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My knowledge is first hand in the US, UK and France only.I. Organization of Medical EducationThe major difference starts with degree level: American medical degrees are Graduate or 2nd degree programs; European medical degrees are Undergraduate or 1st degree programs.Europeans can enter medical school earlier than N. Americans and graduate younger by an average of 3 or 4 years. This is a function of the academic curriculum and configuration of “streaming” that takes place earlier in Europe where the intellectual demands are more focused and competitive from a younger age.European earlier “streaming” in secondary school - early specialization and 2 year pre-University programs. From age 13 in many European nations, students choose a general stream (science, mathematics, humanities). The end of compulsory secondary education occurs after 4 or 5 years. At that point, those academically inclined (perhaps 25%-35%) pursue “Upper Level” education, usually administered in the same physical school; the other 65–75% would either start work, head to a vocational school or other training or apprentice program. These “pre University” grades/forms last at least 2 years in only 3 subjects. The academic curriculum approaches University level; the brightest finish by age 18 but many repeat until their grades are sufficient to age 19 or 20. There used to be intervening compulsory military service for some European males, or, internships/apprenticeship prior to University application - but that keeps changing.The result is that entry to medical school, on the surface, can be without a formal first university degree. I entered medical school at age 18, skipping Y1 of 5 years of medical school since I had studied biology and physics. In effect, I graduated at age 23 but with the UK medical degree of MBChB for “Bachelor of Medicine/Surgery” or MBBS in other Commonwealth systems. Yet, in terms of medical school training, it was equivalent to that of American students who first had to do a 4 year Bachelor’s program. In other words, medical graduates can be as young as 23 in Europe but often at least 26 in the US. After that, the specialization clinical programs are a function of available “posts” in public systems like in the UK; that means that very experienced European specialists may be at a rank below what their skill merits if the posts above are not vacated.However, specialist training in the US is often faster. At the end of the day, the average age of a fully accredited “specialist” would be similar on both sides of the Atlantic but with vastly different financial and work/life situations. The earlier entry into medical school in Europe is balanced with a longer trajectory to becoming a fully-fledged “specialist”. European Post graduate specialization is usually much longer than in N. America, sometimes double the time needed.European medical schools and health care systems are subsidized, with the implication that there may be a limited number of “posts” or slots for senior positions, so a UK doctor may take 8 years to move from House Physician/Surgeon to Consultant Surgeon, whereasan American doctor may do so in 4 to 6 years to be an “Attending Physician/Surgeon” or Board Certified Specialist.II. Financial Aspects and Configuration of Medical ProvisionFinancial Circumstances Dominates US Medical EducationPublic EU medical schools may be virtually “free” (a few thousand euros per year) to as much as GBP 20–40k in Britain for non-EU (soon non-UK) students.While the American doctor is paid perhaps 3–5 times more than a British doctor (gross), he/she starts out with perhaps $500k or more of debt (Bachelor 4 years, plus MD 4 years); in the private sector, he/she would also have much higher administration costs, malpractice insurance and also have 4 weeks fewer vacation than most European doctors.Administrative complexity and lack of coherent, consistent payor systems dominate US health care provision.Lack of Streamlined Payor systems inflate medical costs with the jumble of hundreds of private insurance payor systems in the US. In terms of an IT metaphor, EU health system can be as tied-down as Apple’s closed “universe” whereas there is more of an umbrella of overlapping US systems akin to Linux, Unix and other operating systems coexisting.Depending upon the EU nation, there may be a single or streamlined payor system; so, a solo practice would still be feasible if not highly lucrative.A US PCP (family doctor) would find it almost impossible to be in a solo practice as the hundreds of reference and claims processing variants from medical insurance would easily overwhelm a sole practitioner; so most PCPs are in group practices or employees of “Health Provider” companies. Apart from Medicare (a public health insurance policy at a Federal level), a typical medical clinic has more administrative staff than healthcare staff to deal with the hundreds of every changing variants of individual policies from dozens of insurance firms.Some US doctors have been so frustrated by the non-medical interference and tardiness of having every medical procedure and prescription influenced by private medical insurers that they refuse all insurance - save for Medicare (out of altruism). They either charge a cash fee or form cooperative groups that