a highly competitive residency.

The fact is that as an unmatched American IMG, an applicant is marked as damaged goods. Radiology, and to a lesser extent Anesthesiology, are competitive spots, so are not just automatic for GS rejects.

What struck me about the blogger's post was that the husband applied to 100 GS spots, but not even one alternative specialty.

Skeptical Scalpel said...

Almost no non-designated prelim resident, which is what these unfilled positions are, gets into ortho, GU, ENT etc. Designated prelims are those who have already matched into a categorical ortho, GU, ENT etc position. Neurosurgery is still very competitive.

Yes, the blogger's husband put all his eggs in one basket. He definitely needs a backup plan now.

-STEPHANIE said...

@Pam We are very much aware of the situation we are in. However, it is certainly a blessing to have a paycheck coming in this next year vs. not. Josh was silly to not have applied to back up programs in IM or FM where he likely would have easily matched. He will not be making the same mistake twice and while he hopes to stay in GS, he most definitely will be applying to back up specialties for the 2015 match. We have no choice but to try and see the glass as half full. The GS program at UMass took one of their prelims from SGU last year into their categorical program this year and the PD who interviewed him assured him that they take good care of their prelims in order to help them move forward in whatever field they choose. Sure, it could be BS, but we hope it isn't. As you stated, what is most important is taking care of himself, his wife, and his child which is why he took the prelim position to begin with. During the SOAP, he would have been happy with anything, but post SOAP, this was the only option he was given.

Skeptical Scalpel said...

Stephanie, thanks for following along with the other comments. I'm glad you have a plan in case the prelim spot does not lead to anything further in general surgery. I hope Josh gets a categorical position. With some hard work and the support you are giving him, who knows?

Good luck.

Anonymous said...

For any prospective/current Caribbean students out there who want to be surgeons, it is an uphill battle, in the wind and snow. I went down to the Caribbean to pursue my dream of becoming a surgeon and matched into a categorical 5 year general surgery spot at a University program this year. People will look down on you and doubt you, but, in my opinion, hard work trumps prestige.
@STEPHANIE: Keep the faith

Skeptical Scalpel said...

Anon, thank for the comment and congratulations. Would you mind telling us what your grades and USMLE scores were? Did you have any letters from well-known surgeons? Will you be graduating from one of the 2 schools I mentioned? Thanks.

Anonymous said...

Dear Sir,
My scores on STEP 1/STEP2 were 250/248. I had letters from the CVTS PD at a large university program and a letter from another senior faculty member at the same institution. While on that rotation, one of the faculty admired my work ethic and called his friend, the PD at the institution where I matched, and was an advocate on my behalf. That being said, this was a visiting rotation that I had set up on my own.
Additionally, of the top 5 positions on my rank list, 4/5 were "manufactured runs" where I had either sought out programs to do a rotation there or had people within the programs who were my advocate. I did not attend one of the previously mentioned schools and would prefer to remain anonymous. I did, however, do my 3rd year clinical rotations in the UK which was an awesome experience and a good talking point in my interviews. Hope this helps!

Anonymous said...

Oh, grades were OK, 3.25 GPA but Honors in all but one clerkship...

Skeptical Scalpel said...

Thanks for the information. This should help other students very much.

The USMLE scores were outstanding.There was excellent support from what seem to be influential mentors.

Anonymous said...

Why are unmatched medical students considered "damaged goods"?

Skeptical Scalpel said...

Anon, that is a good question. I can only speculate about the answer. I believe many program directors feel that the fact that someone did not match is proof that there must have been something wrong with that individual. Of course, we all know that isn't true, but the stigma has prevailed for many years. I could be wrong about this.

Unknown said...

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Skeptical Scalpel said...

Malik, thanks for commenting and for the link to your school's website. I was able to find some other links that might help prospective students. Here they are.

Leah said...

Interesting read- My boyfriend just left 2 days ago for Saba University School of Medicine. His father, (who's an MD as well, graduated from Sackler in Israel, and is an anesthesiologist) seemed to support his decision to go there. He wasn't able to get into the US due to his undergrad GPA. (It's a 3.3, bad freshman year, recovered over the next 3 years), yet he got a 35 on the MCAT. I know his case is completely unique, as he's not the traditional Carib student. To me, that score is very, very good!

