Accreditor Shopping and a Race to the Bottom for Caribbean Medical Schools

For-profit, English-speaking Caribbean medical schools have enrolled thousands of US citizens over the past 50 years. While successful graduates have gone on to make substantial contributions to the US physician workforce, many students have not completed their programs and instead been left with debt and no degree. The US government first attempted to regulate quality in Caribbean medical schools when it established the National Committee on Foreign Medical Education Accreditation in 1994, which led to the first medical school accreditor working in the Caribbean in 1995. Persistent concerns about quality prompted the Educational Commission for Foreign Medical Graduates to create a new requirement in 2010 to have accreditors evaluated by the World Federation for Medical Education (WFME) and "recognized" if they met WFME's criteria. As of 2026, six WFME-recognized accreditors were operating in the Caribbean; two located in the Caribbean, the others based in Ireland, Netherlands, Kazakhstan, and Kyrgyzstan. There is evidence that some schools have begun to avoid stringent standards by switching to more favorable terms offered by a different accreditor. There is also evidence that accreditors have tolerated high rates of attrition and student debt among accredited schools. The Caribbean medical education market has expanded beyond medical schools to include a market for accreditors. It challenges the traditional assumptions that medical schools' primary purpose is to produce a physician workforce for their national population and that accreditors serve public interests by monitoring school quality. Incentives in the Caribbean instead favor schools functioning primarily as a source of foreign income for their governments and encourage accreditors to cater to school interests. As the globalization of medical education and accreditation continues, the Caribbean market may serve as a cautionary tale, where ineffective regulation can leave medical students vulnerable to the motivations of profit-oriented medical schools.