The contribution of Caribbean medical schools to the U.S. physician workforce

Abstract Purpose The physician shortfall in the U.S. has given rise to increasing reliance on international medical school graduates (IMGs), including those graduating from what are referred to as off-shore Caribbean medical schools. These schools, which offer instruction in English, draw primarily on U.S. and Canadian citizens while affording students clinical training opportunities in the U.S. The purpose of the present study was to characterize the magnitude and nature of the contribution being made by Caribbean medical schools to the U.S. physician workforce. Method Off-shore Caribbean medical schools were identified based on the aforementioned characteristics as provided by several sources, including schools’ websites. Residency training data from 2013 to 2023 for off-shore Caribbean medical school graduates (CMGs), U.S. and Canadian medical school graduates (USMGs), and other IMGs were provided by the Accreditation Council for Graduate Medical Education. Medical licensure and physician demographic data were provided by the Federation of State Medical Boards. Results CMGs pursued training in family medicine at a rate more than double that of USMGs and other IMGs. Licensure data showed a contribution of CMGs to the U.S. physician workforce that went from 33 CMGs first licensed in the U.S. in 1980 to 2,768 in 2024. By 2024, a total of 49,256 CMGs held a medical license, comprising 5% of licensed U.S. physicians. CMGs holding licenses in 2024 were younger (44.1 years old) than USMGs (51.5 years old) or other IMGs (55.2 years old). The proportion of CMGs certified in family medicine was more than twice that of USMGs and other IMGs. Conclusions Off-shore Caribbean medical schools are making a substantial and growing contribution to the U.S. physician workforce that is disproportionately in the primary care arena. Given the magnitude of this contribution, enhancing accreditation-mandated transparency around student outcomes could inform policy development relating to these schools.