I've been researching his school a lot, and since it's smaller, it's been hard to find any info regarding their match rates, quality of education, clinical rotations, etc. I guess I'm just worried that he went and took out a ton of student loans, only to get screwed over in the end. Maybe you have some insight into this school I'm missing?

Skeptical Scalpel said...

Leah, there's a good reason why you can't find the info on match rates. They probably aren't very good. The clinical rotations in these schools change frequently. Many of them tell their students to arrange their own clinical rotations. Your boyfriend will be able to find out some of these things by word of mouth now that hes at the school.

Anonymous said...

My girl friend studied at University of medicine and health sciences - St.Kitts in Caribbean.She is very hard worker and studied well. All of my savings gone and extra bank loans adds ups. No match, no residency and no more hope. Applied for Medical lab tech and my opinion IMG is not an option, try local medical schools and if not try something else

Skeptical Scalpel said...

Thank you for commenting. I am so sorry to hear this.

I looked at the UMHS website ( and counted 59 graduates who matched in 2014. What I can't find out is how many UMHS students were in the class. Do you happen to know that figure?

Anonymous said...

Thanks Skeptical....................Not really know how many , there were 3 graduation per year and not sure how many applied

Skeptical Scalpel said...


Anonymous said...

Hi, I am a former Cuban medical student. In Cuba I did five years of medicine school and came to the United States. I'm 26 and I intend to continue my studies here. I met with the president of a university in the Caribbean (USAT Monserrat). They have a campus in Miami and they don’t require the MCAT. Only with my transcripts of 5 years of medical school in Cuba I can enroll, 3 year after I’m a FMG. The school website is a joke and the admission process is very informal. They came to Miami only a week monthly and you need to get the clinical practice hours by you own. I want to be a pediatric or general surgeon, and I don’t want to spend years of sacrifices and money for nothing.
On the other hand if I make the college (3 or 4 years), and medical school (4 years) I'm afraid that my age when applying to a surgical residency (34 years or so) will be an impediment to achieve my goals. Any advice will be welcome.

Skeptical Scalpel said...

Anonymous former Cuban med student, thanks for your comments. First, please re-read my post and pay particular attention to the parts about the chances of matching for a 5-year position in a surgical program. Notice that even the offshore schools with good reputationps are matching a very small percentage of their graduates in surgery. The school you mentioned is not well-known. To be honest, I'm not sure you could match in any specialty with a degree from there. Ask them what percent of their grads match in any specialty. Ask them for the names of some recent grads so you can verify the information. Please research all of this carefully. I would advise you to gather as much information as you can. It will be hard as a 34-year-old to start a surgery residency, but it may be the better choice. Good luck.

Anonymous said...

Thanks a lot for the advice

-STEPHANIE said...

I wanted to update you that Joshua (from the linked blog post) found out today that he matched into a categorical general surgery program today. Yes he will have to repeat intern year, but we consider our entire story a huge success. I plan to update my blog sometime after we find out where on Friday. Just wanted those who are discouraged or believe a prelim spot can never turn out positively, especially for an IMG still seeking Gen Surg, it can. And we are living proof of that!

Skeptical Scalpel said...

That is great news. Congratulations. Please let me know where he landed.

Anonymous said...

Thanks for this post. It puts things in a more sobering light. I am planning on applying for next year's match and wanted your thoughts and advice on where I stand and what I could do to improve my chances. I scored a 261 on Step 1. I will be taking my Step 2 in a few months and am working on securing letters of recommendation. I read your post on what elective rotations to do during my 4th year, but I what can I realistically do to improve my odds?

Skeptical Scalpel said...

A little more information would help. At what med school are you studying? Give me some demographics. Where did you do your third-year surgery clerkship? Please email me at SkepticalScalpel at

-STEPHANIE said...

