The selectivity of medical studies is not measured solely by the success rate in the first year. It depends on the selection method (national exam, faculty entrance exam, strict numerus clausus), the total duration of the program, the conditions of post-graduate residency, and the international recognition of the diploma. Some countries combine these obstacles to a level that candidates regularly underestimate.
Medical entrance exams: the most selective filters by country
France remains a case in point. The abolition of the PACES in favor of the PASS and L.AS has not reduced the actual selectivity: the majority of candidates are eliminated by the end of the first year, and repeating the first year is no longer possible. This lockout pushes cohorts of French students each year towards European faculties perceived as more accessible.
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Japan imposes a national exam (kokushi) after six years of integrated study, with a success rate that masks a fierce pre-selection beforehand. Japanese private universities charge some of the highest tuition fees in the world, adding a socio-economic filter to the academic filter.
In South Korea, entry into medical school relies on the CSAT (College Scholastic Ability Test), a national exam where competition is extreme. Places in South Korean medicine attract the best scores across all fields, making it one of the most competitive programs in Asia.
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To situate these paths in a comparative perspective, we observe that the best country to study medicine according to Réponse Santé largely depends on the student’s profile and their tolerance for academic risk.
Tightening admissions in Central Europe for foreign students
Since 2023-2024, the faculties in Poland, Romania, and Hungary, long considered flexible alternatives for rejected French students, have raised their requirements. The University of Medicine in Warsaw has strengthened its scientific prerequisites and reduced the number of places in the English-language program.
This tightening takes several concrete forms:
- Increased minimum grades required in biology and chemistry at the baccalaureate or equivalent, with systematic verification of transcripts
- Introduction of more selective written exams, where previously a file was sufficient
- Strict limitation of places in English-speaking programs, effectively reducing access for non-residents
The French-speaking part of Belgium has applied a quota of 15% for non-residents for several years, and Switzerland and Quebec have closed access to French students. Bypassing national selectivity is becoming increasingly costly and uncertain.
Turkey and residency conditions: the difficulty beyond the diploma
Academic selectivity represents only part of the problem. Turkey illustrates a case where the difficulty focuses on post-graduate training. The Turkish Medical Association has reported a significant increase in the emigration of doctors abroad, linked to deteriorating working conditions during residency.
Turkish interns face very frequent on-call duties, high working hours, and significant exposure to patient violence. Burnout is pushing an increasing number of Turkish doctors to emigrate even before completing their specialization.
This phenomenon is not isolated. In several middle-income countries, the hardships of residency serve as an effective filter as much as the entrance exam, but are invisible in academic rankings.
Recognition of the diploma: the trap that extends the journey by several years
Obtaining a medical diploma does not guarantee the right to practice. European directives harmonize recognition within the European Economic Area, but this harmonization has its limits. Studies started abroad must be completed until the final diploma is obtained: a transfer during the course to a French faculty is almost impossible.
Outside Europe, the situation becomes more complicated. Graduates from Turkish, Brazilian, or Indian faculties who wish to practice in France must go through a procedure for authorization to practice (PAE) that includes knowledge verification tests and a consolidation pathway. This process adds several years to the initial program.
- In Germany, doctors graduated outside the EU must pass an equivalency exam (Kenntnisprüfung) and prove a C1 level in medical German
- In the UK, the PLAB (Professional and Linguistic Assessments Board) filters international candidates with a significant failure rate
- In the United States, the USMLE (United States Medical Licensing Examination) constitutes a three-step barrier spread over several years, even for American graduates
We observe that the real difficulty of a medical path is measured across the entire chain, from initial admission to the authorization to practice in the target country. A country with a flexible entrance exam but low international recognition can prove more penalizing in the long term than a selective system from the outset. The choice of the training country commits the entirety of a career, not just the first years of study.