Old folks and the Caribbean

  • croooz Said:
I will say this and while I wouldn't do it personally it has helped many students which is to look into the Caribbean. I'm one of the ones who warned you against it and would save it as a last resort. However I also know of doctors who didn't want to deal with all the US nonsense, went that route, and are now practicing. They aren't in any other specialties except family medicine or internal medicine but they are physicians. Fourteen months on the islands and you're done with first and second year. All the carib schools are not created equal and truly understand that they are 100% in it for the money. So if you must stick to the big three, SGU, Ross, and I think it's SABA but I don't remember off hand. They have postbaccs on the island as well and would be more than happy to accept your money. So if you do the postbacc with them you would be better prepared for how they do things on the med school side of things.

Why the change in opinion? My take is I'm 42, and if I were 52 how much longer would I wait? The issues of ageism aren't as obvious at 42 as they are at 52. So I figure just go to a reputable school, bust your butt, and get it over with. "Everyone" is talking about getting a residency is going to get exponentially more difficult because more US med schools are opening up and more residencies aren't. Maybe, maybe not. I don't think there is going to be any backlog of FP, IM, or psych residency positions...just saying...food for thought.

Hopefully, my buddy Crooz won't mind me lifting his comment from another thread to start a new topic here.

This is MY take on the Caribbean. Go there ONLY as a last resort, meaning YOU GAVE IT YOUR BEST SHOT at MD/DO schools in the states, couldn't get admitted, so now you're going Caribbean. The area where I feel MANY folks fall short is in the "giving it your best shot" area.

Here's what I KNOW for sure. If mediocre grades and MCAT's are keeping you OUT of US schools, you're going to have a 89 degree academic hill to climb in the Caribbean. The exams they have to take are INSANE, and if your study skills aren't up to par in the US, what changes by going to the Caribbean other than the fact that you'll accumulate > 200K debt?

Are there exceptions to this rule? Of course, I can think if one Dr. that's a SUPERSTAR in her US residency program. But the other stories I've heard of are of people with >250K debt and NO way to pay it back because they couldn't pass the boards after 2 years in the Caribbean.

Well what about the "time" issue, none of us are getting ANY younger? Here's my response to that.

I'm a Black female, in my mid-50s, with a Caribbean MD. That gives me a triple dose of potential "isms" to deal with, racism, ageism, and antiCaribbean-ism. Maybe I should rephrase that, I'll have ~400K in debt too NOT including capitalizing interest.

Put another way, I'd MUCH rather be a 54 year old DO/PhD with 200K in depth. and a way to pay it back as a Doc, than a 51 year old MD with a 400K+ degree I can't use because I'm old, Black, and a Caribbean grad.

Of course, if you're independently wealthy, do YOUR thang!



Aww come on Crooz, no comment?

I read that guy’s blog years ago and it’s a pretty sad read IMHO.

As I stated before, there ARE success stories from the Caribbean, I’m just thinking that for the reasons above and the unknown impact of a national healthcare system, NO ONE knows what the medical landscape is going to look like 5, 10 years from now.

What I do know for sure is that grads of US med schools will be prepared to handle whatever is coming.

Internet connection acting wonky.

Fourth times a charm, I’ll keep it short.

The only reason to not go is the lack of support for passing step exams because that translates into either a very ridiculously expensive paper weight for a diploma or a bright future.

I disagree with your “for sure” statements. Especially the latter, if no one knows what the landscape will look like, then how can anyone know they will be prepared for what they don’t know is coming. Think of it this way, I don’t know what fatherhood has in store but I know that I’ll be prepared for it…would be a ridiculous statement for me to make.

  • croooz Said:
I disagree with your "for sure" statements. Especially the latter, if no one knows what the landscape will look like, then how can anyone know they will be prepared for what they don't know is coming.

I can clarify what I meant by "for sure".

