IMGs Applying to Residency: What Happens When You Don’t Match?

This post is all about perspective. In the short term, the odds do not favor international medical graduates (IMGs) matching—94% of AMGs match compared to 60% of IMGs. That is a tough pill to swallow. It is heartbreaking.

In the long term, though? One in four physicians who practice in the United States are IMGs, according to the Association of American Medical Colleges. That is more encouraging.

If you’re an IMG who hasn’t matched or is worried about what to do if you don’t, you’ve come to the right blog post.

IMGs: Stay positive, take action

We’ll start with a helpful perspective: this is an opportunity to reinvent yourself. What is the best way to do this and match the following year? Here are some of the initial steps to take.

Diagnose the Problem

If the reason that you didn’t match doesn’t jump out to you right away, then ask a trusted friend from your school who has matched. Ask for honest feedback. Touch base with your mentor or sponsor.

Sometimes it is a low Step 2 CS or other sub par test score. Those cannot be changed. Sometimes, however, it is something that can be reconfigured.

Solve the pain points

If you applied to a field in which you are not competitive enough, consider the odds. According to recent data from the National Resident Matching Program (NRMP), the specialties in which IMGs are most likely to match include pathology, internal medicine, neurology, family medicine, and general surgery. Aim for those.

If it is a poor letter of recommendation, then apply for externship opportunities in the field you will be applying to next cycle. That way the letters will be more specific. If one is applying to radiology and a program director in family medicine reads a radiology letter, then he or she might discover that family medicine is a backup plan. Plan ahead for a relevant letter of recommendation next time around.

Is it lackluster interactions with patients and an inability to present information concisely? If that is the case, then take an externship and really hone in on those areas. Find a way to come early, stay late and watch how people present. Be proactive—early on, ask what you can do better in terms of presenting. Watch more experienced residents present. Mirror their tactics.

Other areas to hone in on are: clinical experience, publications, lack of networking contacts, interview skills, and your personal statement.

Stay Clinically Relevant

Email and call people. Ask if they need assistance doing research. Offer to be an MA or scribe. Apply for an externship or subinternship. This will keep your medical knowledge sharp, allow you to become more than the average applicant on paper, and demonstrate a commitment to your (possibly new) field. You could even get a publication or poster presentation.

Apply Smarter

It isn’t the number of programs you apply to, it is the likelihood that they will take you. That means you should figure out which states, programs and specialties people from your school have been accepted. New York, Michigan and Florida could be fertile grounds for continuing your career. Are rural programs a more likely option? These may include Oklahoma, North Dakota, and Nebraska.

Take advantage of the resources out there as you decide how to approach the next year or so, whether to change your specialty and what to change it to. You probably already know about MatchAResident which has an abundance of data and understanding for this purpose. IF YOU REQUIRE A VISA, MAKE SURE YOU ONLY APPLY TO PROGRAMS THAT ARE ABLE TO AND DO SPONSOR THE PROPER TYPE OF VISA NEEDED!

Every year, programs list how many spots were available and how many were matched, giving a good idea of areas where there is a need. Go to their website. What type of resident do they like? Research-focused? Well balanced? Diverse?

Find out who the PD is. Look him or her up and see about their research. Send them an email and make it personalized. And make a call. A phone call may further support that you are really interested in matching there. Taking this focused approach may yield an advantage, and a positive residency interview.

Can you achieve your goals without a residency program?

This is a newer approach, so other people may not know too much about it. Some states allow one to practice without residency experience. Take Missouri for example: this state now allows physicians to practice without residency as Assistant Physicians in health care shortage areas.

Believe it or not, there are benefits to this situation.

Being a reapplicant can come with some surprising benefits. In recognition of the number of repeat applicants each year, most of the official residency services have made adjustments to improve the process for those who are not applying for the first time.

The residency application service ERAS implemented a new “Import” feature in 2017, allowing applicants to import their answers to the previous season’s MyERAS Common Applications. You will be able to import all of your answers, but make sure you go through each answer and edit them as needed!

ECFMG is allowing more documents than ever to be preserved and reused for the following year. As long as you qualify, you will not have to re-upload documents such as:

  • Medical Student Performance Evaluations (MSPEs)
  • Medical school transcripts
  • Photographs
  • Postgraduate Training Authorization Letters (PTALs)
  • Letters of recommendation (LoRs) that were used in a previous ERAS season(s)

Most importantly, knowledge really is power. As a repeat applicant, you will have a much better idea of how the application season works, what deadlines to follow, and what to do and not do. The experience you gained from your previous residency application cycle will put you ahead of the newer applicants who don’t know the process like you do.

Prepare well for round two

Before you apply next time around (if you plan to), you’ll want to be very familiar with the requirements. Have everything squared away before the next match.

Many residencies list their program requirements for applicants on their websites, such as medical school graduation year, types of visas accepted, or number of allowed attempts on the USMLE. Research residency requirements before applying, and direct the submission of your applications appropriately.

Use the Directory of State Medical and Osteopathic Boards to access state-specific information for any state in which you are applying to a residency. You may want to know if you can get a license in a specific state during residency. Some states, such as California, have a list of recognized international medical schools that are eligible for licensure in the state. In addition, some states have restrictions on the number of USMLE attempts allowed or the timeframe in which they must be taken.

Because offers made and accepted during Match Week will be binding under the Match Participation Agreement, only applicants eligible to begin training on July 1 in the year of the Match will be allowed to participate. The NRMP will exchange data with the ECFMG to recertify the status of IMGs.

Get your status sorted

To participate in U.S. graduate medical education programs, IMGs who are not citizens or lawful permanent residents must obtain the appropriate visa. If you’re re-applying, your visa may need extending.

The two most common visas are the H1-B (Temporary Worker) or the J-1 (Exchange Visitor). Some institutions will sponsor the visa for residents in the residency program.

Questions about obtaining a visa should be directed to your residency program staff, the U.S. embassy or consulate in your country of residence, or the U.S. Citizenship and Immigration Services.


Don’t give up

You’ve worked really hard up to this point. Now, with a bit of focused change, reinvention and working smarter you can increase your chances of achieving your goals.

Whether it’s the first time or second time, Thalamus exists to make the application and interview process smoother.