Best Of USMLE Forums and SDN Forums: How To Match as an International Medical School Graduate (IMG) or Foreign Medical School Graduate (FMG)

David and I are a huge fans of USMLE Forums and SDN Forums they are a great resource on how do one can match as an international medical school graduate.  We are regular contributors on both sites.  We post questions and comments regularly.  David and I have learned a lot from these forums.  In this post, we are going to distill the BEST of the BEST from USMLE Forums and SDN Forums to answer this single question:

How do I match as an international medical school graduate (IMG)?

If you are an international medical school graduate (IMG) or a foreign medical school graduate (FMG), you already know you face an uphill battle.  American residency programs prefer medical students that graduate from American medical schools.  In fact, according to the National Residency Match Program (NRMP) statistics, only half of all residency programs consider IMGs or FMGs.

"Did you pass USMLE Step 1, Step 2 CK, Step 2 CS and Step 3 in one try?"

Step 1 - Pick a Target Specialty

You have to pick a reasonable speciality to match into.  The most competitive specialities in the United States have their pick of top American medical school graduates.  As an IMG or FMG, we don't recommend trying to match in a competitive field like Dermatology or Plastic Surgery.  The chances are very slim unless you are in a very special situation such as prior PhD in the field completed at the institution.
From the NRMP, we know that there are certain fields that represent the best chance for a match.  Internal Medicine and Pediatrics are the best options.  They have the most spots.  The match percentage are favorable.  Neurology and General Surgery are also other options.  Although there is a small chance for other fields like Radiology, Anesthesiology and Pathology, you have to realize that there are a LOT less spots in these fields for IMGs.  We suspect that the IMGs that DO match in these fields have practiced in these areas before coming to the United States or completed extensive observer-ships in the specific area.

Many IMGs apply in Family Medicine but only 33% match.  If you look at the data from the NRMP your best shot in matching in a field with the MOST spots comes down to Internal Medicine and Pediatrics.

Step 2 - Are You Competitive? USMLE Scores and Beyond.

David and I can be fairly certain without ever reading your personal statement about your chances to match.  The data is pretty straightforward.  If you answer, YES to the following questions then you stand a great chance to match.

2.  Did you score higher than a 217 on USMLE Step 1?

3. Did you score higher than a 224 on USMLE Step 2 CK?

4.  Did you graduate from  medical school less than 2 years ago?

Here's what your scores mean

A score of 4 means you have a better than 50% chance to match.  If you scored ABOVE 240 on USMLE Step 1 and USMLE Step 2 CK, you SHOULD match.  You would be in the top 25% of all IMG candidates.  You will also likely have a choice of several programs.  If you are in this group, then the interview becomes the single most important way to match at the best program.

A score of 2 means you face a very uphill battle.  Your scores and application would put you in the bottom 25% of IMG applicants.  There should be something very special in your application that would help you. This includes a first author publication in a major journal or a letter of recommendation from a nationally recognized physician or mentor.

A score of 1 or less means the chances of you matching are low.  The main problem is that program directors are going to be concerned about your ability to practice clinical medicine.  The chances are not 0%.  Every year, someone matches with these scores and red flags.  Every situation is unique.  If you graduated medical school many years ago but have been working in clinical medicine ever since in a different country, you would be in a better position than someone who graduated the same year you did but have not spent the time since practicing.   We estimate you would be in the bottom 10% of potential candidates.  You would need something exceptional in your application to overcome these deficiencies but even then there is no guarantee.   We would strongly recommend you consider whether attempting to match in the United States is worthwhile in regards to cost and time if you are in this position.

Step 3 - American Based Clinical Experiences and Observorships

This is important because residency directors have to be sure you can work as a physician in the American health care system. When you graduate from a medical school in a foreign country, you have to demonstrate you are able to work as a U.S. physician.

This usually means getting used to the U.S. system. There is a more team-oriented approach with many different healthcare experts that go beyond just physicians and nurses. There is a greater emphasis on documentation everyday. This will usually involved various different kinds of electronic medical records. There will likely be more work related to ensuring patients receive the appropriate social services such as rehabilitation or visiting nurses.

There are a lot of different companies and hospitals that offer observorships for IMGs. They are not cheap. When picking an observorship, we suggest the following criteria.

1. Is it a respected hospital or institution? This is important as it adds credibility for your application.
2. Do they provide a promise that you will receive HANDS-ON experience? You need to be able to show you have direct experience working with patients in a U.S. hospital.
3. Do they provide a Letter of Recommendation afterwards? This is very important for your residency application. Just finishing an observorship is NOT enough. You have to have an attending physician be willing to write a letter of recommendation that advocates for you.
4. Is it long enough? We typically recommend an observorship that is at least 4 weeks long. This gives you enough time to learn how to operate in a U.S. hospital but also develop enough of a relationship with an attending in order to get you a solid letter.

We have a list of hospitals that are reputable which provide good letters of recommendation afterwards. These hospitals are also recognized by the Program Directors we have talked to.

Step 4 - Write a Strong Residency Personal Statement

If you get to this Step, you have done all the hard work. You have studied for the Steps and scored well. You have invested the time to get U.S. clinical experiences and collected strong letters. Writing a strong essay is very important to tell your story. It should be short but comprehensive. We recommend approximately 750 words in a format that includes:
A strong introductory paragraph that CAPTURES a reader's interest. Remember, there are thousands of essays before and behind your application. If your essay is not interesting in the first 3 sentences, it will be put aside.
Demonstrate your clinical background and explain why you will be a strong physician in the U.S. system
Provide details about why you are unique in regards to your research interests or volunteer interests. This helps set you apart from other candidates with similar scores as you.
Tie it back to why your characteristics and interests CONNECTS to the program's criteria
Our eBook has our inside tips on how to write a strong essay.

Step 5 - Write a Strong Resume on ERAS (Electronic Resume Application Service)

You cannot forget to also spend an equal amount of time filling out the resume section of the ERAS application as you did on your personal statement. This is a place where we see many candidates fall short on. Every experience, research job or hobby should be presented in the BEST possible light. This allows interviewers to quickly skim your application and walk away impressed with what you have done. Our eBook gives you insider tips on how to present your experiences in the BEST light possible.

Step 6 - Learn How to Interview Like an Expert

This is why David and I created RIQ. We saw so many amazing candidates work so hard for years and years only to fall short at the last step. We met and talked to IMGs who spent years in the lab and published important work. They had a ton of experience working in U.S. hospitals. When it came to match time, many opened their letters and were disappointed. They KNEW they were going to match SOMEWHERE. They fell short on WHERE they wanted to match. We know dozens of stories of top IMG candidates interview at strong University programs but ended up matching much lower on their rank list because their interview did not go the right way.

We can help you FIX that by showing you examples of perfect answers. You can watch the videos over and over again until you nail your own answer. Leave a comment with any questions. We are here to help.

All tables attributed to: National Resident Matching Program and Educational Commission for Foreign Medical Graduates. Charting Outcomes in the Match for International Medical Graduates, 2014. National Resident Matching Program and Educational Commission for Foreign Medical Graduates. 2014