• Rajani Katta MD and Samir Desai MD

How difficult is it for international medical graduates (IMGs) to match into a US residency program?

Over the last two decades, there’s been a tremendous increase in the number of foreign medical graduates who are applying for residency. How difficult is it for IMGs to match into a US residency program?


That’s a challenging question to answer because there are multiple factors that impact your chances of residency match success.


Some of the top factors include:

  • Competitiveness of the specialty and the program to which you are applying

  • Letters of recommendation from US clinical faculty

  • USMLE Step exam scores

  • US clinical experience

  • Strength and reputation of the international medical school, as well as familiarity of US residency program decision-makers with the medical school


There’s a complex interplay among these factors, which is why we wrote a 600+ page book on how to succeed in the residency match (The Successful Match: Rules to Succeed in the Residency Match). In this blog post, we’re going to summarize a few of the main statistics for international medical graduates (IMGs) who are trying to obtain a residency position in the United States.


What are the chances for residency match success for US citizen IMGs?

US citizens may choose to obtain their medical training at an international medical school. Many of these students choose to attend medical school in the Caribbean, and for these Caribbean medical students or Caribbean medical school graduates, there is a wide variety of outcomes.


  • Certain Caribbean medical schools, including Ross University and St. George’s University, have a relatively strong success rate in placing their students into US residency programs.

  • Other medical schools do not have as much success overall.

For students who are considering attending a Caribbean medical school, it can actually be very difficult to find transparent statistics on residency match success. The most helpful statistic would be how many students matriculated (began studying at the medical school) as compared to how many graduated and as compared to how many matched into a US residency program on their first attempt. It would also be helpful to know how many attempts were needed to successfully match. Unfortunately, these statistics aren't easy to find. In recent years, we’ve also seen more US citizens choosing to study at schools located in Poland, India, China, and other countries.


While we have overall match statistics for US citizens who have graduated from international medical schools, it's important to be aware that these are only overall numbers. Depending on the strength of their application, some physicians will have much higher chances of residency match success than others.



What are the statistics for residency match success for US citizen IMGs?

In the 2021 NRMP match, 5,295 US citizen IMGs participated, hoping to secure residency positions in the US. Unfortunately, 40.5% of these applicants failed to match.



A donut chart explaining how many US Citizen IMGs matched in 2021.
Almost half of US Citizen IMGs failed to match in 2021



What are the chances for residency match success for non-US citizen IMGs?


In the 2021 NRMP match, 7,943 non-US citizen IMGs participated, hoping to secure residency positions in the US. Unfortunately, 45.2% of these applicants failed to match.



A donut chart explaining how many non-US Citizen IMGs matched in 2021.
54.8% of non-U.S. citizen IMGs matched in 2021



The Chances of Success for IMGs are Significantly Lower than for US Medical Graduates


Compare those statistics with that of US medical graduates. In the chart below, this group had a 92.8% match success rate.


A donut chart explaining how many MD seniors matched in 2021.
Only 7.2% of MD seniors failed to match in 2021

What specialties are IMGs able to successfully match into?


Specialties with the highest number of IMG trainees include:

  • Family medicine

  • Internal medicine

  • Pediatrics

  • Psychiatry


Other specialties are far more challenging for IMGs to match into, because they're far more competitive in general. These include:

  • Ophthalmology

  • Otolaryngology

  • Radiation oncology

  • Dermatology

  • Urology

  • Plastic surgery

  • Orthopedic surgery


There are many more US applicants who wish to enter these fields than positions available. Therefore, a significant number of US medical school graduates fail to match into these fields. As you might expect then, IMGs find these specialties the most difficult to enter.

Are there ways for IMGs to match into the most competitive specialties?


In spite of the statistics, we have to emphasize that every year there are IMGs who successfully match into highly competitive specialties.


For example, I know multiple IMGs who have successfully matched into dermatology. However, this type of success usually reflects additional years of hard work and a multi-year strategic plan, and any IMG considering a highly competitive specialty needs to factor that in.

How difficult is it to match into less competitive specialties such as family medicine?


Every year, there are large numbers of IMG applicants who match into these less competitive specialties. That often leads to the perception that it’s easy to match into these fields.


That's simply not the case. It's still challenging for IMGs to match into these fields. In fact, in examining the data, close to 50% of applicants failed to match into these specialties.