Josh matched categorical general surgery at the University of Massachusetts where he is currently a preliminary resident. I wrote about that part of our story here:

Skeptical Scalpel said...

Thanks for the follow-up. Your blog post is very well-written and honest. You were fortunate to have landed in such a reasonable program. From what I have read, the soap process is even worse this year.

Good luck to you and Josh (and your cute child).

Anonymous said...

as an "offshore" student... what can I do for residency?
Att: -C

Skeptical Scalpel said...

I'm afraid I'm going to need a little more information. I don't know what you mean by "Att: -C." Why don't you email me Skeptical Scalpel (at) Hotmail (dot) com?

Anonymous said...

Anyone have any perspective on issues at Ross and American University? They advertise high match rates, which seem difficult to understand given the feedback here.

Skeptical Scalpel said...

The match rates for all these schools are unknown. What they tell you is which students matched and where they matched. What they don't tell you is how many students didn't match and what percent of students didn't match. If you did not see my recent post about this year's match (, you should take a look at it.

I assume by "American University" you mean "American University of the Caribbean." Other schools have those words in their names. All Caribbean schools are not the same. As I point out the the recent post, you need to research the schools you are interested in very carefully.

The chances of matching also depend on your choice of specialty. For Caribbean grads, family medicine and internal medicine are not hard to get into. Some of the surgical specialties are very hard.

Anonymous said...

seeking some serious advice. I am a student who went to a pretty decent university ( university of Georgia) however my gpa took a beating as well as facing some personal issues within the first two years. I also did bad pretty bad on my mcat. When it was all said and done i graduated with a 3.2 gpa and 20 mcat. Now i have been accepted into Ross and also accepted into a Masters program at PCOM. I wanted to see what your advice would be, whether to retake my mcat and reapply or to go with Ross and not waste anymore time. I fully understand you can not tell me what to do, but I did want to know what you would do in my place. My work ethic is pretty stellar, and I have drive and motivation. However I do not want to be Naive and make a mistake. I have research , medical missions trip , shadowed and did community service outside medicine/science related fields. I know residency spots for foreign graduated students is decreasing each and every year. What i fear the most of course is not matching anywhere. I don't mind retaking and studying for the MCAT as well.

Skeptical Scalpel said...

You are right. I can't tell you what to do, and I wouldn't want to.

Ross is one of the Caribbean schools that seems to do well in placing students in residencies. However, no Caribbean school ever discusses the number or percentage of students who go unmatched and never secure a residency position. Only the very best Ross graduates are accepted into categorical general surgery slots. Very few go into surgical subspecialties. If you want to be an internist or family practitioner you probably have a good chance of doing so.

There is also the matter of tuition. I do not know how offshore graduates who never find a residency position pay off their student loans.

Regarding the MCAT, do you really think you're going to go from a score of 20 to > 30? And there is still the matter of your 3.2 GPA which will not be too attractive to US medical schools.

The comment thread on this post hasn't been too active, but maybe some others will comment on your situation. Good luck.

Anonymous said...

I went to Noreste in Tampico back in the early Eighties. What a Shithole! Folks haven't gone to THAT school for thirty years! I am Shocked that the Island schools are increasing in number! I mean the whole Profession is FUBAR...excessive paperwork, prior authorizations, having to recertify at Least every SUCKS!

Skeptical Scalpel said...

I too am surprised that more offshore schools seem to be springing up and that so many students are enrolling. I wrote this and other posts in an effort to make sure that they know what they are getting into.

Anonymous said...

Hello Scalp, thanks for all the info here.

I applied for several in state schools last year and didn't make it into any of them. I don't really have the money or desire to be doing that again, especially if I am just going to be rejected again. My academics are slightly wonky (3.01 GPA but 31 on MCAT) but I have also been working full time as a scribe in a trio of local EDs for the past 2.5 years, logging nearly 3000 hours side by side with emergency medicine physicians.

I have been looking at Caribbean schools as an option, and in particular the Trinity School of Medicine in St. Vincent and the Grenadines. They boast small class sizes and an average residency match rate of 86% (

Additionally I am NOT interested to going into surgery and most likely would be looking at Internal Medicine. I was wondering if you would have any advice regarding my situation.

