American vs. Caribbean med for Canadians who want to come back to Canada

[Jloyay]

Hey guys,

I am new here, and I am currently in my junior year at the University of Toronto. My GPA is kind of low for med, around 3.6 but I'll try to bring it up to over 3.7 when I graduate. My first choice of course would be to get into Queen's or Western, hopefully with a top 2 year GPA higher than 3.8 by working hard these last 2 years with a decent MCAT score this summer.

If that doesn't happen, I've got a dilemma, I've got some American medical schools that I want to go to (ie. University of Chicago or Georgetown) but I'm also considering some Caribbean Medical schools since I heard they're softer than the ones in Canada and the US and I want an opportunity to live for a while in the Caribbean.

What are the pros and cons for a Canadian who wants to come back to Canada after graduating for either one? Which would be a better choice? Would it be hard to get residency in Canada for American/Caribbean medical students?

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[Giemsa]

What are the pros and cons for a Canadian who wants to come back to Canada after graduating for either one? Which would be a better choice? Would it be hard to get residency in Canada for American/Caribbean medical students?

Assuming this question is on the level:

Ummmmm, a US school is better. LOTS better.

Unless you have no other option, do NOT consider the Caribbean. And think about it twice. And then about it again.

Why?

If you attend an American med school, you are considered a CMG in the CaRMS match (e.g. technically on par with other Canadian med school grads), not an IMG. There are a limited number of IMG spots in the CaRMS match and the matching rates are low. Secondly, if you don't attend a Canadian medical school, you have to consider the real possibility that you will have to do residency in the US and then come back to Canada, and your odds of matching as a US med school grad are MUCH higher than as matching in the US as a visa-requiring IMG.

Long story short: Canadian med school best. American medical school good. Caribbean bad.

 

[docnotsopc]

What Giemsa said

Being an IMG trying to get back to Canada is like trying to run towards and through a stampede of bulls. Sure its possible, but its highly unlikely you will be successful.

ALSO you need to be realistic, there is not a 100% chance you will match back in Canada for either route. The match rate coming back to Canada from an american school was like 67% and from Caribbean was 19% i believe.

Compare back up of working in the US
1) Caribbean. You are an FMG (you arent america). Thus you are the bottom of the bottom. The match rate for FMGs (according to the USMLE first aid book) is >50%. If you do match, its probably at an undesirable location.
2) American school. You have a 90+% chance of matching in the US. Better location for residency.

 

[fj90]

I've been hearing stories about Canadians who went to US med schools, whose work visa expired after 2 years of residency and have to return to Canada for half a year before returning to the US. How does the visa situation work after you complete med school?

 

[clifftacopter]

This is an insane comparison. University of Chicago is one of the best medical institutions in the world--on par with Yale or Columbia. It runs circles around any medical school in the Caribbean. If you feel you are competitive enough to have a shot getting in there (it's not a walk in the park -- the average MCAT for Chicago is a 36), then there's no question you should be applying to American medical schools rather than Caribbean as your back up.

Above posters have already mentioned that you're treated as a CMG with CaRMS, which is a big advantage over the Caribbean. But in addition to that, if you have trouble matching in a program there, you would have no problem matching into an American residency of some sort. Most provinces recognize American credentials as equivalent and would grant you license to practice there (ex: http://www.healthforceontario.ca/Wo...ntario/PracticeRequirements/UnitedStates.aspx)

If you want to live in the Caribbean you should take a year off and do that. Don't possibly screw up your future over geography.

EDIT: There's also an abundance of medical schools in Florida if you really want the tropical environment.

 

[mlw03]

This is an insane comparison. University of Chicago is one of the best medical institutions in the world--on par with Yale or Columbia. It runs circles around any medical school in the Caribbean. If you feel you are competitive enough to have a shot getting in there (it's not a walk in the park -- the average MCAT for Chicago is a 36), then there's no question you should be applying to American medical schools rather than Caribbean as your back up.

Above posters have already mentioned that you're treated as a CMG with CaRMS, which is a big advantage over the Caribbean. But in addition to that, if you have trouble matching in a program there, you would have no problem matching into an American residency of some sort. Most provinces recognize American credentials as equivalent and would grant you license to practice there (ex: http://www.healthforceontario.ca/Wo...ntario/PracticeRequirements/UnitedStates.aspx)

If you want to live in the Caribbean you should take a year off and do that. Don't possibly screw up your future over geography.