propose their own “plans”.III. The Pathway to becoming a fully independent specialist.The Admissions criteria vary from “grades only”, a mix of grades and CV and stratified systems (one part grades only, one part a mix and one part other criterion).France is unique in that anyone with an advanced high school diploma can enter 1st year, but, by design, only 10% of top grading get into the Y2 (numerus clausus by competition).Germany has stratified admissions, 20% based exclusive on grades, 60% on a mix of grades & CV and 20% influence by seniority.US schools vary by State and sector (public or State versus private). However, in the most selective programs (Harvard, Stanford, Yale, Dartmouth, Penn etc.), fewer than 5% of applicants gain entry, so academic scores may be all that differentiate candidates who all have a decent candidacy.In the UK, it used to be mainly purely on academic scores from the “Advanced Level General Certificate of Education” exams administered by London or Cambridge Universities (GCE “A”-Levels) in only three subjects for 2 years following obligatory education (GCE “O”-Levels).For over a decade, the number of medical training slots in the UK has been below a replacement rate, with vacancies filled by a combination of EU doctors and immigrants from Commonwealth nations (the Indian subcontinent, S. Africa mainly). In 2019, 1 in 8 healthcare professionals in the UK were foreign born and trained.With the closing off, unless GB negotiates otherwise, of access to the medical manpower from the EU, Britain would either have to expand a) medical schools or b) access to medical immigration; probably a mixture of the two. Maybe the expected influx of some 1 million Hong Kong people would include doctors to replace EU trained doctors who choose to leave the UK after 2020Curricula in the US tend to be 4 years, followed by clinical training in hospital (“residency”) or in the field (for PCPs). In the EU, the curricula tends to be 5 years, sometimes reduced to 4. The net result is that the age of first medical degree can be as young as 23 in the EU compared to 26 in the US; however, the actual ages tend to be older in the EU than 23 since many students either undergo voluntary preparatory education of 1–2 years, or have to make several attempts, or, male students have 1 year of compulsory military service.Assessment and Attrition during Medical Training. Assessments are a mix of group work, examinations, interviews and clinical evaluation. In general, once one gains admission into medical school, the students advance in a cohort with the vast majority graduating; only in France is there a tweak in that only 10% of those who enter 1st year get into 2nd year (the rest being also a cohort). As such, while grades were key to admission, they are not after admission. In my case, out of some 150 medical students, only two failed to graduate; one committed suicide in his last year and another suffered from endogenous depression.Academic or grades tend to be tougher in the EU simply as there are proportionately far more applicants than school training slots. In general, only the top 10% of academic or entry examination performers get accepted; even fewer for the top schools. There is the French exception, on paper, since there is no minimum grade requirement for 1st year medical school, BUT continuation to Y2 is subject to numerus clausus in that only the top 10% get into Y2; in effect, the French simply funnel students in but make the academic cut after 1 year - It’s extremely stressful. If you happen to be in a year with particularly bright performers, your passing “grade” would be higher than in a year with a less bright cohort!Traditional Grade 85/100 (left) versus Numerus Clausus to select only top 15%.IV. American Considerations in Attending EU Medical SchoolsEnglish language programs are also sometimes offered in Pre-Clinical education (theoretical) in several non-Anglophone nations (CZ, BG, HU, IT, LT) countries, but fluency of local language is expected at the time of clinical training.Outside of GB, IRL and Malta, instruction in English is a “niche” private sector offering - not a mainstream one. Although everyone learns to read, and perhaps write, English, that still means that verbal communication with patients and other personnel would NOT be in English outside of places where there is greater English literacy than in the US or UK! (NL, principally). Unlike the US, Europeans go to a private medical school when one’s grades are insufficient to get into the tougher public or State schools i.e. Those who pay tend be the less academically-performing candidates - almost the opposite to the US phenomenon where the private for-fee medical schools occupy the top ranks of medical research, clinical specialization, and reputation.Hungary offers an English-language medical program (although, it would be difficult to do clinical training in Hungary in English).Italy has a private school offering theoretical (pre-clinical) training in English; however, clinical training would be very difficult if one is not fluent in Italian.This is the case, outside Europe, with UAG (Guadalajara, Mexico) where preclinical instruction is given in English but clinical training would be with Hispanophone patients and staff.Private and public (at State level) medical schools in the US