Should You Study Medicine Abroad?

Medical school in Canada is competitive. Very competitive. As a result, many aspiring physicians look to alternative routes to becoming a doctor that don't involve attending a Canadian medical school. The number of students choosing this route was very small only a decade ago, but has grown substantially, particularly in the last few years. The stated reasons are diverse, but most students study medicine outside of Canada because they are unable or unlikely to obtain admissions to Canadian medical schools.

So I see this question a lot from people interested in pursuing medicine but with an application that is below the standards for Canadian medical schools: should I study medicine abroad?

To answer that question, there are a few considerations worth addressing.

First and foremost is cost. Medical school is expensive. In Canada, our schooling is heavily subsidized and Canadian medical students (CMGs) have access to cheap loans, both private and public. Canadians Studying Abroad (CSAs) get no subsidies, have access to higher-interest private loans that typically require a cosigner, and public loan availability varies by province. Some schools are more expensive than others, but $200k in total costs is about the bottom line once tuition, living expenses, and travel are considered. Some schools require significantly more debt. Australian schools, for example, have very high tuition for international students, in the range of $60-70k per year, leading to total costs reaching $400k.

Second is likelihood of a successful outcome. After all, CMGs also take on a fair bit of debt, with $125-150k being a typical debt load after med school, but it's a worthwhile investment because a CMG's chances of a career in medicine (and the high salary that goes along with it) are very, very high. Virtually guaranteed, in fact. CSAs aren't so fortunate. The chances of matching into a Canadian residency have fallen from an already-scary ~50% to around 30%. As more people decide to study abroad, that number is more likely to fall than it is to rise, barring an increase in IMG-dedicated residency positions.

Now, success doesn't have to mean obtaining a Canadian residency - there is the option for residency positions outside of Canada. However, most countries that train CSAs for medical school have little interest in providing residency positions for them, unless they happen to be a citizen of that country. In many cases, that leaves the US as the only viable option for CSAs unable to obtain a Canadian residency. Non-citizens of the US without a US medical degree already face an uphill battle, but that situation looks to get even worse. Not only is there increased competition for US residency positions, but many of these residency positions can only be obtained by a Canadian if they have a study visa endorsed by Canada. These J1 visas used to be offered in essentially unlimited numbers, but recently, it was announced that hard limits will be placed on these endorsements for would-be physicians wanting to train in the US, limits that are set to shrink each year. Those limits apply collectively to CSAs, Canadians studying at US MD or DO schools, as well as CMGs wanting to do their residency in the US. These endorsements are first-come, first-serve, and without them, even if a CSA obtains a US residency positions, they cannot legally study in the US. If the US was the pressure valve on the build-up of CSAs without a Canadian residency, it appears that may not longer by the case.

All told, CSA opportunities to become a fully-trained physician are mediocre at best and dwindling quickly. Strong performance in medical school can improve one's chances (as does having connections, sadly), but there does seem to be a major luck component.

Despite these odds, some CSAs do successfully complete their training on this pathway and manage to practice medicine in Canada. And, despite an ever-worsening outlook, there will probably still be CSA success stories in the future. The CSA route is a viable path to practicing medicine in Canada, just not a reliable one.

So, should you study medicine abroad? If you have enough money or credit to pay the cost of being a CSA and can accept a large (50%+) chance of failure, then maybe. Otherwise, probably not.