EDIT: There's also an abundance of medical schools in Florida if you really want the tropical environment.

Can verify that one, as I went to one of them (was a Florida resident at the time). That said, it's tough for non-Floridians to get into Florida MD schools besides University of Miami since the others give strong preference to Florida residents.

I don't know how it works in Canada, but in the US the heiarchy is: US MD, US DO, Carribean MD. may not be fair, but that's the general perception.

 

[Medstart108]

Ya. Try and get into Canadian medical schools first, if not go for the U.S however the U.S is not much easier than Canadian medical schools. If you can get into UofC as a Canadian you will almost definitely get into at least one Canadian medical school. Don't go to the Carribbean unless you apply to Canadian schools at least twice. It really is the last choice because it is not only expensive but match rates are low in Canada. The match rates are higher in the U.S however.

 

[RC1414]

I turn 35 end of August. I am a chiropractor and have decided to apply for medicine. I am currently enrolled in UNF for this Sept to retake/upgrade undergrad courses Gen Chem, Org Chem and Physics as advised by my academic advisor. Then I need to take the MCAT. I will not be able to get in to a med school until Fall of 2014 and there is no guarantees I will even be accepted based on my qualifications. Btw I graduated 2004 chiro college with 3.4 gpa and alot of those courses such as biochem, microbiology, anat etc I have already taken in chiro college. I would have to go through the same courses again in med school. My point is I dont want to waste any years. I am married and have two kids. Thankful, my wife who is an RN is very supportive if whatever direction I take.

Reading your comments, I know it is best to try to be accepted in a US or Cdn college rather than a Carribean medical college because foreign medical students have a more difficult time getting the residency they want. Right now I can see myself doing Gen surgery rotation. I have the desire to work in the hospital and specialize as opposed to a clinic because Ive been there done that. Should I attend a carribean college Jan next year? Or, should I take these undergrad courses again, MCAT and apply for 2014 year with no guarantee of acceptance? I am trying to decide whether another one and a half years is worth it just to try to to get into a US/Cdn college and not a carribean.

Also I am Canadian, I would like to practice in Canada. An MD friend I have recommended I take carrib because time is an essence. He said that once Im in my first residency I can switch the following year with a better chance of getting in to the residency I desire. He said I can make good connections and go through the back door. For eg, from FM in US, IM in Canada residency to Gen surg to residency Is that possible? Is that easy?

 

[clifftacopter]

Your friend gave you incredibly, incredibly bad advice. In fact that's an insane proposition.

A couple of problems:
A) There is no guarantee you'll get into any residency from a Caribbean school in the US or Canada. Most Caribbean schools will gouge you with exorbitant tuition and leave you out to dry by making you ill-prepared for both the licensing exams and residency. There are a few that are supposedly pretty good, and even they have pretty dismal match rates compared to American and Canadian medical schools.

B) You'll spend more wasted time switching from a FM and IM residency to a general surgery residency than if you just took a year (or two!) to knock out the pre-requisites you need to apply to medical school. If they even accept a foreign graduate transfer to a surgery program from FM or IM, you'll still need to re-do your first year in your surgery residency (and possibly repeat two years if you are unable to transfer into a second year slot).

C) Those pre-requisite classes are pretty important. While they're admittedly less important in the real clinical world, you'll absolutely need a reasonable understanding of organic chemistry and physics in order to do well in some of your medical school classes.

D) 35 is not terribly old. We have a few students in my class that are your age. Just accept that you'll be around 45 when you start making good money. What's the difference between one or two years? I get that there's no certainty that you'll be able to get into a Canadian or American medical school after taking those university courses, but you're making that same bet by going to a Caribbean school and not being accepted into a residency field you desire (except it's much worse as you'll have wasted even more years plus you'l have 4 years of debt with their sky-high tuition).

 

[docnotsopc]

We dont need any Canadians filling up our medical schools. There's already a limited number of seats and shortage of doctors.

I see that you made the same post twice in two different threads. Considering US medical schools are significantly easier to gain admission than Canadian medical schools, I feel obligated to tell you its survival of the fittest so study hard

 

[septoplasty]

I did want to point out that most american schools require you to be an american citizen / permanent resident. So to the OP, i'm not even sure you are eligible for admission just based on that.

