IMG Perspectives

For IMGs: 2013 Post-Match Analysis: Resolving Concerns for IMGs

By Sarah Wesley

Recently, a number of sources have raised the concern that match statistics were worse for IMGs this year, including particular alarmism about the few Family Med and Pediatric spots that went to IMGs and DOs. In particular, these sources have caused a great deal of angst as people have conjectured that this year’s primary care stats may reflect a general trend for the future involving all types of residency programs. I wish to address the error of reading into isolated statistics, with the hope that my viewpoint will ease the minds of international medical school graduates minds and encourage them to continue applying to residencies in the US.

How Did IMGs do in the Match?

The first discrepancy I’d like to address is the misconception that IMGs did not do as well in the match this year. In fact, the overall percentage of matched IMGs actually increased by about 5 percent for both US citizen IMGs and non-US citizen IMGs.

In terms of the focus on primary care statistics, it is important to note that the numbers lump all independent applicants into one group to include DOs and IMGs of all citizenships. It is impossible to make generalizations from this diverse group of people based on statistics. The U.S. has a medical training system that lures internationals for some primary care training but also for a lot of subspecialty training. Their Match numbers simply cannot be equated with those of osteopathic grads, as the field is traditionally more primary care oriented. So, saying that a low number of “independent applicants” matched to family medicine is misleading, because you need to look at the different groups separately.

Furthermore, even if IMG rates were low this year, it is conceivable that people did not match because they were not qualified, not because of some prejudice against IMGs, and that next year’s group of applicants will be more qualified and increase the success rate.

Do U.S. Residency Programs Welcome IMGs?

The second issue I’d like to address involves the claim that unfavorable odds will continue in future years. Yes, at the end of the day, the majority of programs are designed to ensure that US grads have jobs, but that has always been the case. However, in a system that relies on nearly 40 percent non-American grads, the strength of an IMG’s application, his or her mastery of the English language, and that individual’s interviewing skills are going to trump a foreign medical degree.

Hospitals, particularly in multicultural urban centers actually recruit doctors with additional language and cultural skills to enhance patient care. And if I were to make my own projections, I would venture that people with these skills are actually going to be more and more sought after as the US becomes increasingly diverse.

With the Affordable Care Act, there will be an expansion of primary care and preventative medicine, which will perhaps be more reflected in future years with a waxing of the number of spots for all types of applicants vying for these positions. In 2015, there are predicted to be more US grads than there are residency spots, which appears to be a point that is used as an ominous sign for IMGs applying to the US…but, no one seems to be mentioning that there will also be an increase in the number of residency positions.

What’s your take on this issue? Let us know in the comments below.

Categories: IMG Perspectives

18 replies »

  1. Thank you for your article, Sarah! That’s a helpful perspective. I’m an ‘IMG’ from a Commonwealth nation hoping to come to the States for residency. Might I ask about this bit please: ‘but, no one seems to be mentioning that there will also be an increase in the number of residency positions’. I’ve had other Americans tell me the direct opposite that there won’t be an increase in residency spots. I don’t suppose you would happen to have a source for this? Cheers!

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  2. Thanks for your question, Brian A. Part of the reason there will be more US applicants is because in the last few years, there have been a number of new medical schools that have opened in the US. The impetus behind this move was not to create a “better” US-grad to International-grad ratio, it was to train more physicians for an increasing population size. The system must respond by also increasing the number of residency spots in order to produce a larger generation of doctors for a larger population. Even this year in my own field of neurology, I have seem dozens of programs get accreditation for additional residency spots. This issue is overwhelming to analyse in some respects, because it is akin to fortune telling! But I am confident in saying that qualified international grads are still going to make up a large percentage of the work force. Even it the past, it has been known that to be “safe,” an international grad needs to score higher on USMLEs etc. just make yourself competitive, get some research in during medical school, kill your interviews, and you will stand as good a shot as you might have 5 years ago.

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  3. thanks dear Sara for both helpful and hopeful information you shared!
    i have one question. has salary-payment to IMG as residents changed during last year?is it possible that they dont give salary to IMGS? i have heard from one person in my country (Iran) but not found any where on the net mentioning it. you know far from there, we hear very rumors here and i want to be sure,it is just one of them!

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  4. Very encouraging words indeed. Could you tell me how important are research electives for the residency? I do know about the clinical electives, but as they are difficult to get for IMGs, unless you have passed Step 1, i was wondering if research is worth spending so much money on..

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  5. Where did you hear there will be more residency spots? Unless the government budgets more money, to is patently false. The number of residencies has been capped since 1997.

