AMBOSS Algorithms: The Perfect Match (Part III)
According to the 2017 National Resident Matching Program (NRMP) report, the number of international medical graduates (IMGs) who applied to medical residencies in the United States dropped from 7,460 in 2016 to 7,284 this year. Still, 52.4% of non-US citizens from schools abroad matched into a position, which was the highest rate for this group in over a decade (NRMP, 2017).
Why is it that IMGs are so eager to obtain residencies in the U.S.? According to Dr. Naren Nallapeta, a 2015 IMG from India who successfully matched as an internal medicine resident at the University of Buffalo, “I have always been fascinated by the advances in science and technology in the United States and I have always dreamt of being a part of that innovation and advancement myself. The opportunities for research and academics are endless in the U.S. and there is constant encouragement and appreciation for every individual's interests and needs in spite of the cut-throat competition. In India, we have limited residency spots, especially on the clinical side. The match rate in India is even less than in the U.S., so there was a better chance for me to get into a residency program in the U.S. as opposed to my home country.”
While Dr. Nallapeta’s story is one of success, there are many obstacles IMGs face when applying for residencies in the United States. Dr. Nallapeta states, “there are a limited number of surplus spots awarded to IMGs each year. The bottom-line is this - the last spots are given to IMGs. Disparities exist in the perception of which countries are favored or why, especially after the recent change in governmental laws in the U.S.”
IMGs aren’t the only ones voicing concern. According to a statement released by the Association of American Medical Colleges (AAMC) earlier this year, “the revised executive order [although blocked] does not explicitly recognize the importance of international medical graduates, physicians and medical researchers to the nation’s health security.”
These aren’t the only roadblocks IMGs must face. For example, the U.S. does not recognize international medical training as meeting its quality standards. Therefore, doctors licensed to practice in their home country must start at square one if they wish to practice medicine in the U.S. Additionally, IMGs applying to U.S. residency programs must first obtain approval from the Educational Commision for Foreign Medical Graduates. Currently, only around half of the international programs offered are certified.
Another major hurdle, apart from the written exams, is the USMLE Step 2 Clinical Skills test, which requires the demonstration of high-level English proficiency and a costly trip to one of the five U.S. cities which offers the exam. However, some opportunities do exist for IMGs to improve their chances of being accepted. Many have been encouraged to conduct research years, and/or complete rotations in U.S. hospitals, although these attempts create more demands on time, energy and resources for an endeavor that might not come to fruition. From Step exams to application fees and travel expenses, Dr. Nallapeta suggested that IMGs should plan on spending anywhere from $10,000 to $15,000 to cover costs.
Are there certain components that IMGs should focus on when applying to American residency programs? According to Dr. Nallapeta, “the most crucial mistakes that IMGs make are to solely focus on obtaining good scores on their Steps and/or only paying attention to the basic Match requirements when applying. But the common error here is that IMGs do not know about what programs are available and what these programs are expecting from them.”
Dr. Nallapeta recommends IMGs to ask themselves the following questions before preparing for Step I:
- What speciality are you planning to get into (this should be clear since each program requires different credentials and scores)?
- How many programs are there in your speciality?
- Is it common for your preferred speciality programs to accept IMGs?
- How many spots are roughly available in the speciality of your choice?
- MOST IMPORTANTLY, where do you want to work? List at least 10 dream institutes you wish to attend and check the minimum application requirements.
Luckily, all of the aforementioned information is available at the click of a button, thanks to the internet. Helpful websites for IMGs include Freida, a wonderful database with compiled information on all available residencies and requirements. The Electronic Residency Application Service (ERAS) is another helpful resource, which links to all residency program websites. Dr. Nallapeta states, “compiling information before starting the IMG application process is a great way to come to terms with what you are aiming for and what you need to do to get there!”
A final thought from Dr. Nallapeta, - “Be yourself - in the U.S., residency programs appreciate a person who takes initiative, is driven and has a unique skill set. Set yourself apart from other interviewees by taking up different roles in the local, national and international community. I highly recommend getting involved with the International Federation of Medical Students’ Association (IFMSA). The last thing I will mention is to have a ‘never give up’ mentality!”
This is Part III of our IV part series on matching. Stay tuned for more tips and resources from AMBOSS on the matching process. In the meantime, if you are looking for more information on IMG matching, see the NRMP guidelines. Feel free to read AMBOSS Algorithms Part I on couples matching and Part II on matching into highly competitive and selective residency programs.
Did you apply for the Main Residency Match? Share your experiences and advice with AMBOSS by contacting Olivia at firstname.lastname@example.org.
Naren Nallapeta is a 2015 IMG from India, who successfully matched as an internal medicine resident at the University of Buffalo where he will work in the following hospitals: Erie County Medical Center, Buffalo General Hospital, Roswell Park Cancer Institute and Veterans Affairs Hospital.