Although there are schools near the border that do except Canadians, I'd find out before I apply blindly.

 

[sweetatom]

ok, there is a lot of misinformation going around....so some myth busters for the original poster.
about me: I am a canadian studying in an american medical school. in 4th year now, applying for residency. I went to UofT as well. Did well there, but kept getting waitlisted. I interviewed at a few places too but wasnt getting in, applied to US one cycle and got in. I do have a few masters degrees.
1. American schools are a little easier to get into, but you damn well be MUCH better than the average student they take into their own medical school in the states because why would they take you over a Local american student? a 3.6-3.7 will not get you into UofC. Period!
UofC is a very competitive program, and secondly, There are VERY Few programs that sponsor F1 to canadians...do your homework...when i applied there were maybe 12-15. Yes, Harvard and yale and columbia, but can you afford to go there? and can you really get in there? think about it.
Then again, i dont know maybe you are the world famous cardiothoracic surgeon's son or daughter and have connections, then yes, you will get it in. who am I to say anything??
2. $$$. Some american schools charge exorbidant amounts from non-citizens, check the tuition, i think wayne state was asking $70K from non-citizen and only $40K from citizen...I dont know your financial situation, but that did not work for me. Canadian banks are not very willing to give loans for american education...they are ******ed. and GOOD luck getting anything from an american bank without a gauranter, with this economy.
3. Medical school itself is stressful, if you are gonna be away from home, be ready to deal with that depending on which part of US you are in. last time i went home was christmas. STEP 1 and 2 are tough. If you had a hard time with MCAT, forget about it. American students generally are better at standardized testing.....and also, carribean students are known to take months off to study for them, as an american grad, we do not get time off....we take them on the roll with classes and in between rotations.
4. Being a non-citizen, it limits opportunities. For instance, I could not get a research position at my school...eventhough they do a lot of cool research and have lots of funding...they will be like, "sorry" cant pay you. I got the opportunity to teach a class in medical school because I had a grad degree. but I had to do it for FREE, cause they could not put me on payroll with my F1.
5. Come time to apply for electives, I spent a lot of money trying to apply to different places that my "american" collegues were applying to only to be rejected because their hospital does not support F1.....dumb cause technically my school is covering me...whatever, better not to argue.
6. Applying to residency as a non-US citizen is a nightmare. Primary care is ok, forget about neurogurgery or ENT. I am being told and witnessing that an american Carribean grad gets preference over me. I have been deligently calling programs and it is a PAIN trying to explain I am a canadian citizen studying in an AMERICAN School. Some put me in the pile with AMG's, (but i wonder if they will rank me over an american), and some put me on the top of the IMG pile...GO FIGURE...so far, I have enough interviews, I am sure I will match, but where is the question.....most interviews I have gotten are from places where there are a lot of FMG's and I will be the superstar there...something to brag for the program...I do not know how I feel about that.
7. Visa - an issue. J1 or H1. Very few programs give H1...and these are usually rural where no american grad wants to go, and so the only way they attract candidates is by offering that to FMG's.
8. Going back to canada is fairly easy. no exttra tests or requirements. We are considered CMG's. Tons of people from my school in the past have gone back to canada. FM easier than lets say Urology. But then again, for all I know, your dad is the head of the cardiothoracic surgery at University of Ottawa. then u can do whatever you want.
That said, not everything is bad, I am not trying to be cynical, I am trying to tell you the truth.
ADVANTAGE: I get to be a doctor from a legit AMERICAN School that I can be proud of. I get to practice cutting edge medicine.
message me if anyone has any questions.

 

[septoplasty]