Thank you very much!

Skeptical Scalpel said...

Sorry for the delayed response. I had never heard of Trinity, but it may be an option. Is there any way to verify that they really matched 86% of their graduates?

If I were you, I would try to contact some of the recent graduates and see what their experience was. If the school won't give you their names, I would proceed with caution.

You could also google the programs that supposedly matched with Trinity grads and see if in fact they have residents on their rosters from Trinity. If they are not listed, I suggest you call a few programs and see if you can get an idea of how those Trinity grads are doing.

Good luck.

Unknown said...

These offshore Caribbean med schools are useless degree mills that turn out little better than quackery. Small wonder that legislation is pending in Congress sponsored by Senator Dick Durbin, President Obama's friend and former colleague. Since 2013 he has been championing the cause of stopping such nonsense.

Skeptical Scalpel said...

I wasn't aware of that legislation. Below is a link to a story about the most recent activity on the bill which would tighten up the rules regarding offshore schools and student loans. The story quotes a USMLE pass rate of 53% for graduates of foreign schools.

Doctor Day Trade, MD said...

Hello Skeptical Scalpel,

The 53% number is an oft cited figure that doesn't really put much into context. Some offshore medical schools fair better than others, for instance St. George's had a match rate of ~69% whereas Ross is at around the high 50's according to the last ECFMG report (2014) - you can simply check the match rate of the respective country of origin of a US IMG - some countries just have one school. Personally, I interviewed at a few MD and DO schools and, while waitlisted at the former and accepted to the latter, I decided to attend an American program at Tel Aviv University. Israeli medical schools are a great example of precisely why the 53% figure is not appropriate - graduates from Sackler, Technion and Ben Gurion average an 83% match rate, above that of DO graduates, and have a good chance of matching into competitive specialities.

Skeptical Scalpel said...

Kons, of course the 53% figure is an average. Some schools have much higher rates of matching and some have much lower. You much also consider that all students are not the same either. Some will excel and others will barely get by.

According to Sackler's website (, 40 students matched in 2015. The denominator is unknown. Three matched in categorical general surgery and one in orthopedics.

You can draw your own conclusions from those figures.

Doctor Day Trade, MD said...

Thank you for the comment. My reason for choosing Sackler over American medical schools stems from their Tel Aviv University's world renown research facilities and Israel's efficient healthcare system — and of course myself being Jewish. Indeed, the class is very small - the list you just mentioned - the number is actually 45 (the parentheses indicate more than one student matched into a particular program). That years class was rather small, as I recall 3 did not match and 15 decided to take a year to do research (an unfortunate side effect of wanting a competitive residency with an IMG background).

The year before that (2014), the match was 56/63 ( with a spot in urology, 2 dermatology, 1 plastic surgery and 4 general surgeries.

This being said, I completely agree that this depends entirely on the student. I think you should take the time to look at the more competitive medical schools beyond the Caribbean and write about them - it's something I would love to read. My reason for chiming in is the previous commenters mention of Sackler.

Thanks again, Doc. Keep up the good work.

Skeptical Scalpel said...

Kons, thanks for clarifying the Sackler match numbers and for the suggestion about the schools other than those in Caribbean. I will think about it.

Anonymous said...

was part of the 6 yr program (1yr pre med and 5 yrs med) in ireland..I was repeating the 3rd med year and to resit one of my exams..unfortunately the exam somehow was leaked and had to resit it again with only a weeks notice..i failed and have been discontinued..any idea where I should apply?? or places that take transfer students?? thanks

Skeptical Scalpel said...

Anonymous, I regret I can't think of anything much to suggest. For a possible transfer, I suppose you could try some of the Caribbean schools, but honestly, I don't know what your residency would be with repeating a year and flunking a major exam anyway.

If I hear of anything, I will comment again. Good luck.

Anonymous said...

thanks for the help

drpoundsign said...