This means that while these fields are easier to match into than the most competitive specialties, it doesn’t mean that they’re easy to match into.



Additional statistics that reflect match success rates for IMG applicants and their first choice specialties


Family Medicine:

  • A total of 1,348 IMGs selected family medicine as their first choice.

  • 48.4% of applicants failed to match.

Internal Medicine:

  • A total of 4,346 IMGs selected internal medicine as their first choice.

  • 41.8% of applicants failed to match.

Pediatrics:

  • A total of 660 IMGs selected pediatrics as their first choice.

  • 37.9% of applicants failed to match.

Psychiatry:

  • A total of 494 IMGs selected psychiatry as their first choice.

  • 57.5% of applicants failed to match.

Will it become more or less difficult for foreign medical graduates to match into US residency programs in the coming years?


This is a great question, and there are certainly a lot of unknowns. However, there’s significant concern that it will only become more difficult for IMGs to successfully match in the coming years. In order to meet the needs of an anticipated physician manpower shortage, US medical schools have significantly expanded their enrollment over the past several years. Unfortunately, because of government funding issues, we haven’t seen a corresponding rise in the number of available residency positions. Therefore, as more and more US medical school graduates have entered the residency match, we’ve seen competition for the available residency positions intensify. Dr. Desai works closely with many IMGs applicants with strong credentials. Some of these applicants would have easily received a high number of interviews just five years ago, but now are finding it far more challenging. That doesn’t mean it’s not possible, but it does mean that IMG applicants have to pay far more attention to every single aspect of their application.

Are IMGs valued in the US medical system?


IMGs have made a significant impact on the United States healthcare system. Study after study has documented important contributions to medicine in patient care, teaching, and research. At the same time, the US is facing a growing shortage of primary care physicians, and IMGs are doing their part to fulfill the nation's primary care manpower needs. The primary care physician workforce shortage is felt most by people in rural areas. Over 60 million Americans lack access to primary care, and there’s evidence to indicate that IMGs are filling these gaps in many states. IMGs are also performing very important research in institutions across the United States.


The contributions of IMGs are significant and are valued in the US medical system.

Are there residency programs that are more open to IMG applicants?


Absolutely. There are certain residency programs across the United States that have a history of accepting IMG applicants. There are different reasons for this. Some programs have worked with outstanding applicants, for example, from specific Caribbean medical schools or specific countries, and these programs may then gravitate to those schools or countries for future cycles. Other programs may be located in states or cities that have a harder time attracting interest from US medical graduates. For highly competitive IMGs, with strong letters of recommendation from US clinical faculty, extensive US clinical experience, and high exam scores, there may be no need to target IMG friendly programs, as they would be considered competitive for many US residency programs. For applicants who are considered less competitive overall, it may make sense to look more closely and target IMG friendly programs. We’ve completed our own analysis of IMG friendly programs for 6 specialties. These specialties include:

  • Family Medicine

  • Internal Medicine

  • Neurology

  • Pediatrics

  • Pathology

  • Psychiatry

For more information on IMG friendly programs, please see this resource.



The Bottom Line:


Although it can be challenging for international medical graduates to match into US residency programs, planning and strategy can enhance your chances of success.


The statistics overall paint a challenging picture. About half of IMGs will fail in their attempt to secure a US residency position. This emphasizes the fact that strategic planning is key.


  • For more information on residency match statistics for specific specialties, please see this guide from the NRMP.

  • For more information on IMG friendly residency programs, please see this resource

  • For more information on topics related to the residency match, please see our blog series.

  • If you prefer to listen, we devote multiple episodes of our podcast Success in Medicine to residency match success.


We wish you all the best in your journey in medicine.


 

Dr. Rajani Katta is the creator of The Residency Interview 101, the online course that helps applicants quickly and confidently prepare for their residency interviews. She is also the co-author of The Successful Match: Rules to Succeed in the Residency Match and served as Professor of Dermatology at the Baylor College of Medicine for over 17 years.



Dr. Samir Desai is the author of 20 books, including The Successful Match and The Clinician's Guide to Laboratory Medicine. He has been a faculty member in the Department of Internal Medicine at the Baylor College of Medicine for over 20 years and has won numerous teaching awards.



If you'd like to receive a free 100+ page excerpt of The Successful Match, please sign up here.


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