Foreign medical schools remain a viable option for Americans who are unable to secure a place in a U.S. school. Certainly, the academic competition for a spot in a U.S. school is intense now, just as it was years ago.
A significant number of people who truly want to become physicians, if denied a place in the States or in Canada, will seek out an alternative pathway.
Schools in Mexico, the Caribbean and Europe are often open to Americans who meet their requirements for admission. As many of these schools are 6 or 7 year programs that combine both pre-med and med school courses in their curricula, North American students generally are accepted with little trouble.
However, this "open door policy" does not guarantee the student a degree. In general, foreign schools are less supportive of the student who is having difficulty mastering the material; "sink or swim" might be an appropriate motto for many of these schools.
Students who do well, assuming they pass the USMLE steps 1 & 2 and then obtain an ECFMG certificate (for more detailed info, see: http://www.ecfmg.org
), will usually be able to get a spot in an ACGME-accredited Internship or Residency program somewhere in North America.
At that point, the alternative pathway converges with the traditional pathway, and with successful completion of the training program the foreign educated physician is able to practice with the same rights and privileges as his or her North American educated colleague.