So you didn’t match … now what? (An IMG Perspective)

By Fady Akladios

Being unable to secure a residency after an educationally and personally demanding journey of a decade is probably one of the most disheartening experiences any of us can have. However, having that extra year until the next ERAS/NRMP cycle is not an excuse for a much needed vacation. This is a critical time for an IMG to unflinchingly and quickly assess what went wrong, how you can fix it, and if you truly can fix it.

Understand that an IMG will usually not match because he/she did not apply to a good number of programs, to programs seeking applicants like him/herself, or his/her application was simply not competitive enough. This becomes such a dilemma for IMG’s, who end up thinking the solution is blindly applying to 200 or even 300 programs. Applying to 200 programs blindly is not the equivalent  of applying to the right amount programs.

Let’s first start with the “what went wrong” part. Sit down and read a printout of your application. Highlight the items you think made you a less a competitive applicant. How are your USMLE scores? Did you do elective clerkships or have any US experience? Was your US experience relevant to the programs you were interested in? How was your personal statement? Aside from the application itself, how was your interview performance? Did you practice enough beforehand? Do you think you needed to participate in an interview training course?

The programs you applied to also fall under the “what went wrong” part. Did you apply to too few programs? Did you apply to too many highly competitive programs and ignore the less competitive ones? Did you apply to programs that historically never/rarely took IMG’s or that take IMG’s with specific backgrounds only? For example, there are some programs that prefer Caribbean IMG’s over others. If you are not a Caribbean IMG, applying to such a program would likely be a waste of time and resources.

There are so many things that can go wrong with the application and/or interview process. However, it is important to understand what is fixable and what is not. Aside from the interview, the two most important parts of your application as an IMG, in my opinion, are your USMLE scores and US experience (which can provide you with required and relevant LoR’s).  If your USMLE scores are not that great, there is really not much you can do about that besides working on improving other parts of your application.

During this extra year, try to bolster your application with relevant additional experience. Seek out externships or other clinical positions in your specialty of choice and obtain good LoR’s from them. Seek out volunteering experiences in your specialty of choice. Some students may want to consider earning an MBA or other degree (master’s in public health if you are interested in family or preventative medicine, masters in health informatics if you are interested in radiology etc..). Try to strengthen your ties with the programs in which you are interested. Call the program coordinator; ask for advice on how to improve your application. Really try to make yourself stand out.

There are a great many examples of applicants, IMG’s and AMG’s, who failed to match on their first attempt. However, a large portion of these individuals ended up matching on their second try. Their success is largely due to their perseverance in improving their skills, knowledge, and wealth of experience. Do not think of this as a failure, but a chance to re-invent yourself.


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