I mean that a US grad will ALWAYS have training/job opportunities in the US. Especially since the demand for Docs is expected to increase significantly with a national US healthcare system. And I don't mean in clinical settings either. Insurance companies, the government ie FDA, NIH, Patent office, Pharma, education, there are TONS of opportunities.

Of course, this also argues in favor of caribbean grads finding jobs too, but with no increases on the horizon for residency slots, I think they're far more likely to end up with degrees with no where to train than a US grad.

As for the parenthood comment, I knew LONG before I became a parent that I would be a great one. And my kid is living proof of that.

Some people need to see proof of action before they believe in something. I believe our thoughts and actions BEFORE hand tells the "universe" that failure is NOT an option.

What does the bible say, "faith with WORKS is dead"? You'd better believe it!

I hope you see the duality in your post. You end it with “faith without works is dead” and yet your posts on the Carib are all about not believing things will work out. Your own post is a testament to you needing proof of action before believing that the Carib route is a defensible choice and yet you claim to believe our thoughts and actions before is what matters. You cannot have it both ways. See if someone believes that their thoughts and actions tell the universe that failure is not an option then them going the Carib route should not present a problem for you.

Besides the bible is not talking about faith but Faith. Our faith in a risen Saviour without keeping the commandments and loving all people is a dead faith. It is not talking about believing in yourself or that your circumstances will work out.

Lastly believing you would be a great parent is not what I believe either or us posted. We were talking about being prepared not the result. Did you know you would be prepared for everything that came and is coming your way as a parent? Prepared not that you would deal with it fabulously and make it work but that you are prepared. I don’t think anyone can be prepared for everything and perhaps that is not the word you meant to use. I mean, how do you get prepared for the unexpected? Sickness, disease, death, politics, human nature, RedSox winning…

  • croooz Said:
I mean, how do you get prepared for the unexpected? Sickness, disease, death, politics, human nature, RedSox winning...

1)If I had to go Carib to become a Doc, I would.

2) With a degree in Religion and having grown up a Christian I understand that biblical scriptures can mean different things to different people. And as long as it's used for something positive, I seriously doubt God minds.

3) The answer to the above question for me is faith, I have FAITH that God will see me through every challenge life sends my way.

Finally some people see obstacles, others see opportunities. I'm in the later category. Personally, I don't believe in failure, I believe that God changes the plan he has for our lives based in large part on how we LIVE our lives. And sometimes it changes because it's His will.

Either way I'm cool with the outcome because I'm around to experience it. And while it isn't always what I'd like it to be, it sure beats being dead.

And now I shall exit stage left, before I get my "shout on" up in here!

I just want to comment that I just interviewed (yes, at a family medicine residency program) - a large one. I was the only D.O. applicant there on that day, with 7 applicants from Ross (who had done their clinical rotations in New York and (in one case) Jamaica. I was also the only old one. Many of the current residents were also from Ross. Seemed like they had a good shot. Felt I did as well.


With my discipline of interest being psychiatry,all but one of the MD psychiatrists who have mentored me over the last 18 years were IMG’s two from India, one from Mexico, 3 from the Caribbean. The one who graduated from a US school had switched to psychiatry after years of being an anesthesiologist - he wanted to continue practicing and was in his 80’s. My current primary care doctor is a Caribbean grad as well. The great leveler is the USMLE. If you are an excellent student, with a good work ethic and the discipline to study hard, as many of us with age under our belts are, AND you are not looking for a competitive specialty - like orthopedics and such, my experience with the ad coms, etc. thus far, has led me to believe that the Caribbean is a very non-trad friendly place. One of our speakers at the Conference this year spoke about his experience, and did not paint a negative picture.

  • Kate429 Said:
I just want to comment that I just interviewed (yes, at a family medicine residency program) - a large one. I was the only D.O. applicant there on that day, with 7 applicants from Ross (who had done their clinical rotations in New York and (in one case) Jamaica. I was also the only old one. Many of the current residents were also from Ross. Seemed like they had a good shot. Felt I did as well.


