Attending Medical School on Foreign Ground

It's a Small World

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By Sherry Gray

Getting into medical school can be quite a challenge. Prospective students work hard to build a well-rounded background that will appeal to to the college of their choice, knowing that their chance of acceptance is 8.3% overall, and an abysmal 4% or less at top-tier schools. Harvard, ranked number one, accepted 3.9% of applicants, 226 of 5,804 hopefuls. State schools are far cheaper to attend and offer a better chance of acceptance, 44% of applicants.

Some students who are turned away remained determined to achieve their goals, and one way to do that is by applying to a school in another country. How does a foreign medical education compare to a U.S. education? The answers might surprise you.

Comparing costs
The cost of attending medical school varies widely both inside and outside the U.S. Once tuition, fees, and the cost of living are figured in, American private schools come in on the high end of the scale and state colleges land in the middle. Average medical student debt ranges from $70K for medical students in Poland to $200K for medical students in Australia and Ireland.

  1. Nearly 90% of U.S. student loans for medical schools outside the U.S. go to Caribbean medical schools, popular for proximity to home, tropical beach locations, and reasonable cost, which compares favorably to the mid-range schools in the U.S.
  2. Medical schools in Mexico are cheap and so is the cost of living, but the high crime rate must also be taken into consideration.
    Canada might be an appealing low-cost option if prospective Canadian med students were not saddled with similar issues faced by those in the U.S., more aspirants than programs.
  3. The cost of attending schools in Europe range from very inexpensive Poland to astronomical prestigious schools such as St. Andrews University in Ireland…which costs over $250K in tuition alone, but comes with guaranteed admission to the University of Edinburgh for post-graduate studies.
  4. The average student expenses in the Middle East are comparably low, but there are cultural and language hurdles.

Are international medical schools worth the cost?
With student debt at the forefront of the national conversation, ROI – return on investment – is a natural concern. Between 1998 and 2008, the total loaned to U.S. students attending foreign medical schools was $1.5 billion, which represents less than 1% of all federal student lending. Participating schools are required to meet certain requirements. One of those requirements, and a good measure of the school’s success rate, is the student pass percentage for the USMLE. In 2010, Congress increased the USMLE must-pass rate from 60% to 75%. The U.S. Government Accountability Office (GAO) estimates that, while most schools meet the old standard, only 11% are likely to meet the new standards to be eligible for the federal lending program. The report looked at 218 schools in nine countries popular with American students.

According to a press release from one of the more popular Caribbean medical schools, Ross University School of Medicine (RUSM), their 2012 USMLE Step 1 pass rate is 96% on the first try. This is marginally better than the pass rate for students attending medical school within the U.S.

Another indication of education value is the number of students who secure a place in residency programs. RUSM reports that 733 recent graduates obtained residencies at U.S. hospitals in 2013.

Foreign-educated doctors practicing in the U.S.
One in four doctors currently practicing in the U.S. attended medical school in another country, but only 20% of them are Americans who were educated elsewhere.

In the past, there was a certain stigma attached to students educated at foreign schools. There were some concerns that graduates would prove less educated than students who graduated from U.S. schools, and that sub-standard students who had been turned down for admissions were more likely to apply. A study conducted in 2010 refutes those concerns. Doctors analyzed the records of 244,153 hospitalizations in Pennsylvania to compare quality of care based on patient outcomes and found no significant difference in mortality rates between patients with American-educated physicians and patients with foreign-educated physicians.

Advantages to attending foreign schools
Some schools offer an accelerated program, allowing medical students to graduate in three years instead of four. Cutting a year of living expenses can amount to a significant savings, as does entering the workforce a year earlier.

Acceptance is also more streamlined. Since there are fewer applicants to process, students who are turned down by U.S. schools can often apply and be accepted during the same school year.

It’s a small world
When talking about attending foreign schools, it seems only reasonable to discuss the global nature of medicine today. Technology makes it possible to collaborate with doctors all over the world, and it’s common to see research conducted with widely separated teams working on the same problem.

The global nature of society has broken down the barriers to communication, making such real-time collaboration a reality. In the last few years, Twitter has seen teams from hospitals tweeting during operations, like the live-tweeted heart surgery performed at Memorial Hermann in Houston, Texas, and brain surgery performed at Henry Ford Hospital in Detroit, offering medical students a rare glimpse into procedures long before they will witness them in person.

Since opportunities often spring from networking, working with international doctors or aspirants has significant potential. From a global perspective, living and working in another culture could present a significant advantage for a prospective doctor whose dreams go beyond private practice.

Disadvantages to attending foreign schools (things to consider)
Schools in foreign countries may require that students be fluent in the language, and those who are not may face a difficult time understanding the material and taking tests. Choosing a school in a country where English is the national language or the school is designed to attract English-speaking students is an obvious way to avoid a learning disadvantage. Medical school is difficult enough without the impediment of an unfamiliar language.

Distance is another consideration. Few situations are more lonely than a deserted campus during the holidays. Students may want to take travel time and cost into consideration before making a decision.

Reciprocal residency agreements. It will be easier to get into a residency program if the school you choose has a number of reciprocal placement programs in place.

All medical students seeking a residency program in the U.S. must pass the Step 1 USMLE, and students graduating from some schools are required to have ECFMG certification. Not all foreign graduates need this additional certification to qualify.

To go or not to go?
Naturally, some students will opt to wait and try again the following year for an American school, and some will decide to follow a different path altogether. Those who want to attend a foreign school have plenty of viable options to get a quality education in an exotic location.

Sherry Gray is a freelance writer in Orlando, Florida. Science, medicine, and politics are her favorite topics to write about and obsess over.

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