ok, there is a lot of misinformation going around....so some myth busters for the original poster.
about me: I am a canadian studying in an american medical school. in 4th year now, applying for residency. I went to UofT as well. Did well there, but kept getting waitlisted. I interviewed at a few places too but wasnt getting in, applied to US one cycle and got in. I do have a few masters degrees.
1. American schools are a little easier to get into, but you damn well be MUCH better than the average student they take into their own medical school in the states because why would they take you over a Local american student? a 3.6-3.7 will not get you into UofC. Period!
UofC is a very competitive program, and secondly, There are VERY Few programs that sponsor F1 to canadians...do your homework...when i applied there were maybe 12-15. Yes, Harvard and yale and columbia, but can you afford to go there? and can you really get in there? think about it.
Then again, i dont know maybe you are the world famous cardiothoracic surgeon's son or daughter and have connections, then yes, you will get it in. who am I to say anything??
2. $$$. Some american schools charge exorbidant amounts from non-citizens, check the tuition, i think wayne state was asking $70K from non-citizen and only $40K from citizen...I dont know your financial situation, but that did not work for me. Canadian banks are not very willing to give loans for american education...they are ******ed. and GOOD luck getting anything from an american bank without a gauranter, with this economy.
3. Medical school itself is stressful, if you are gonna be away from home, be ready to deal with that depending on which part of US you are in. last time i went home was christmas. STEP 1 and 2 are tough. If you had a hard time with MCAT, forget about it. American students generally are better at standardized testing.....and also, carribean students are known to take months off to study for them, as an american grad, we do not get time off....we take them on the roll with classes and in between rotations.
4. Being a non-citizen, it limits opportunities. For instance, I could not get a research position at my school...eventhough they do a lot of cool research and have lots of funding...they will be like, "sorry" cant pay you. I got the opportunity to teach a class in medical school because I had a grad degree. but I had to do it for FREE, cause they could not put me on payroll with my F1.
5. Come time to apply for electives, I spent a lot of money trying to apply to different places that my "american" collegues were applying to only to be rejected because their hospital does not support F1.....dumb cause technically my school is covering me...whatever, better not to argue.
6. Applying to residency as a non-US citizen is a nightmare. Primary care is ok, forget about neurogurgery or ENT. I am being told and witnessing that an american Carribean grad gets preference over me. I have been deligently calling programs and it is a PAIN trying to explain I am a canadian citizen studying in an AMERICAN School. Some put me in the pile with AMG's, (but i wonder if they will rank me over an american), and some put me on the top of the IMG pile...GO FIGURE...so far, I have enough interviews, I am sure I will match, but where is the question.....most interviews I have gotten are from places where there are a lot of FMG's and I will be the superstar there...something to brag for the program...I do not know how I feel about that.
7. Visa - an issue. J1 or H1. Very few programs give H1...and these are usually rural where no american grad wants to go, and so the only way they attract candidates is by offering that to FMG's.
8. Going back to canada is fairly easy. no exttra tests or requirements. We are considered CMG's. Tons of people from my school in the past have gone back to canada. FM easier than lets say Urology. But then again, for all I know, your dad is the head of the cardiothoracic surgery at University of Ottawa. then u can do whatever you want.
That said, not everything is bad, I am not trying to be cynical, I am trying to tell you the truth.
ADVANTAGE: I get to be a doctor from a legit AMERICAN School that I can be proud of. I get to practice cutting edge medicine.
message me if anyone has any questions.

Your visa situation is quite understandable, but I'd say appreciate the fact that you're even allowed to apply for the match in the first place versus Canada not allowing foreign nationals into their system.

Also, getting back to Canada is easy? No tests? What?

Go have a look at the other thread, if you're ABIM certified, this doesn't equal licensure in Canada (as stated by another attending in a thread).

 

[docnotsopc]

