Roughly 80% of secondary students in Macau graduate from Chinese medium of instruction (MOI) classrooms to find themselves in tertiary (i.e., higher) education environments that are predominantly English MOI institutions. This situation has presented unusual challenges to university educators working within the EMI tertiary institutions in Macau, and it has posed a potential threat to the viability of English as the MOI within Macau universities. The number of English speakers within the university-aged population has increased dramatically during the past twenty years since Macau’s 1999 handover to Chinese administration, and the number of residents who hold tertiary degrees—especially tertiary degrees from local Macau universities—has also increased significantly. Nevertheless, each of Macau’s public and private institutions face a similar conundrum: whether to focus on local students and local needs for education (and, thereby, limit the possible growth of the institution), or to focus on growing the institution by recruiting students from China (but, thereby, isolating the institution from the local community). Although public institutions are required by the Macau government to foreground local needs in their admissions, private institutions don’t face these restrictions. Consequently, the choice to focus on growth rather than local needs may pressure institutions to eventually abandon EMI education in favour of Chinese.