coexist; the key difference is that private schools tend to be more expensive. In the EU, most medical schools are public (national) but a few private universities exist, catering to foreign students in English, sometimes with clinical training arranged with hospitals in another language/country.In the US, the top tier tends to be dominated by private schools, although some State schools are also in the top 10–20.In Europe, there are no private schools, that usually are for foreign students, that are long-established or centers of excellence.Tuition and CostsUS tuition is generally much more costly than in the EU, especially with less financial aid available, and higher living costs.Financial aid, scholarships and loans are more available to American residents than to international students.US schools charge the same tuition regardless of the nationality of the studentState universities offer lower fees for in-State residents, the range of tuition is from $10–40k per year.Private schools, the range is from $35k-93k, with a median of $58kIn the US, some of the most prestigious private schools have large endowments that often mean that anyone who is admitted can have tuition subsidized by the school relative to their ability to pay.The cost of living must also be factored into account as it can vary from $15k-45k per year depending upon location and lifestyle.EU tuition varies from country to country but overall costs are usually much lower than in the US.Public schools are highly subsidized with some in Germany charging under €1k per annum. However, the average seems to be around €9000 per annum for nationals or EU citizens; depending upon the school:International students are charged much higher tuition; with the most expensive in the UK rising to around £35–45k per annum. This is also similar to the few private schools catering to international students. However, due to the insufficiency of numbers medical training posts, that means that the NHS has relied upon foreign MDs, principally from the EU (until January 2021’s Brexit), and from Commonwealth nations like S.Africa, or the Indic nations.Overall costs can be lower than in the US since urban transport is usually denser and subsidized: However, locations like Paris, London, Dublin, Geneva, Zurich and Scandinavia tend to have much higher accommodation costs - similar to Boston, NYC or SFO.V. Beyond Medical School - Differences in Medical Demographics, Admissions Criteria.Economic FrameworkIn Europe, most medical schools are state-funded, public institutions that are highly-subsidized. Medical graduates’ debt would largely be for living costs incurred.In the US, the most prestigious schools are private and have sky-high tuition ($35–93k per year in private schools; $10–40k in State or public schools). In addition, unless one is in a dense urban setting or content to live on campus, additional living costs may include a car (at least $7k per annum in the US).The American graduate may often end up with student debt accumulated for the 8 or 9 years of Bachelor and medical degrees. A Federal loan program is often available but it can mean $300k-$1 million of nearly a decade of no income apart from any part time job. This motivates American graduates to gravitate to the most lucrative specialties, rather than to the most needed ones, and, also, to the most remunerative regions and employers. The expansion of Obamacare to an additional 21 million Americans has placed enormous strains on the inadequate population of Primary Care Physicians (= GPs or FPs) who act as gatekeepers to specialist care.Instead of exploiting the education and experience of immigrant doctors into the US, the AMA and most State Medical Boards have pursued a professional protectionist accreditation system. Especially non-Anglophones would basically have to spend a year or more studying English and medical school coursework that they had not studied for a decade; THEN, Board accreditation would mean a chase for the “leftover” residency slots, often in “rural” and less popular regions.When you have a 40 year old ophthalmologist immigrant in the US, the prospect of two years to pass medical exams and then face the challenge of finding a suitable residency - most of which would be in Family Medicine or Internal Medicine, it means that experienced specialists and surgeons are effectively kept out of competing with US-trained doctors.However, in a bizarre turn of events, the severe shortage of PCPs has led to the creation of ersatz PCPs in the form of “Physician Assistants” (2 year program - no obligatory clinical training; supposedly always under an MD - but often abused) and “Nurse Practitioners” (nurses who pursue a 4 year Masters program) who have more independence than PAs in that they can work independently as PCPs and prescribe all except neuroleptics. So, the person in white coat at the clinic may have 2 to 4 years less medical training than the most junior of freshly minted immigrant doctor!Would you prefer to see a foreign oncologist with 15 years experience, or a “Physician’s Assistant” fresh out of 2 years’ education, or even an “Advanced Nurse Practioner” who has 4 years of training? If language is a problem, take an interpreter. Especially now, with the pandemic, it is such a waste to have perhaps thousands of experienced foreign MDs stuck