When I was "Turned Out" back in the Eighties, we had to take the FMGEMS (because some wiseguys stole the answer key to the old ECFMG exam) It was a Two Day MONSTER test that flunked about 90% of those who took it, at one point. I made it on Day I (Basic Science) after multiple tries. Passing score was 75 and MANY of us kept failing with 73-74. There was also the MSKP which we took to transfer into a US School (not many were able to DO this) or get better residencies at teaching hospitals in NYC. Those schools in Mexico and probably offshore have unilateral attendance policies (Physiology teacher comes in once a month, has students give the lecture, and takes attendance for the Whole Month) and maybe five cadavers, rotting, dug up from pauper's graves. The Dean and Assistant Dean are Autocratic Bastards, and you have no academic rights. Not to mention that you have No Civil Rights, or Landlord Tenant rights down there. Rent the movie "Bad Medicine" it's VERY Realistic! I am a General Internist. After YEARS of saying they needed primary care, they are replacing us all with NPs and PAs as well as pharmacy assistants in the CVS Minute Clinics! Even guys from MY school, if they were Good in residency and did a Chief Resident year, went for Cardiology or GI or a lesser fellowship like Onc. or Renal.

Skeptical Scalpel said...

Ah yes. Do you think that FEMGEMS test had a steep curve?

Regarding primary care, I have heard similar stories from others. A few years ago having swallowed the Kool-Aid, I wrote that the impending doctor shortage was real. Now I'm not so sure. I guess we will find out over the next few years.

Anonymous said...

Any thoughts on a US citizen studying at an Australian medical school because of half the family is Down Under while the other half is in the States, and wanting to come to the US for residency in anesthesia?

Skeptical Scalpel said...

I have no knowledge of match rates for Australian med schools and very little knowledge about anesthesia. As I have advised others in the past, except for the money spent on excess applications, It does not hurt to try. Go for it.

Aussie said...

Thank you for replying, Skeptical Scalpel! I definitely plan to apply to as many places as I can afford. Fingers crossed!

Anonymous said...

I am a non traditional student. I'm 35 now and graduated in 2013. I have been supporting my wife while she's gone through veterinary school but now I'm trying to get into medical school. My GPA is avg. 3.5 recovering from an old 1.4 and new MCAT isn't good 495. So with that MCAT would you advise waiting a year and again trying to get into a US school or accepting a spot at SGU? Keeping in mind that I was a U.S. Navy Hospital Corpsman with the Marine Corps for many years and not interested especially at my age in trying to match to a surgery residency. My interests lie primarily in ED. Any advice would be appreciated.

Skeptical Scalpel said...

Anon, good question. As you can see from this link about the 2015 match [], SGU has placed >10 of its several hundred grads in EM residencies. EM is highly competitive. If you plan to be one of the top graduates from SGU, you probably could match in EM. What is your wife going to while you're in Grenada for two years? I doubt they need a vet there.

Anonymous said...

She's trying to match and ultimately get a small animal surgery residency. Which in vet med entails doing two years of internships, one rotating small animal med then a year of specialty internship such as small animal surgery, then a 3 year residency. So for the two years I'd be in Grenada, she'd be doing her internships. I'm just torn on going or not. If I wait until summer and redo AMCAS and hopefully score higher on the new MCAT, I would be 36 before I matriculated and 40 at grad. What do you think?

Skeptical Scalpel said...

The vibe I am getting from your most recent comment is that you really don't want to go to medical school in Grenada, and you just want me to say that's okay. Since I am not you, I am reluctant to do that or tell you what to do.

Bear in mind that you will be 40 at graduation and facing a minimum of three years of residency no matter what field you go into.

You haven't mentioned any student loan debt for you or your wife. You should factor that in as well.

Assuming you don't go to SGU and take the new MCAT, what is your backup plan if you don't do as well on the test as you would like and don't get into a US medical school?

Tough decisions. I hope I have helped you work through this. Good luck.

Anonymous said...

