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5 Things US IMGs Should Know When Applying to Residency

9 min


A group of US IMGs after applying to residency


United States International Medical Graduates, or US IMGs, are citizens of the USA who are completing their medical school education at an international medical school. According to the NRMP, 5,167 US IMGs entered the match in 2020, up nearly 2% from the year prior, with a record-high match rate of 61%. Over the past 5 years, the rate of successfully matched US IMGs has jumped by over 7%. This incredibly promising results justifies the increasing optimism that US IMGs should bring into the match. With that in mind, this match rate still lags far behind the rate for US seniors (94%), so it is essential that US IMGs enter the match informed and prepared to maximize their chances of success. We will review the 5 things that every US IMG should know when applying to residency.


Your Scores Matter

There is no other way around it: US IMGs who successfully match have higher scores than those who don’t. In 2020, the average USMLE Step 1 and Step 2 CK scores were 10 to 11 points higher for US IMGs who successfully matched. With Step 1 moving to a pass-fail scoring system, this simply increases the importance of scoring well on Step 2 CK. If you are studying now and are concerned about your scores, reach out to our team at EMP and consider working with one of our professional tutors!


More US IMGs Match in Internal and Family Medicine

While this data my fluctuate year to year based on the specific interests of applicants, knowing where most US IMGs have historically matched is incredibly important in helping future applicants find homes in US residencies. In 2020, the majority of successfully matched US IMGs were in Internal Medicine categorical positions (36%) or Family Medicine (25%). The next most popular matched specialties were Pediatrics (7%), Psychiatry (5%), and Emergency Medicine (5%). Of note, of the students matching into Pathology, over 65% were not US MD seniors, a trend that has been noted annually. In terms of match rate success, the fields with the highest percentage of successfully matched applicants were Pediatrics (68%), Pathology (68%), and Neurology (68%). If these are the fields in which you intend to apply, you are starting in an advantageous position; specialties that tend to match more US IMGs will continue to do so. If you are interested in other fields, such as OB/Gyn, Anesthesia, or General Surgery, there is certainly still hope for your application, but you should have a “Plan B”. Specifically, those applying into more competitive fields should strongly consider applying to a back-up specialty amongst those with higher US IMG match percentages.


Your Application Matters More

The reality is that US residency programs will typically be more familiar with US medical school schools rather than international programs. That does not mean that graduates from highly-regarded international schools will be discounted, it simply implies that their chances of success may be lower. This is largely due to the fact that residency programs frequently use an applicant’s medical school as an initial determinant of the quality of the application. If the applicant comes from a school that has previously provided great residents, that applicant’s chances of success increase. If the applicant comes from a program the residency has not previously heard of or matched from, that applicant may not have the same advantage. With that in mind, the quality of the application matters much more in these circumstances. Step one is that you must take the time to complete all sections of the application fully, including awards, publications, and experiences. Step two is to construct a meaningful and unique personal statement (see our blog post on how residencies rank applicants for more information). Finally, it is imperative that you choose letter writers from within the field or fields to which you are applying. These letters should be from people who know you well, preferably from attendings who are either well-known internationally or known by decision-makers at residency programs.


Know Your Residency Programs

There may be very different rules and restrictions at the residency programs you are applying to, particularly with regards to licensing requirements. It is essential that you carefully review the application requirements at every program to ensure that you won’t have difficulties in obtaining a license. For example, although all state licensing agencies require IMGs to complete at least 1 year of accredited US or Canadian graduate medical school education, 12 states require 2 years and 25 states require 3 years, so know the rules in all the states that you might be working in. For more information, check out the Initial Licensure of U.S. Medical Graduates and International Medical Graduates document on the AMA website.


Apply to as Many Programs as You Can

The math is easy: the more programs you apply to, the greater your chances are of successfully matching. While we do not mean to downplay the tremendous cost of more applications, we recommend applying to as many programs as you can realistically manage financially. For those applying in the 2020 cycle and perhaps for years to come, more programs may conduct online interviews, dramatically reducing the expected cost of travel for interviews and allowing for more to be spent on applications.  In the end, it is always easier to decline an interview opportunity than it is to try to scramble to get more interview requests.


That’s all! I hope this post helped provide some insight into how programs rank residency applicants. If you are a US IMG and need additional help with your application, be sure to check out our residency matching services!


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About the Author

Michael Zobel, MD

Michael Zobel graduated Phi Beta Kappa and Magna Cum Laude from the University of Southern California as a member of the Baccalaureate/MD Program, with a…

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