doing some other work, and instead have pseudo family “doctors” with far less education and clinical exposure. Maybe the FMG should be better educated in spoken English than being obliged to basically re-do final year medical school, and then hospital training.Foreign Medical Education for Americans. Even Americans who attend foreign medical schools are disadvantaged if they try to subsequently integrate into the US medical training systems. Even if they handily pass the USMLE etc., some 50% of them are never “matched” with a residency of their choice and location, and they pursue some other profession. Their only advantage over foreign-born FMGs is that they don’t need a visa to work and stay.Medical Schools in large Anglophone nations. The UK, Ireland, Australia, NZ, India and South Africa. While tuition and language are most attractive, can you believe that academic competition is much higher than for the average US medical school? If you can’t get into Harvard or Columbia or Penn, it is highly unlikely that you would have the academic profile to get into UCL, Cambridge, Edinburgh, Sydney, New Delhi or Cape Town medical schools. Those schools are public and often there are insufficient number of training posts (particularly in Britain that may see 12% of its medical workforce leave after Brexit to return to the EU). On the other hand, although you would be in the same category as all other FMGs when it comes to residency, the pedigree of the UCL, Cambridge, Oxford, Imperial College London, Edinburgh, Melbourne, Sydney, Tropical SoM London may well give you a calling card in the US - particularly if you first arrange a “medical elective” in the city and hospital group of your choice between 3rd-4th or 4th/5th years. I did my medical elective in UCSF Moffitt Hospital and, had I wished to get residency, it was easy to sit and pass the ECFMG and USMLE when I was still in Medical School in the UK; there was also no language barrier with patients (especially as I could converse in Spanish for Hispanophone patients).Anglophone Island Schools- Limited Clinical Program. Americans who choose an “off shore” medical education are viewed as “less academically performing” since they were not accepted into US schools. In some ways, the handicap is not “intelligence” but lack of challenging medical cases. The medical school in the tiny Caribbean islands (Grenada, Sint Marteen, Saba) just don’t have much tertiary medical infrastructure or patients.Non-Anglophone Big city Schools with English Programs - Make sure US Pathway to Residencies after Y4. Any international public school would have competition as intense as top private universities in the US. However, the great advantage would be low cost if you can choose say between Harvard and Karolinska Institute or Heidelberg. Only private medical schools with a reserved quota for international students would be readily accessible. Americans may also attend a medical program in a larger, urban setting with decent tertiary medical infrastructure in English, but they cannot really get adequate clinical training unless they fluently speak the language of locals past 4th year (when clinical training begins). These are not top ranked schools but you don’t have to be “genius level” to make a good GP, PCP. one should have great diligence and a good heart for the well-being of others.The best-known programs include that at the UAG (Guadalajara, Mexico), the 2nd largest Mexican city.In W. Europe, there are two Italian medical schools with formal teaching in English, the excellent (but very competitive and limited to GP training) La Sapienza University (Rome) better known for Art, Archaeology and History; I understand that the University of Navarra (Spain) also has a medical program mostly in English.A slew of Eastern European schools also offer medical pre-clinical training in English. Budapest’s Semmelweis is an old school that offers an English program. However, check if they have any streamlined pathway to USMLE and US residency arrangements if your intention is to work in the US.In Asia, Khalifa Univeristy in Abu Dhabi is private school founded recently but not particularly affordable. In addition, a few dozen Chinese medical schools have opened their doors to non-Chinese students including the oldest Western Medicine school in China, Sun-Yat-Sen in Guangzhou province. Tuition in the PRC would be much more reasonable (some $6k-$10k per year). Again, make sure that you either have a ready pathway to US Residencies or are already fluent in local language and content in remaining.Supply and Demand of MDs. Shortage of GPs in the US, of specialists in the EU.In the US, there is a high desire to specialize, partly as medical graduates have accumulated some 8 years of tuition and living cost debt, that can easily reach $500k. Extreme shortage of PCP/GPs in USA, ever since Obamacare added nearly 20 million more Americans as “Patients”In the EU, there are proportionately fewer slots for specialist training, and even fewer in the public health systems as head specialist, leading to long periods in a junior position. As a result, there are shortages of specialists, notably in ophthalmology and some types of surgery.MD Protectionism - Immigrationin the US. Instead of facilitating the process of foreign medical immigration to the US to meet the enormous