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there is also the person that their UG is no longer representative of the type of student they are...say went to grad school or a post bac and had a great GPA, improved their MCAT scores, did research, etc, but can't get away from their crappy UG gpa...applied to the US MD schools for a number of cycles, waitlisted, and then didn't get off the waitlist...there are going to be factors you can control and others that you can't...i agree with you about the concern about that person that couldn't wait a year, but there are others where its either DO or IMG or not a doctor...
I don't disagree. If you can't get your GPA fixed with the DO grade replacement, an MCAT fixed with a retake, and multiple cycles, sure try for the Caribbean. If you just can't wait another year and want it now, now, now... well that's that kind of person that has made a really bad mistake.