The superstar Psych resident I'm familiar with went to Ross, so no suprises there. The smartest Path resident I've EVER met was a DO. The best will ALWAYS rise to the top!

On that note, I've also heard some people say that a foreign MD trumphs a US DO because of all the ignorant "prejudice" against DO's. I've had great doctors of every kind, including foreign and DO.

There's NO right or wrong answers here. Only what you're willing to risk/sacrifice to achieve your goals.

And having an open and honest discussion about the pros and cons is an important first step.

For me personally I WOULD attend AUC in the Caribbean as it seems the best fit for me. I think that fairly soon the bills going through Congress will pass and the residency spots will increase. If they don’t then we are going to have American MD’s and DO’s without residency spots and that isn’t going to fly.

I go back and forth with the DO route for myself personally. I have no issues with DO. I only know one DO in my area. He is phenomenal. However there is tremendous bias in my area against DO from the medical community that ironically isn’t not as strong as the bias against the top 4 Carib schools. I feel like I will face bias either way if I have to go to the Caribbean route but have seen the bias with the initials D.O. here among patients because it just isn’t seen as often. I plan to practice in a rural area so I think the initials are compounded there as some have asked me if that means some sort of therapist?

I do not know where the bias comes from. I am not sure if it because in LA there are three medical schools and then one school that awards MBBS with two years here and two years in Australia or what the issue is. I was also open to the MBBS route until I found out that I can’t fly my dogs in the cabin to Australia and they face strict quarantine. That would mean that DH would have to stay here and I go away for two years. Personally I know I am not up for that challenge. Just me personally others may relish the two year break.

Would I see a DO versus MD? Absolutely Caribbean versus allopathic US MD? Who cares? I just don’t know if my future patients would care too much or not. I could care less what my coworker MD’s would think.

From the residency programs’ perspective, the issue of Caribbean grads is more related to clinical experience, not academics. While it’s true the USMLE is a great equalizer, the experience offshore students get in the 3rd and 4th years varies widely between institutions and sometimes within institutions. Some students get a great, well-rounded, hands-on experience, while some just go through two years of expensive observership.

I don’t know what the problem is or how to fix it. Honestly it’s becoming so frustrating that I’m sure I’m guilty of overlooking qualified candidates just to avoid the possibility that they will not be ready to roll in July. It’s very disheartening to spend months recruiting and putting together a class of interns, only to find that some of them have never performed a pelvic exam or put in an IV. Forget about recognizing a truly sick patient. The sad thing is they’re a bazillion dollars in debt and way behind their stateside peers right out of the starting gate. I’m hoping that at some point there will be a consensus among offshore schools to adopt a milestone-based curriculum, in the same direction that the LCME and ACGME are doing for US students and residents respectively. Until then, residency programs will continue to focus on recruiting US students first (MDs and yes, DOs).

If the choice is either offshore or no med school at all, go for the offshore school, but also think ahead. You’re going to have be aggressive and smart about your clinical years. Make sure you’re getting into rotations that will provide the most patient contact and opportunity for direct interaction with precepting doctors who take their roles as educators seriously. Understand that you will not get the supervision most of your stateside peers get, so you’re going to have to be much more self-directed. There’s too much at stake to just fly under the radar until graduation.

I have been accepted to both Ross and St.George’s and have a choice I need to make. I will keep everyone posted as to my experience. I’d prefer to stay stateside but I feel it’s better than not going at all. Sure, I’m worried about the debt and the residency issue, but I’d be concerned about that regardless of where I went to med school.

  • jmdmd Said:
...while some [students] just go through two years of expensive observership.

This sounds a lot like my clinical years' experience and I go to a US allopathic school. I feel very unprepared for internship next year. Medical school in general is a crap shoot.


Please do let us know what you decide. Like you said, you would worry about the loans no matter where you went.

That is what kept me from so far filling out the secondary app for Tulane. It is 55K a year and I just keep staring at that number.