I am saying that people don't often see MBBS as an equal degree to an MD/DO. But what are you talking about with this "habilitation" thing? That isn't even as common as the situation described here. Also, not a lot of MBBS students will go on to do doctor of medicine in countries where this is offered. It is the mindset here that the more specialized we become by pursuing higher degrees, the better- but that is not the rule overseas. Not really understanding why you are repeating the justification of an MBBS being somewhat the same as MD/DO. Unlike MBBS, MD/DO have longer residencies that need to be fulfilled- thereafter they are not the same exactly. The thesis thing you mentioned really doesn't equivalize to a residency, I would think it more as a fellowship. Still US MD/DOs go through longer and more specialized training. Anyways, despite that, it depends on the person and how perseverent they are of going further. With technology nowadays, you can find state of the art equipment in countries even such as the one OP mentioned. There is no reason to think they need to go outside to study unless it is a recent technique/specialty that they cannot have training for in their country which I'd need an example.