My wife goes to Oregon State as an in state student but even with that, veterinary school is really expensive and we are approaching the 250K mark.
If I didn't take the SGU spot, my backup plan would be to continue the volunteer research assistant program that i participate in at OHSU, dual apply through AMCAS/ACOMAS and hope I get in somewhere. Barring that, also apply to PA schools next summer. I'm definitely not looking for you to validate my choices just offer unbiased advice. I feel like my window for medical school is closing and am getting nervous about that.

Skeptical Scalpel said...

That is a pretty substantial debt.

I don't know what the tuition is at SGU, but certainly tuition at any medical school in the US will put you well over $300,000 in total debt. There's also the matter of travel back and forth to Grenada and living expenses. Your third and fourth years will take place somewhere other than Grenada, and there will be living expenses for that too.

Even if you go to US med school, you will have living expenses and the interest on your debt will go on.

Maybe you should sit down and do the math on how much time it will take you and your wife to pay off all that debt and how much income you would need to not only do that but also survive.

Somewhere in one of my posts is a comment from someone who has a collective debt of more than $300,000 with a spouse, and that individual has been unable to find a residency in any specialty. That couple has zero chance of paying off their debt. I don't know what happens to them as the years pass.

Anonymous said...

Yes, it is a scary amount of debt. I'm hoping that SGU qualifies for the HPSP scholarship program, which would effectively end my angst about matching and debt but again my age is borderline.

Anyway, I appreciate your advice and quick responses.

Anonymous said...

After not doing well enough in undergrad, the rejections from med schools in the country were to be expected. I spent 2 years trying to avoid the carribean med school route due to reading up on all these forums. But after 2 years I decided to give it a shot. I went to Ross in 2007 and graduated in 2011. I matched into Peds and am now practicing. Debt is well over 200k at the end of it all and I had tried to live low key during my school and residency days. A few friends of mine did match into surgery some even anesthesia. however the vast majority went into FP and IM. I don't have any stats, just some anecdotal history.

Skeptical Scalpel said...

Thank you for commenting. Your experience mirrors the stats I have found. I hope it has worked out for you.

Anonymous said...

One of the comments made above made the assumption that because Saba University does not publish their match percentage that it must be poor. This is not the case as Saba is in fact one of the better Carib schools. Their match percentage is over 90% which is close to the American grad rate. Students do tend to match in primary care specialties such as IM, FM, and Peds... however many also match into specialty fields. As for categorical surgery it is true that it is very competitive, but every year a few out of 100++ students who match after graduating from Saba do manage to obtain a cat spot. (Four last year)

Do some research prior to making blanket replies to posts and needlessly causing panic in your reader.

Skeptical Scalpel said...

Anon, sorry to have upset you. There are about 25 Caribbean medical schools. I didn't have time to dig into the websites of every one of them.

I concluded my post by saying that Caribbean grads have a 2.5-3% chance of matching in general surgery. I counted 142 student matches on the the link you posted. 4/142 = 2.8%. So 2.8% of SABA grads match in general surgery. And that's 2.8% of those who matched in any specialty. We don't know how many didn't match at all or how many students graduate each year.

bwiene said...

Hi Skeptical Scalpel,

It looks like I will be taking the leap to attending St. Matthew's University in the Caribbean next year. This was my third year applying to medical school, and although it is possible that I could still get into a US medical school it is unlikely.

A little about me:
undergrad GPA:2.68 in Biomedical Engineering (UNCCH), then 2 years of additional upperlevel undergraduate coursework in Biology and Chemistry (UNCG) GPA:3.85, cummulative GPA: 3.08, and MCAT:34, research experience in mass spectroscopy (NIEHS), neuropathology (Duke), hematology and stem cell therapy (Duke), oncology (Vanderbilt), and organic synthesis (UNCG).

I am curious about what you think of the number of residency positions available to Caribbean grads moving forward. Since the match is going to be merged for DO/MD candidates and there have been a large number of DO schools opening, will this force the number of seats available for IMGs to go down? Also, I know that there was a push to better fund and enlarge the number of residency positions in the US. Do you know if this was successful? Will there be more spots opening up to create more physicians?

Thank you,

Skeptical Scalpel said...

