We all heard the announcement: the bastion of computer science and engineering in Canada is finally pivoting to get its slice of the pre-medical student pie. Starting in September 2026, Waterloo will launch its new streamlined Honours Bachelor of Medical Science, which will enable students to obtain an MD from St. George’s University, a medical school located in the Caribbean. This path will not require students to take the MCAT, and it’s also a shortened timeline: five or six years as opposed to the eight total years (four years of undergraduate and four years of graduate medical studies) that most Canadian students must undergo to become a doctor. Even with all of this, however, the proselytizing of the program’s proponents doesn’t stop there. This innovative program is uniquely designed for the purpose of addressing the acute doctor shortage that Canada is facing by lowering the barrier of entry and the training time of physicians. Canada gets more doctors, more people can achieve their dreams of becoming doctors. Overall, it’s a win-win for everyone involved.
But as Topwix_MD says on r/premedcanada, “All parties involved here knew this isn’t about addressing the shortage, framing it as such and advertising it like that is just a game of pretend.” I echo this sentiment. I, myself, am a current medical student, and frankly, I’m disappointed with my alma mater. The time that one spends in their required 3-4 years of undergraduate studies before they even apply to medical school is one of the most stressful periods in their journey. The uncertainty, the second-guessing, and the fear of getting left behind are common feelings among all those wishing to don the white coat. It’s a vulnerable time for many, and it leaves a lot of students grasping for whatever chance they can get to walk through a hospital’s hallowed halls.
This is why this program, with a ~600k CAD price tag for the five or six years, that is made expressly for these scared and anxious prospective high school students and mid-career undergraduates, looks to be ill-advised at best and predatory at worst.
My main qualm with this program is not concerning its education: it is concerning its failure to provide matriculants with the information that they will have extreme difficulty in coming back to Canada to practice medicine. It is well known that Caribbean medical schools are not the best option for many applicants. While it may be easy for those too afraid to apply for Canadian medical schools to send an application to any institution in the sunshine isles for a guaranteed seat in a school and a shot at a medical doctorate, the reality is less rosy.
On the Student Doctor Network, for instance, one user states that “The point isn’t that there [aren’t] successful Carib grads. The point is how many additional obstacles to success you face by going to a Carib school,” says one user. “It’s a setup for failure. The match rate into a residency is very low. And now with Step 1 being a pass fail exam it is gonna be even tougher to secure a residency spot. Also there are more US med schools now which will make it even harder to match from an offshore medical school. My advice is up the GPA and MCAT and get into a U.S. medical school,” says another.
While these comments are focused on a U.S. context, Canadian students face the same, if not worse, challenges. “But they’ll become doctors!” You say. “It’s an investment to make the big bucks later down the line!” Therein lies the rub. Imagine paying all of this tuition, working hard to pass a rigorous curriculum, only to find out there are no spots available for you to train as a resident physician in the place you were born. For context, residency is the period after medical school during which MD graduates practise for anywhere between two to five years to become licensed as a practising physician. This is something that cannot be circumvented. No residency, no practice, no big bucks. For Canadian grads, this is no problem. As per the Canadian Resident Matching Service (CaRMs), more than 95 per cent of graduating students from Canadian schools in any given year will match into a residency and be able to move on to the next step of their medical training.
For international medical graduates (IMGs), the situation is vastly different. There is a huge disparity between reserved residency spots for IMGs and the number that apply every year. It’s often even difficult to get an interview — you’re often competing with practising physicians from other countries who immigrated to Canada, previous unmatched graduates, and many other highly, highly qualified applicants for very few spots. The 2020-2024 match rate for Caribbean graduates hovered between 22 to 35 per cent, and given the fact that most IMG residencies are for family medicine, it is likely that those who matched went on to become family physicians.
Now, how bad it is to be unmatched depends on a lot of factors, but a lot of these factors are working against Caribbean grads. The only thing you can really do to tide yourself over is to work part-time at any job that can take you and let the interest accumulate on the hundreds of thousands of dollars of debt you have found yourself with as you wait for the next cycle of CaRMs to roll around to do it all over again (with a 22 to 35 per cent shot, don’t forget!). Is this the path we’re encouraging our future physicians to take? Is this really the best we can do for our students?
I want to warn many of you that this match rate is not something you can ignore because “you are hard working.” You are beholden to the cruel calculus of compounding interest, and every year you go unmatched is potentially hundreds of thousands in lost income, along with tens of thousands of dollars in interest. I want to warn prospective applicants again: this is generational debt you are risking. Let me put this into perspective.
Let’s assume you practice in Ontario as a family doctor. Your salary, on average, is $310,000. After overhead costs (your clinic, your licensing fees, etc…), that goes down to around $250,000 on the upper end. After income tax, that goes down further to around $155,000 (calculated from here). For argument’s sake, let’s say you spend 50 per cent of your total income just on loan repayment at a 5 per cent interest rate. At the very least, assuming ideal conditions, no emergencies, and no unemployment, it will take a decade to pay off your loans. For most applicants, this will be more than half the length of time they have been alive. That is a quarter of most people’s professional career spent paying off debt.
This is not to bash Caribbean medical schools — one of my mentors graduated from there and now owns a highly successful family practice in my community. The education there is accredited, and there are undoubtedly great doctors who are alumni from these schools. What I wish to do by writing this article is to be honest with applicants about the financial burden they are incurring, because these programs will not be. I am speaking against the system that is pigeon-holing high school students into an international medical school before they even have a shot at trying to learn medicine in the country they call home, the system that is deceiving them about the ease of this path. If we want to fix the family doctor shortage, lobby for more hospitals, for more residency spots, for better physician compensation and incentives. There are so many other things the university could do, and I wish it could’ve taken the initiative on those instead of gouging student coffers for its bottom line.
