How Many Medical Schools Does a Country Need? A Global Framework Applied to Libya

Abstract

Medical schools play a crucial role in training competent physicians to meet a nation's health care needs. However, establishing and maintaining medical schools requires significant investment, strategic planning, and a careful balance between quantity and quality. This review explores four key questions: (1) Who needs a medical school? (2) What criteria should guide the establishment of new medical schools? (3) How can the optimal number of medical schools for a country be determined? (4) How can nations balance expansion with quality assurance to prevent an oversupply of substandard institutions?

Using Libya as a case study, this article examines the rapid proliferation of medical schools in a developing nation with unique socioeconomic and political challenges. Libya's medical education system has grown from two schools in the 1970s to 17 today, yet this expansion has not been matched by proportional increases in faculty, clinical training capacity, or educational quality. Political interference, deregulated admissions, and lack of oversight have led to declining standards, with pass rates as low as 50% in some institutions. The Libyan case highlights broader issues faced by low- and middle-income countries (LMICs), where unplanned expansion of medical schools often results in poorly trained graduates, limited job opportunities, and brain drain.

The World Federation for Medical Education provides a framework of seven criteria for establishing new medical schools, emphasizing the need for adequate faculty, clinical training facilities, sustainable funding, and alignment with national health care demands. Applying these criteria could help LMICs avoid the pitfalls of unregulated growth. Recommendations for Libya and similar contexts include: (1) immediate actions: a moratorium on new medical schools and strict accreditation audits, (2) medium-term strategies: faculty development programs, partnerships with international institutions, and curriculum reforms, and (3) long-term solutions: national licensing exams, consolidation of underperforming schools, and policies to align medical education with workforce needs.

The review underscores that while medical schools are essential for health care development, their establishment must be guided by evidence-based planning rather than political or emotional motivations. Uncontrolled expansion risks producing inadequately trained doctors, eroding public trust, and wasting resources. Conversely, strategic development—balancing access with quality—can strengthen health care systems, improve education standards, and ensure sustainable physician supply.

Keywords

undergraduate medical education - medical schools - developing countries - Libya - WFME criteria - quality assurance - health care workforce needs

Authors' contribution

S.A.B. proposed the idea, collected the data, and wrote the first draft. H.T.S.B. contributed to the concept development and revised the draft. Both authors jointly further developed the manuscript and agreed its final version.

Publication History

Received: 25 March 2025

Accepted: 06 May 2025

Article published online:
10 July 2025

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