As far as I can tell, nothing has changed since I wrote this post. The number of residency positions has increased slightly every year. However, there are several new US med schools and many established schools are increasing class sizes. There are about 25 Caribbean med schools and new ones are opening seemingly every month.

If you do well in school, get a good USMLE Step 1 score, and choose your specialty wisely, you may be ok. But no one knows what it will be like 4 years from now. Good luck.

bwiene said...

Perhaps the UK and Canada will be a possibility if the US is not... as you implied, who knows...

Skeptical Scalpel said...

Yes. And a US residency is always possible.

Anonymous said...

Yeah i disagree with what is said above At Ross there are several students who got 260+ on STEP1 and 3 going to derm last year. I got a 240 and am starting at a good IM program next year which was my specialty of choice. I know people going into ob as well as surgery. Dont listen to the hates Its not handed to you but if you are hungry enough you can get it.

Skeptical Scalpel said...

Anonymous, thank you for your comment.

The 2016 match data posted on the Ross website ( lists all of the specialties match by the 778 graduates this year.

The overwhelming majority of graduates matched in family medicine or internal medicine.

Two graduates matched in dermatology. That is 0.25%. 19 (2.4%) matched in OB/GYN.

For general surgery [presumably categorical since preliminary is listed separately] 20 graduates (2.6%) matched. If you add another 8 listed a matching in "surgery," that would make it 3.6%. However, one of those is also listed as having matched to anesthesia for the PGY-2 year so it may be that "surgery" means preliminary surgery.

Either way, the percentage is not very high. I stand by the last paragraph of my post which is as follows:

"If you go to an offshore school, the best case scenario is that you'll have about a 50% or perhaps slightly better chance of matching to a residency position in any specialty and about a 2.5% to 3% chance of matching in general surgery. These odds may be worse if you choose a lesser-known school."

Drew said...

Hi Skep,

Great piece. Hopefully I can offer some insight.

First, I work at Trinity and I fully support your suggestion of looking for verifiable data out there and Googling around for our grads. While we're not going to give out a list of alums out of respect for their privacy, if someone has an interest in a particular program or programs where we have someone, we are always willing to contact them on the inquiring party’s behalf for a chat. There’s also, as you mentioned, just Googling around to the individual program sites and seeing for yourself. (Actually, doing this one day for a blog entry is how I realized we had so many grads become chief residents).

If you're curious about any more on the topic of verification, I'd be happy to have a conversation with you (or anyone reading this) about our own uphill fight for transparency in IMG numbers/outcomes and what some less-than-reputable schools out there are doing to gate their data to achieve their published match rates.

It’s also worth commenting on our relative anonymity “never heard of ‘em!, etc.” We're young (founded in ‘08) and small (we do three start dates a year, but our largest class has a limit of around 80 students.) That said, we're proud of what we've built in a relatively short time--we're in the minority of schools in the Caribbean that has CAAM-HP accreditation-- and there are some major developments in approvals and certification right around the corner for us.

Anyway. That or anything else, just click any of the “contact” buttons on the page my name is linked to, you’ll get to me.

Regardless, great blog, thoughtful posts.

Skeptical Scalpel said...

Drew, I looked at your school's website. It may be very well-hidden, but I can't find any information about where your graduates have matched and in which specialties except for a couple of stories about individuals.

Skeptical Scalpel said...

Note: I updated this information in a new post on 7/26/16. Here's the link:

student residence Madrid said...

Love this post and your blog, keep doing the good work like this Skeptical

Anon. said...

Sackler School of Medicine
CLASS OF 2017 Match


Icahn SOM St. Lukes-Roosevelt-NY
Maimonides Med Ctr- NY (2)
St. Elizabeths Med Ctr-MA
SUNY HSC Brooklyn-NY
Thomas Jefferson Univ-PA
Yale-New Haven Hosp-Ct

