This is a big fork in the road for you as you are looking at two completely different careers and lifestyles. With the Caribbean you risk getting $100Ks in debt, wasting at least 4 years of your life, opportunity costs, self-esteem. With PA you run the risk of being dissatisfied with your work and having regrets later in life about not pursuing an MD.
But lets take a step back. Your post makes me concerned about your dedication to either field. First of all, if you are worried that you'll have to "study alot" then medicine (and to a lesser extent PA) are off the table. If you go into medicine and want to be anywhere close to competent you'll need to study ALOT. You'll study to pass USMLE/boards, to learn concepts, to understand patients etc. I'm guessing that you applied to and were rejected by US medical schools. ***Most important*** If you believe a large part of why you got rejected from US med schools is because of difficulty with handling academic performance, think long and hard about how well you'll do studying medicine in the Caribbean with x4 times the work of undergrad.
I couldn't tell from your post whether you were taking comfort in the fact that you planned to apply to a less competitive residency. Let me just say that if you apply as a Caribbean medical student, realize that the concept of a 'less competitive' (i.e. backup) residency does not apply to you. At least half of your class will not match and that's if you go to one of the better Caribbean schools. Did they all just happen to apply to a neurosurgery? Think about that but my guess is no.
I think being a midlevel can be a rewarding career if you go into it for the right reasons and have the right expectations. Despite efforts by professional societies to blur lines between physicians and midlevels, a midlevel will never be a doctor. You won't earn as much, know as much, or have an MD/DO after your name. Can you handle that? I can't. If I couldn't be a doctor I would consider law, business, or teaching. Failing to get into medical school then 'settling' for a job as a midlevel or RN would eat at me forever. I know myself too well to be that cruel. That said, many of the midlevels I know are well adjusted, love their jobs, and see their families a lot more often than I do. They often earned 2-3 times what I made as a resident too.
In summary, I can't recommend Caribbean to anyone who wants to do medicine and I can't recommend medicine to anyone who isn't absolutely sure it's for them.
Depending on your financial situation and where you are in your life you can consider taking a year or two off to do something productive and think about it.