ok, there is a lot of misinformation going around....so some myth busters for the original poster.
about me: I am a canadian studying in an american medical school. in 4th year now, applying for residency. I went to UofT as well. Did well there, but kept getting waitlisted. I interviewed at a few places too but wasnt getting in, applied to US one cycle and got in. I do have a few masters degrees.
1. American schools are a little easier to get into, but you damn well be MUCH better than the average student they take into their own medical school in the states because why would they take you over a Local american student? a 3.6-3.7 will not get you into UofC. Period!
UofC is a very competitive program, and secondly, There are VERY Few programs that sponsor F1 to canadians...do your homework...when i applied there were maybe 12-15. Yes, Harvard and yale and columbia, but can you afford to go there? and can you really get in there? think about it.
Then again, i dont know maybe you are the world famous cardiothoracic surgeon's son or daughter and have connections, then yes, you will get it in. who am I to say anything??
2. $$$. Some american schools charge exorbidant amounts from non-citizens, check the tuition, i think wayne state was asking $70K from non-citizen and only $40K from citizen...I dont know your financial situation, but that did not work for me. Canadian banks are not very willing to give loans for american education...they are ******ed. and GOOD luck getting anything from an american bank without a gauranter, with this economy.
3. Medical school itself is stressful, if you are gonna be away from home, be ready to deal with that depending on which part of US you are in. last time i went home was christmas. STEP 1 and 2 are tough. If you had a hard time with MCAT, forget about it. American students generally are better at standardized testing.....and also, carribean students are known to take months off to study for them, as an american grad, we do not get time off....we take them on the roll with classes and in between rotations.
4. Being a non-citizen, it limits opportunities. For instance, I could not get a research position at my school...eventhough they do a lot of cool research and have lots of funding...they will be like, "sorry" cant pay you. I got the opportunity to teach a class in medical school because I had a grad degree. but I had to do it for FREE, cause they could not put me on payroll with my F1.
5. Come time to apply for electives, I spent a lot of money trying to apply to different places that my "american" collegues were applying to only to be rejected because their hospital does not support F1.....dumb cause technically my school is covering me...whatever, better not to argue.
6. Applying to residency as a non-US citizen is a nightmare. Primary care is ok, forget about neurogurgery or ENT. I am being told and witnessing that an american Carribean grad gets preference over me. I have been deligently calling programs and it is a PAIN trying to explain I am a canadian citizen studying in an AMERICAN School. Some put me in the pile with AMG's, (but i wonder if they will rank me over an american), and some put me on the top of the IMG pile...GO FIGURE...so far, I have enough interviews, I am sure I will match, but where is the question.....most interviews I have gotten are from places where there are a lot of FMG's and I will be the superstar there...something to brag for the program...I do not know how I feel about that.
7. Visa - an issue. J1 or H1. Very few programs give H1...and these are usually rural where no american grad wants to go, and so the only way they attract candidates is by offering that to FMG's.
8. Going back to canada is fairly easy. no exttra tests or requirements. We are considered CMG's. Tons of people from my school in the past have gone back to canada. FM easier than lets say Urology. But then again, for all I know, your dad is the head of the cardiothoracic surgery at University of Ottawa. then u can do whatever you want.
That said, not everything is bad, I am not trying to be cynical, I am trying to tell you the truth.
ADVANTAGE: I get to be a doctor from a legit AMERICAN School that I can be proud of. I get to practice cutting edge medicine.
message me if anyone has any questions.

welll.....dam man! Im just starting 2nd year at a US med school.....

Thats no fun!

 

[sweetatom]

I am very thankful, like I said in my post.
This has been my window of opportunity to live my dream, a SMALL window I am squeezing through, unlike the doors I see my peers walking through. please do not give the stuff of always look at those less unfortunate. This instance, I am just stating the reality.
Canada always has restrictions. I have not reached that point yet, and neither have I had the time to look into everything. I am sure there are hoops and bumps.
I meant, no exams/tests to take before applying, as many of you are aware, timing is tight in US med school, i do not have time for that. But, we do have to take the mcque thing that every canadian student takes before graduating, after match. I will worry about that later.

 

[sweetatom]

i do not know where this other thread by an attending is, I have actually run into residents here who have decided to move to Canada, AMERICAN MD school graduates, who finished an american residency. but it is required to finish the length of training. Just like US will not accept a 2 yr family medicine residency, Canada will not accept a 3 year internal medicine or Pediatrics residency. Might have to do extra year of training here or there....I am aware...I was trying to look at something positive here

 

[CanadianPremed]

,.,.,.,.,.,.,.

 

[simin]

I am in my final year of undergraduate biology and psychology program from university of Toronto. My GPA is not high enough to be able to apply for canadian medical schools. I am going through a very difficult time of decision making. Some of my friends have decided to go to Carribean med schools and are studying there currently but they know that they are going to be struggling with residency later on. Some one suggested that I should start another degree for 3 more years with an easierprogramm to buld a better GPA and stay in Canada instead of going through the battle of coming back to Canada and passing USMLE in USA. I would realy like to hear more facts and stories of people who have experienced and went through the same path. what would be your advise to me?

 

[MadHopsMD]

Other than maybe Toronto, all canadian medical schools are on par with mid tier American Schools, sometimes even below them.

For example my school wasa a mid tier american school, and they had robotic surgery for gyn onc. The only place in Canada that had it? Toronto. We routinely did laprascopic surgery in Gyn, while it was just starting to break ground in Canada. I worked along side people who trained in John Hopkins, MGH, MD Anderson, Sloan Kettering to name a few. Doubt any canadian medical school will give you that opportunity.

