The bottom line is that Carib schools (especially Med Schools) are a mixed bag. Calling them "a scam" or "a waste" or "a diploma mill" is unfair, since there are plenty of successful carib grads. Saying that they are "equivalent to US schools" is also untrue. I agree that advertising them to HS students is complicated and fraught with difficulty, as many will assume that all medical schools are equivalent. And a guaranteed acceptance seems like a good deal, but it isn't at all. So, here's my summary of Carib schools (shamelessly copied from another thread):
1. They accept people who cannot get into a US medical school. Whether you see this as "giving deserving people who messed up their GPA / can't do well on the MCAT a second chance" or "leeching tuition off of desperate students who can't get into US medical schools" depends on how you view the situation. No combination of metrics perfectly predict medical school success, some people with poor GPA's and MCAT's do fine. But many with low prereq's will struggle.
1b. It is hard to explain how much work medical school is. Most find it much more difficult / time intensive than college. Everything builds on everything else, so you can't just study / test / forget like you can for lots of college courses. Getting in isn't necessarily the hardest part -- it's succeeding / surviving.
2. Top performers in Carib schools will do fine, and be able to get mid-competitive fields /spots. Anesthesia, EM, Rads, University IM, etc. Ortho/NS/Vascular/Derm is very unlikely even for the top performers, and usually requires years of research and/or connections.
3. Middle performers will also do fine, but often end up in FM / Community IM / peds / Psych / Neuro. Nothing wrong with those fields, but those attending Carib schools should understand that their choices may be limited.
4. Those at the bottom of their class, failing a class, or worse failing a step, often have much more problems. Students retake, pass, and then think everything will be OK, and it might not be. These students might still match, but it's much harder. These students are definitely limited to the least competitive fields and programs.
5. A reasonable percentage of all students starting in carib schools fail out in the first 2 years. Exactly how high that percentage is, is unclear. It clearly varies by school. Some see this as "The school takes more students than it has clinical spots for, and then fails them out to make more money". Others see it as "These schools know that some percentage of students will fail out. Rather than leave clinical spots empty, they take enough pre-clinical students so that their clinical spots are filled -- this offers the maximum number of students an opportunity to be a physician". The crux is whether the pass level is adjusted specifically to fail out people, or whether it's set at some reasonable benchmark and some people happen to fail.
The other part of this discussion usually revolves around "Well, the school takes people with very low MCAT's and then they fail out -- it's a scam and they should have a higher MCAT cutoff". Data from the LCME shows that lower MCAT scores tend to be associated with failing the USMLE. But population statistics don't tell you how any one person will do -- some people with low MCAT's do just fine. So, again, how you interpret this depends upon how you look at it.
6. If you fail out of med school, or can't match to a residency, you really have limited options. A partial MD is of no value. An MD without a residency is also of very limited value, especially an international degree. People talk about "consulting", but I've never seen that actually happen. There are several stories of people getting jobs working for insurance companies, or state disability office, etc. These positions don't pay well, but at least they are something and might qualify for PSLF.
7. If you fail out of school, or can't find a residency because of poor performance, your loans are non-dischargable. Paying them off is very difficult. PSLF or "extreme hardship" may be able to discharge them after 10+ years. if you have a cosigner, they are on the hook just as much as you.
8. It's hard to assess how successful Carib schools are at placing grads into residencies. They sometimes list their "placement lists", although there's never a denominator of how many people initially started in the class. Many schools end up being 4.5 or 5 years due to some delays / exams / etc. Positions in IM or GS are often not labeled as to whether they are Prelim or Categorical, a huge difference. That said, some carib grads do just fine and end up in great fields / programs.
9. US med schools have increased their class size. Residency spots are also increasing slowly. So far, it hasn't been a problem. It may be that as time goes forward, IMG's will have further trouble getting even IM and FM spots and the change might happen between the time you matriculate and graduate. But, the opposite might be true also -- spots might grow at a higher rate than students.
So: Going to a Carib school is an uphill process. You need to work harder and be better than your US colleagues to do "equally" well. Carib schools often tout their successes, and ignore the students who never make it to graduation, are only able to get a prelim spot, or not match at all. Yet, at the better carib schools, the majority of students probably succeed (again, difficult to say due to lack of transparency), mainly in the primary care fields. Advertising from these schools (on their websites) doesn't do a great job of balancing these risks and benefits. Threads on SDN tend to tout only the negatives.
The Carib should never be someone's Plan A. In general, going to a US school is far preferable. You'll have all fields open to you, the match process is much more streamlined and you'll have more success. These direct admission / combined programs sound like a bad idea all around. I expect some of it is marketing -- the metrics they are setting to get into the program are probably the same as what you'd need to simply apply, from anywhere, and get in. If you're interested in medicine as a career, you should go to college and do the pre-reqs, take the MCAT, and apply to US schools (MD and DO). If that is unsuccessful, then the Carib may be worth considering, as long as you understand the risks. Some would argue that you should try two full application cycles in the US before considering the Carib.
