First of all, a bit of background about myself. I'm a US-IMG who came over to England for medical school in 2007. I managed to jump through all the hoops and was able to match into a pediatric residency in America. As an IMG, I've always had my eye on the foreign graduate situation and I've been seeing a disturbing trend over the last few years. And I just wanted to take this opportunity to share my thoughts and findings. Ever since the onset of residencies in America, there have always been more residency spots than American medical graduates. That's why it has been relatively easy for foreign graduates to match into the 'IMG friendly' specialties (FM, IM, Neuro, Psych, Peds etc) and even occasionally sneak into the competitive fields. Foreign graduates were the ones who filled the gap. But over the last few years, there has been a boom of osteopathic schools + increased enrollment in MD schools + opening of new MD schools. On the other hand the number of residency spots have remained the same due to budget constraints, and financial troubles. So if you put two and two together, there is a really dark cloud looming in the horizon for foreign medical graduates. It's projected that by 2015, the number of American graduates (MD+DO) will nearly equal the number of residency spots. This would mean that even those five specialties will be quite challenging for IMGs (Even if you are from the UK or Ireland), unless you are an exceptional candidate with really high grades, excellent USMLE scores, research and electives at top hospitals. Have a look at this thread if you want to read more about the American situation http://forums.studentdoctor.net/showthread.php?t=858100 I am fairly certain that highly qualified IMGs will still be able to get "a" residency spot in America even if it's 2017 or 2020 in the traditionally IMG friendly specialties. But I'm pretty sure competitive specialties will almost certainly be off-limits unless you are an absolute superstar candidate (I'm talking PhD, years off for research, multiple publications in international journals etc.) There are a handful of Canadians in my class, so I am quite aware of the CARMS situation as well. It's a similar type of picture, with more and more Canadians studying abroad with each passing year and a stable number of residency spots. Most of the times you are competing for a very very limited number of IMG 'quotas' or fighting for unfilled spots in the second round. I know a few people who decided to settle for Family Medicine or Psychiatry although they really wanted to do Pediatrics or Internal Medicine. The competition is getting incredibly tough and this article breaks it down quite nicely. http://www.cbc.ca/news/health/story/2011/02/22/canadian-students-medicine-overseas.html The UK is really strict when it comes to foreign students (not sure about Ireland). Even if you go to school here, if you are not an EU/UK citizen, it is almost impossible to find good training posts beyond 2 years after graduation. If you do come here, keep in mind that from the day you set foot in England/Ireland, you are walking on eggshells. You cannot afford to have even one red flag on your application. The competition for residency is going to be extremely tough in the coming years. So, no retakes during medical school and no poor scores or failures in any of your USMLEs or MCCEEs. Trust me...that is a lot of pressure, because one slip up and you have almost invariably burned off all your bridges to head back home. Even if you come out on the other end unscathed, getting into a well reputed residency program in a good metropolitan city will be tough, much much harder than getting into a north american medical school. There's a good chance that you'll find yourself in an unfortunate position where you'll have to compromise on your career choice and not be able to do what you love. Therefore if you are a high school student, I would strongly advice you to do your undergraduate in North America, and apply to North American medical schools in a few years time; even if it means a bit of short term pain and uncertainty. Trust me, the long term consequences of going abroad significantly dampen the short term gains. If you are an undergraduate student or finished your degree, try to get into North American medical schools for at least two years. In my opinion, only then should you even consider the possibility of going abroad for medical school. Do a post-baccalaureate or post graduate degree, retake the MCATs, do whatever it takes to improve your application. Europe should be your last resort after you exhaust all your North American options. If you are already in UK/Ireland, at least you now know what you are up against and will be better prepared when the time comes to wage that uphill battle to get back home. Do audition electives at places where you want to work, these are invaluable!! Second only to your USMLE/MCCEE scores. On top of that, do research, get published, go to conferences, present audits, volunteer, and take on leadership roles. Turn yourself into a solid, well rounded applicant! If I were applying right now, I wouldn't even entertain the possibility of studying in the UK, not even for a nanosecond!! Things have changed so much in the last five years and they're heading downhill with each passing year. Of course you'll hear the anecdotal success stories, but please take them with a grain of salt. Because behind every success you hear about on SDN there are stories without happy endings; struggles, hardships and regrets we never hear about. I'm the only American in my class and we had seven Canadians when we first started. Three of them failed out at different junctures of our course. Out of the four who are still here, two of them applied to Canada this year (the other two are planning to apply next year because they haven't written their MCCEE yet). Unfortunately both of them did not match despite coming from a well reputed medical school in England and possessing bachelors degrees from Canada. They're trying for round 2, but most likely they'll have to stay here and try again next year. So if this is the situation today, just imagine what's looming in the horizon? There is a category 5 hurricane brewin' in the ocean my friends.....be very very careful before you decide to swim directly towards it. Sorry about this epic gloom and doom message. But I really think that anyone who comes to England or Ireland should be aware of the long term consequences and be able to make an informed decision. I know how difficult and unfair the medical admission process in North America is. I've seen many qualified candidates fall through the crack time and again. And I understand the appeal of well reputed medical schools in Ireland and England, places that are willing to give you a shot at your dreams. But just make sure that you have exhausted all your options back home before you get on that transatlantic flight. That way you will have absolutely no regrets a few years down the road, and you can be at peace with your decision for the rest of your life. If you knew all this already, I'm sorry for taking up your time. But either way, I hope it was at least a little bit helpful. All of this is just my personal opinion based on my own experiences and observations; please don't take it as anything more. Having studied in the UK and having just gone through the match, I feel like I have gained quite a lot of insight into this process. Others might disagree with me. So please do your own research and come to your own conclusions. I wish you all the best and don't hesitate to message me if you have any more questions or need any help.