Emory Univ SOM-GA
Univ. of Tennessee COM-Memphis, TN

Harbor-UCLA-Med Ctr-CA
Mt. Sinai Med Ctr-Miami-FL
Stony Brook Teach Hosps-NY

Jackson Park Hosp-IL
Wilson Mem Reg Med Ctr-NY

Cedars-Sinai Medical Center-CA
Cleveland Clinic Fdn-OH
George Washington Univ-DC
Icahn SOM St. Lukes-Roosevelt-NY (2)
Maimonides Med Ctr-NY*
NY Methodist Hospital-NY *
Providence Health-Portland-OR
Stamford Hospital/Columbia-CT
Stony Brook Teach Hosps-NY (3)
U Illinois COM-Chicago
Western Univ, London, Ontario, Canada

U Illinois COM-Chicago

U Minnesota Med School

Crozer-Chester Med Ctr-PA
Rochester Gen Hosp- NY
Tufts Medical Center-MA
Montefiore Med Ctr/Einstein-NY

Montefiore Med Ctr/Einstein-NY

Hofstra Northwell SOM-Cohen Children
Jersey Shore Univ Med Ctr-NJ
Johns Hopkins Hosp-MD
Kaiser Permanente-Los Angeles-CA
Rochester Gen Hosp – NY
Stony Brook Teach Hosps-NY (2)
U Connecticut School of Medicine
U of Toronto, Toronto, Ontario, Canada
Winthrop-University Hospital-NY (2)
SUNY HSC Brooklyn-NY

U South Florida Morsani COM-Tampa

Creedmoor Psych Ctr-NY
Montefiore Med Ctr/Einstein-NY
Metropolitan Hosp Ctr-NY
NYP Hosp-Weill Cornell Med Ctr-NY
St. Louis Univ SOM-MO
SUNY HSC Brooklyn-NY
U Texas Med Sch-Houston

UC Irvine Med Ctr-CA
U Rochester/Strong Memorial –NY
Winthrop-University Hospital-NY

Montefiore Med Ctr/Einstein-NY

Skeptical Scalpel said...

Anon, thanks for your input. I 'm not sure what point you are trying to make. You listed about 55 matches. How many in the class did not match?

I see only one surgery match--orthopedics at Montefiore.

I think your list reinforces my point.

Temi said...

I just wanted to comment about med schools in Canada & UK. Someone had stated earlier that it might be easier to attend a med school in Canada or UK if you can't get into a med school in US. Canada has fewer med schools than US and as a result I would say is more competitive also because of the high GPA & Mcat score requirements. Also, most med schools in Canada require you to either be a Canadian permanent resident or citizen to be accepted. Getting into a UK med school is also very competitive especially a school in London so I think you will have a better chance getting accepted into a US medical school than a Canadian or UK med school. U can do more research on d schools.

Skeptical Scalpel said...

Temi, thank you for the useful information about Med schools in Canada and the UK.

cantor said...

I am a physician and my office assistant once asked me to write a letter of rec for her to go to a Caribbean school. I declined and said you're too good for the Caribbean, dont waste all that money for a useless degree, etc. she then went to respiratory therapy school, and now makes about 75-100k a year without all the burden of a huge student loan.

Anonymous said...

Went to a Caribbean (Dominican Republic) Med School in the 80's for the first 2 years, studied like crazy, was fortunate enough to gain transfer to a US school for my 3rd and 4th years (maxed the MSKP exam). Matched in a residency, finished, boarded, practiced x 30 years successfully ..... it can be done. Granted things have changed a lot, BUT sometimes the "stars" line up for you !! NEVER give up if you REALLY want to do it ! Prefer not to give specific school and state details. With medicine the way it is now , not sure if I'd recommend domestic or foreign med schools ..... but I understand if someone was really intent on pursuing .... we all have to live our dream, I did !!

Skeptical Scalpel said...

Anon, thank you for commenting and congrats on your success. No doubt there are many success stories like yours. However, the statistics for US IMGs continue to be dismal. In the 2018 match, 2175
(42.9%) did not match, and 1911 others either withdrew or did not submit a match list. That's 4086 people.

samuel said...

4086 multiplied by an average debt of 180K = a little over $700 million in student loans that will never be repaid.

Skeptical Scalpel said...

Samuel, thanks for the calculation. We the taxpayers will be footing that bill. And that is for only one year.

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