5 Things US IMGs Should Know When Applying to Residency

United States International Medical Graduates, or US IMGs, are citizens of the USA who have completed their medical school education at an international medical school. According to the NRMP, 4,863 US IMGs entered the match in 2023, with 3,441 matched. Over the past several years, the rate of successfully matched US IMGs has been steadily going up, reaching 67.6% in 2023. These incredibly promising results justify 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 (93.7%). 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 for residency. To be fully prepared, we recommend taking a look at our residency application timeline as well.



Your Step 2 CK Scores Matter


There is no other way around it: US IMGs who successfully match have higher scores than those who don’t. According to the biannual NRMP charting outcomes, in 2022, 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 now being a pass-fail scoring system, we will likely see Step 2 CK becoming a primary point of interest for residency programs. 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!



Your Application Matters More


The reality is that US residency programs will 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, that applicant is at a disadvantage. 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. This includs 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. Watch out IMG residency roundtable recorded session for more tips.




While this data may fluctuate year to year based on the specific interests of applicants, this has been the case for several years. Knowing where most US IMGs have historically matched is incredibly important in helping future applicants find homes in US residencies. In 2023, the majority of successfully matched US IMGs were in Internal Medicine categorical positions (34.8%) or Family Medicine (23%). The next most popular matched specialties were Emergency Medicine (8.4%), Pediatrics (6.5%), and Psychiatry (5.9%).


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 likely 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. That being said, you should have a “Plan B”. Specifically, those applying to more competitive fields should strongly consider applying to a backup specialty amongst those with higher US IMG match percentages.



Know Your Residency Programs


There may be very different rules and restrictions at the residency programs you are applying to. This is particularly true with regard 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. Know the rules in all the states that you might be working in. For more information, check out the IMG toolkit page 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 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 2024 cycle and perhaps for years to come, more programs may conduct virtual residency interviews. This will dramatically reduce the expected cost of travel for interviews and allow 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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