shortage of GP/FP/PCPs that medical regulators have taken the short-sighted corner-cutting policy of allowing “Nurse Practitioners” (nurses with a Masters of 4 years) who can act as GPs, including prescribing, and “Physician Assistants” (with only 2 years training but who must work under the supervision of an MD) attempting to fill those roles. It’s misguided. It’s counter-productive since the FMG would be able to fill the extreme shortage of “gatekeeper” PCPs in the US, whereas American MDs are more likely to be in specialist programs.in the EU, there is mutual acceptance of EU degrees but each country may have specific requirement for Board registration; in reality, EU-trained doctors can work anywhere in the EU. After Brexit, Britain’s medical staff shortages will jump, as EU doctors would no longer be free to work in the UK, and vice versa masked its chronic under-funding of medical education since about 12–18% of NHS doctors are foreign-trained, most of whom are EU citizens. However, it may also have caused shortages in parts of Europe with a brain drain from East to West. While northern Europeans tend to speak excellent English, Europeans from other countries may have to either choose non-clinical careers or go to the effort of gaining fluency in English.Discriminatory Admissions Criteria at some Private US schools EU schools place most emphasis on academic grades with a few exceptions. They have strict EU non-discriminatory admissions criteria. However, the lack of national guidelines on admission criteria, especially in private schools has a highly variable influence on non-academic factors.“Affirmative Action” Formalized Pro-Black Discrimination Social engineering “reverse” discrimination of Blacks to encourage “minorities” (=Blacks in US parlance; the term usually does not refer to numerical minorities like Asians, gays, deaf etc.) also plays a variable role in the US where there are even “traditionally Black” universities (Itself a most inegalitarian/racist concept); I had a French friend who did his post-doc at Howard, completely unaware of its predominantly “Black” reputation - He and a Pole were the only two White faces in their section (but both had a great experience, once the others realized they were foreign!)Influence, Money and Fame. US private medical schools are NOT egalitarian and can be unabashedly “discriminatory” in a positive or negative sense. A wealthy donor parent or a prominent personality explain why some Bushes and Trumps gain access to school where they are surrounded by far more academically accomplished students. The fact that DT was able to attend (although he was mostly absent) Penn for an economics Undergrad (i.e. probably NOT Wharton, NOT an MBA, although the faculty may have overlapped), has tarnished Penn’s reputation somewhat.Unofficial “Anti-Asian Discrimination” Some schools have an unspoken bias against Asians (ironically, a numerical “minority” in the US) against a backdrop of a much higher proportion of students of Asian origin than in the general State population.On closer examination, it may be that recent immigrant “Asians” perform better than average as they are often offspring from the most skilled immigrants . This has come about as a result of recent changes in immigration policies from accepting almost anyone from Europe from the late 19th to mid 20th Century (no money, no education, not English speaking) to screen for wealthier, more educated profile of immigrants. So, barring family-sponsored, undocumented and refugee immigrants, latter 20th Century immigrants to the US had to be of higher socio-economic profile that the average American.Since the majority of the world’s population is “Asian”, most qualified immigrants are Asian (Indian, West, Central, Southeast and East Asian) immigrants simply as a result of statistics, 27% of humans are of Indian subcontinental origin and 22% are of East Asian origin, if one adds South-east and Central Asians, the total approaches 60% of humanity.This is supported by examining the immigrant background of prominent “minority” Americans.Leading “Black” politicians are offspring of one or more Black immigrant parents who arrived educated: Barak Obama (Kenyan father was PhD), Senator Kamala Harris (Jamaican father was Economics Professor at Stanford, Indian mother was PhD cancer researcher!), Dr. Wayne Frederick, President of Howard University (a real-life Doogie Howser MD, immigrated from Trinidad to enter a joint BS/MD program at age 16 at Howard, completing it by age 22 as MD!).Past Governor Nikki Haley (née Nimrata Randhawa) was born to Indian (Punjabi) immigrants, her father being a PhD Professor in South Carolina. I just wish she would stop with the whitening skin treatments and electronic lighteners.Then, a highly disproportionate number of prominent Hispanics are offspring of Cuban immigrants (Senator Marco Rubio, Senator Robert Menendez, Senator Ted Cruz, Andy Garcia, Gloria Esteban, Eva Mendes, Cameron Diaz); yet, Cuba is a nation of just over 10 million! Cuban Americans are around 500k versus a total of some 55 million Hispanic Americans, mostly of Meso-american origin and based mostly in the southwestern USA. However, unlike most refugee immigrants, it was the better educated, better-to-do Cubans who dominated the immigrant wave from Cuba to the USA as of 1960.