WILLEMSTAD – The future of private medical schools on the Caribbean islands of the Kingdom of the Netherlands is under pressure following a significant policy shift by the Educational Commission for Foreign Medical Graduates (ECFMG) in the United States. By eliminating the requirement for foreign medical schools to be accredited, the ECFMG has removed a key incentive for these institutions to maintain international educational standards.
The change has major implications for several English-language “offshore” medical schools on Curaçao, Aruba, and Saba—institutions that primarily cater to international students aspiring to become physicians in the U.S. On Curaçao, this includes Avalon University and Saint Martinus University. Aruba is home to Xavier University, Aureus University, and the American University School of Medicine, while Saba University School of Medicine is one of the region’s most well-known programs.
Under previous ECFMG rules introduced in 2010, students had to graduate from an accredited medical school to be eligible for the U.S. licensing pathway. This requirement led many Caribbean institutions to invest heavily in quality improvements, curriculum reforms, and international evaluations. That pressure is now gone: as of 2024, graduates from non-accredited schools may once again apply for certification.
“A Skewed Playing Field”
A recent analysis from Avalon University warns that the policy reversal may not only stall quality improvements but also create a two-tier system, where under-regulated schools with minimal standards can continue operating unchecked.
“The playing field becomes skewed,” the report states, pointing to the rise of “cross-border accreditation,” where agencies from countries like Kazakhstan or Kyrgyzstan grant accreditations without stringent oversight.
While some institutions—such as Saba University and the American University of the Caribbean (AUC) in Sint Maarten—have built strong reputations and maintain rigorous academic standards, the quality of education across the region remains inconsistent. Complicating matters, Aruba and Curaçao lack a national accreditation system for medical schools, and government approvals for site visits often prioritize economic benefits over educational integrity.
A Vital Pipeline for U.S. Healthcare
Caribbean offshore medical schools supply a significant portion of the U.S. healthcare workforce—with over 20% of all foreign-trained physicians in the U.S. coming from the region. More than half of the graduates end up working in primary care, filling critical shortages in underserved communities.
The now-defunct accreditation requirement led to tangible improvements, including higher exam pass rates and more successful placements into U.S. residency programs.
Whether the schools can maintain their international appeal and credibility without this quality incentive remains to be seen.
“If the bar disappears, there’s a real risk of uncontrolled proliferation of low-quality schools that undermine confidence in the diploma,” the researchers conclude.
The coming years will determine whether the Caribbean’s offshore medical sector adapts to maintain standards—or slides into a fragmented market driven more by profit than professionalism.