Yes, I payed for the experience, especially as a Canadian...there are no easy loans you can get. But its the SAME cost of going to a Caribbean school. In addition, the support I got by the school was amazing whenever I wanted to. eg. calling on my behalf to residency programs to get me a more favorable spot on the rank list. Also most importantly if I wanted to Radiology, Plastics, or any other field was open to me after I graduated. As a Caribbean medical school graduate unless you are 99.9999%tile you can say bye to any competitive speciality.

So I amazed that some people think American Schools are equal to Caribbean. Just shows you the brain washing Caribbean schools do to recruit students there. Seriously I know many canadians who went to Caribbean didnt match to residency and now are 200 K US in debt.

Your comparison of UofChicago to Caribbean is even more laughable. UofChicago is one of the top medical schools in the WORLD. If you can get in there you can go easily get into ANY canadian schools.

 

[MadHopsMD]

I am in my final year of undergraduate biology and psychology program from university of Toronto. My GPA is not high enough to be able to apply for canadian medical schools. I am going through a very difficult time of decision making. Some of my friends have decided to go to Carribean med schools and are studying there currently but they know that they are going to be struggling with residency later on. Some one suggested that I should start another degree for 3 more years with an easierprogramm to buld a better GPA and stay in Canada instead of going through the battle of coming back to Canada and passing USMLE in USA. I would realy like to hear more facts and stories of people who have experienced and went through the same path. what would be your advise to me?

As for your question. I would try to get a GPA of 3.7 and MCATS of 32-34 to easily guarantee a spot in American Medical Schools. American school are more forgiving if your MCATS for example is 9 or 8 VR. In Queens or Western, I did not get an interview because my VR was 9. Seriously??? They also give you leaway a little if your GPA is 3.5-3.6 if you did well in science courses and have decent extracurricular and have a good MCAT to boot (34+).

The biggest limiting factor is there are few schools that take Canadians even more now since I applied (6 years back). My medical school stop taking Canadians. The visa issue was a factor, but even bigger was finding loans to finance the education. Its very difficult to find Canadian banks to give you loans. Caribbean schools have options because they get so many Canadians going there, but in the US medical school you kinda alone.

The average state as an international student getting accepted to American medical school is 3.6 with 32+ MCAT school. I have know people who got in with less GPA, but almost always their MCAT was super high. Overall, MCAT means more than GPA in terms of admission. So make sure you ROCK that. I would apply early also. In June. Apply broadly. But know your path is a difficult one. Also apply to Caribbean school just as back up.

 

[MadHopsMD]

Hey guys,

I am new here, and I am currently in my junior year at the University of Toronto. My GPA is kind of low for med, around 3.6 but I'll try to bring it up to over 3.7 when I graduate. My first choice of course would be to get into Queen's or Western, hopefully with a top 2 year GPA higher than 3.8 by working hard these last 2 years with a decent MCAT score this summer.

If that doesn't happen, I've got a dilemma, I've got some American medical schools that I want to go to (ie. University of Chicago or Georgetown) but I'm also considering some Caribbean Medical schools since I heard they're softer than the ones in Canada and the US and I want an opportunity to live for a while in the Caribbean.

What are the pros and cons for a Canadian who wants to come back to Canada after graduating for either one? Which would be a better choice? Would it be hard to get residency in Canada for American/Caribbean medical students?

This post is just so hilarious. Comparing UofChicago to Caribbeans. haha. Also, beware when you say "live for a while in the Caribbean". Some schools are in islands where there is no supermarket. From my coworkers, they are thankful for the opportunity to go there to get a medical degree and rotate at american hospitals for medical school. But living there was a nightmare for two years. And always they would choose an american medical school in a heart beat.

 

[septoplasty]

This post is just so hilarious. Comparing UofChicago to Caribbeans. haha. Also, beware when you say "live for a while in the Caribbean". Some schools are in islands where there is no supermarket. From my coworkers, they are thankful for the opportunity to go there to get a medical degree and rotate at american hospitals for medical school. But living there was a nightmare for two years. And always they would choose an american medical school in a heart beat.

You're getting trolled, I suggest stopping lol.

Anyone who chooses to go to a Caribbean school over an American one is insane and probably shouldn't be an MD.