Accreditor shopping and a race to the bottom for Caribbean medical schools

For-profit, English-speaking Caribbean medical schools have enrolled thousands of U.S. citizens over the past fifty years. Successful graduates have gone on to make substantial contributions to the U.S. physician workforce. Unknown, however, is how many students have enrolled only to not complete their programs and been left with debt and no degree. The U.S. 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 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 2025, there were 6 WFME-recognized accreditors operating in the Caribbean; two located in the Caribbean, the others based in Ireland, Netherlands, Kazakhstan, and Kyrgyzstan. There is evidence that some schools are avoiding stringent standards by switching to more favorable terms with another accreditor. There is also evidence that accreditors have tolerated high rates of attrition and student debt among accredited schools. The Caribbean market challenges the traditional assumptions that medical schools’ primary purpose is to produce a physician workforce for their national population and accreditors serve that same public by monitoring school quality. However, incentives in the Caribbean suggest that schools primarily are a source of foreign income for their governments and accreditors may serve school interests. Without reform, the persistent lack of effective regulation in the Caribbean leaves medical students vulnerable to the motivations of profit-oriented medical schools.