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  6. Any position filled through the NRMP Match is funded by CMS in the US; therefore, even if they are filled by IMGs, the IMG still gets paid the standard salary for that institution. However, some institutions/programs offer unfunded positions. In that case, the resident may have to find an alternate source for their salary or other financial support. These unfunded positions are fairly uncommon, though.

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  7. I’ve never heard of these so-called unfunded positions, it seems inconceivable that someone could become board certified in an American training program and not be paid. I know for certain that If you stay within the match, it’s not going to be a concern – everyone regardless of visa status is paid equally with the same benefits. Furthermore, I know a few people who have been offered positions outside of the match, but naturally their salaries are the standard salary for a house officer at their level at that institution.

    In terms if research electives that are costly, yes they are good in your résumé for the match, but it is important that you at least get an abstract, poster/oral presentation, or a full publication out of it. On your match application, you can mention unfinished projects, but there is an actual section for listing poster/oral presentations at national conferences and publications. It looks better to do research at your home institution that you actually publish versus a four-week elective for which you have nothing to show.

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  8. More residency positions yield more opportunities to match but then again, prerequisites for particular programs have never been stronger. IMG do make up a good portion of the US Healthcare system and that is a positive sign of their ambition and dedication to this craft but continuing government and lobby pressure to mitigate a lot of the healthcare issues we face and will face in the next decade will have a direct impact on this entire residency and match process. How and when, adverse and positive, that remains to be seen. On any case, a 250 on both steps and a respectable familiarity and understanding of the healthcare system will certainly not hurt any aspiring candidate.

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  9. Very misleading. “but, no one seems to be mentioning that there will also be an increase in the number of residency positions.” No one mentions this because regardless there will be more US Grads than residency positions. Obtaining reaidency as an IMG will continue to be more difficult.

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  10. Brian A:

    Thank you for your article, Sarah! That’s a helpful perspective. I’m an ‘IMG’ from a Commonwealth nation hoping to come to the States for residency. Might I ask about this bit please: ‘but, no one seems to be mentioning that there will also be an increase in the number of residency positions’. I’ve had other Americans tell me the direct opposite that there won’t be an increase in residency spots. I don’t suppose you would happen to have a source for this? Cheers!

    Brian: write to me drpjdalziel at gmail dot com I’m an aussie that just matched. I can help you if you need/ would like it.

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  11. Respectfully, this article glosses over two important points.

    1) while residency spots do increase annually they are not increasing anywhere near the rate of US medical school admissions, not to mention US-IMG school admissions which continue to balloon out of control. This puts increasing pressure to perform at a very high level to stay competitive (arguably a good effect) BUT the bar is always set higher for IMGs than US grads.

    2) Not every residency program is created equal. What’s happening now is that, increasingly, there are programs that accept IMGs and DOs, and there are programs that will accept an application fee, but toss the application out. Surely there are excellent accademic programs that will consider any applicant based on merit, but the vast majority of these programs are community-based and service heavy where academics take a back seat. Fine for basic training, but limited in terms of future opportunities. So looking at the whole you can easily say that IMGs are no worse off than they’ve ever been, but pedigree is overvalued in this system and it’s easy to see when you start parsing the data from program to program

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  12. Excellent points, Bernard. However, we may argue that point #1 was not glossed over since Sarah does mention in her article that “the majority of programs are designed to ensure that US grads have jobs, but that has always been the case.”

    Still, we appreciate your position. Sounds like a rebuttal post in the making. We welcome anyone to respond to, or rebut, any one of our blog posts by submitting their own article to submissions@usmlerx.com.

    Thanks again!


    Bernard K:

    Respectfully, this article glosses over two important points.
    1) while residency spots do increase annually they are not increasing anywhere near the rate of US medical school admissions, not to mention US-IMG school admissions which continue to balloon out of control. This puts increasing pressure to perform at a very high level to stay competitive (arguably a good effect) BUT the bar is always set higher for IMGs than US grads.
    2) Not every residency program is created equal. What’s happening now is that, increasingly, there are programs that accept IMGs and DOs, and there are programs that will accept an application fee, but toss the application out. Surely there are excellent accademic programs that will consider any applicant based on merit, but the vast majority of these programs are community-based and service heavy where academics take a back seat. Fine for basic training, but limited in terms of future opportunities. So looking at the whole you can easily say that IMGs are no worse off than they’ve ever been, but pedigree is overvalued in this system and it’s easy to see when you start parsing the data from program to program

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  13. Does all of this information apply to Caribbean grads that are US citizens? I’m studying for my step 1 now and I’m wondering how scared I should be. I took an nbme practice test and scored ok but now I’m wondering what I should be scoring at in order to be competitive. My advisor says over 450 but that just puts one over 200 😦 Should I shoot for 600?

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