A much needed update, albeit brief. I write this prologue after fighting tooth and nail for my success. An outlier for sure, as the majority of Caribbean medical students who graduate find themselves jobless without the necessary post graduate training required to practice. Not a day goes by where I am not reminded how I must “prove” myself to colleagues and counterparts because of my Caribbean MD. Six years since graduating from medical school and I am still haunted by the unforseen consequences of going to a Caribbean med school.

“Momentus” changes to the USMLE (United States Medical Licensing Examination) have occured. Step 1 of the 3 USMLE is the first of three major tests a medical student must pass to graduate with an MD. Step 1 used to be the most crucial part in defining oneself as ‘worth the cut’ when applying for post graduate training.

It is well known that medical students who train at osteopathic or international medical schools must outperform their US allopathic counterparts to ‘merit’ interviews for post graduate training residencies and fellowships. Directors of these post graduate training programs rely heavily on the USMLE step 1 score to stratify potential candidates competitiveness. This change further disadvantages osteopathic and international medical graduates by forcing program directors to rely more heavily on other factors – some of which are strategically not available to osteopathic or international medical students.

The systematic marginalization of more than qualified, arguably better, candidates from non “traditional” pathways of medical training continues. As big of a challenge as it was to make it as a Caribbean grad – without the numerical USMLE step scores, I can almost guarantee that my overqualified applications to mediocre residencies would have ended up in the bin.

I would like to take this opportunity to thank my wife for all her love and support. Without her fortitude and endless compassion – I would not be here today.

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As I wrap up my final weeks of medical training and prepare to graduate from the “Harvard of the Caribbean” – I realize the biggest mistake of my life was going to a Caribbean medical school. It seems like it was only yesterday when I climbed down the stairs off the plane and onto the tarmac. Drenched in the Caribbean sun, this wide-eyed and ambitious young man began the long and arduous journey to become a physician.

Many people choose a career in medicine to help others, myself included. As a budding physician and human rights activist it only made sense to put my smarts to use and become a doctor. Physicians are respected members of the community, earning big salaries and enjoying comfortable lifestyles.

In retrospect, pursuing my medical degree has amounted to a million dollar mistake. I have accrued 250,000 dollars of student loan debt over the past four years. Although I have lived frugally, survived on Ramen, and enjoyed a 1/3 tuition remission scholarship – it adds up. These for profit schools have no qualm in selling their worthless degrees (http://www.washingtonpost.com/news/get-there/wp/2015/07/09/these-20-schools-are-responsible-for-a-fifth-of-all-graduate-school-debt/) If instead I had worked a 50,000/yr job with my bachelors degree, I would have earned 250,000 dollars over the past 5 years. So far that’s half a million in net losses. If I had studied at a U.S. medical school, my career opportunities would have truly been up to me and my merit as a student. However, since I attended a Caribbean school – my specialty and expected salary are concretely limited. The projected loss of income after one year of practice is 133,500, averaged among the specialties which Caribbean grads are most likely to go into (and the one I have been forced into) After 4 years of practice, my net losses will be more than 1 million dollars.

In the following posts, I will paint an accurate and objective picture of Caribbean medical schools. Drawing from personal experience and available data. (http://www.nrmp.org/match-data/main-residency-match-data/)

The selection system for post graduate medical training is rigged.

(http://www.theatlantic.com/health/archive/2014/11/doctors-with-borders-how-the-us-shuts-out-foreign-physicians/382723/)

(http://www.nejm.org/doi/full/10.1056/NEJMp1511707?query=TOC&&&)

Even if you beat the odds, perform phenomenal during medical school – match into a residency program – survive without developing crushing depression and contemplate suicide. Your massive student loan debt and, more than likely, meager primary care physician salary will be waiting to remind you of the mistake you made.

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