• Michael Dworkin, MD

The key to matching in the US as an IMG

Updated: Aug 18, 2018

What USMLE scores do IMGs need to match in the US? What specialties are most accepting of IMGs? Read on to find out!


Matching as an IMG may be considerably harder or nearly impossible depending on the specialty of interest.


The latest data on what it takes to match as an IMG is summarized in the 250+ page NRMP Charting Outcomes in the 2018 Match for IMGs Document. Given the length of this document, the fact that it is not digested, and does not provide recommended goal scores for various specialties, I've gone through the whole document and digested it for you as follows.



Definitions


IMG: International medical graduate. Refers to students who graduated from medical schools physically located outside of the United States. Example: A Graduate of a Caribbean medical school.


US-IMG: An IMG who is a USA citizen. Example: Someone born in New York who graduated from a Caribbean medical school.


Non-US-IMG: An IMG who is not a USA citizen. Example: A Canadian graduate of a Caribbean medical school.



Breakdown of applicants in the 2018 main residency match by the numbers


Of all applicants in the 2018 main residency match, 19 percent were non-US-IMGs and 14 percent were US-IMGs. See the full data breakdown here.



What specialties accept the largest numbers of IMGs?


Internal medicine (3,000 matches), family medicine (900 matches), pediatrics (500 matches), neurology (260 matches), psychiatry (250 matches), anesthesiology (240 matches), pathology (220 matches), general surgery (130 matches), diagnostic radiology (120 matches), OBGYN (108 matches), emergency medicine (107 matches), physical medicine and rehabilitation (30 matches), med peds (19 matches), child neurology (19 matches), dermatology (15 matches), orthopedic surgery (13 matches), neurological surgery (10 matches), vascular surgery (4 matches), plastic surgery (3 matches).



What specialties have the highest match rates for IMGs?


The specialties with the highest match rates (% match rate for US and non-US IMGs respectively) are pediatrics (70 and 63%), pathology (61 and 67%), anesthesiology (64 and 60%), internal medicine (55 and 56%), neurology (52 and 54%), diagnostic radiology (52 and 44%), family medicine (52 and 39%), dermatology (44 and 46%), emergency medicine (46 and 41%), psychiatry (30 and 35%), and general surgery (32 and 26%). See the full data breakdown here.


What are the most important factors for matching as an IMG?


USMLE Step 1 and Step 2 CK scores are the only factors discriminate matched from unmatched students as a whole. The length of the rank order list is also crucial in determining probability of the match; rank as many places as you interview at. Extra research experience only seems to help for dermatology, and the surgical specialties. Letters of recommendation, clinical grades, and clinical experience in a US hospital are also key factors to consider.



What are the average USMLE scores for US and non-US IMGs who matched vs those who did not match overall?


US-IMGs who matched vs those who did not match had an average USMLE Step 1 and Step 2 CK scores of 222 and 232 vs 212 and 222.


Non-US-IMGs who matched vs those who did not match had an average USMLE Step 1 and Step 2 CK scores of 234 and 240 vs 221 and 228.


Thus, in general, non-US-IMGs have to score about 10 points higher on both USMLE Step 1 and USMLE Step 2 CK on average in order to match.



What are reasonable goal Step 1 scores for various specialties for US-IMGs?


By "reasonable goal score", I mean the mean score of matched applicants + 5 points.


240 - reasonable goal score for diagnostic radiology, general surgery, orthopedic surgery, and neurological surgery.

235 - reasonable goal score for anesthesiology.

230 - reasonable goal score for internal medicine, emergency medicine, OBGYN, neurology, and pathology.

225 - reasonable goal score for med-peds, pediatrics, and physical medicine and rehabilitation.

220 - reasonable goal score for psychiatry and family medicine.



What are reasonable goal Step 1 scores for various specialties for Non-US-IMGs?


By "reasonable goal score", I mean the mean score of matched applicants + 5 points.


250 - reasonable goal score for neurological surgery.

245 - reasonable goal score for general, orthopedic, and vascular surgery.

240 - reasonable goal score for anesthesiology, dermatology, diagnostic radiology, and neurology.

235 - reasonable goal score for child neurology, internal medicine, med-peds, OBGYN, and physical medicine and rehabilitation.

230 - reasonable goal score for pathology, pediatrics, and emergency medicine.

225 - reasonable goal score for family medicine and psychiatry.


What are reasonable goal Step 2 CK scores for various specialties for US-IMGs?


By "reasonable goal score", I mean the mean score of matched applicants + 5 points.


255 - reasonable goal score for orthopedic surgery.

250 - reasonable goal score for general surgery.

245 - reasonable goal score for diagnostic radiology, emergency medicine, and OBGYN.

240 - reasonable goal score for anesthesiology and physical medicine and rehabilitation.

235 - reasonable goal score for internal medicine, med-peds, neurology, pathology, and pediatrics .

230 - reasonable goal score for psychiatry and family medicine.



What are reasonable goal Step 2 CK scores for various specialties for Non-US-IMGs?


By "reasonable goal score", I mean the mean score of matched applicants + 5 points.


250 - reasonable goal score for neurological surgery.

245 - reasonable goal score for general, orthopedic, and vascular surgery.

240 - reasonable goal score for anesthesiology, dermatology, diagnostic radiology, and neurology.

235 - reasonable goal score for child neurology, internal medicine, med-peds, OBGYN, and physical medicine and rehabilitation.

230 - reasonable goal score for pathology, pediatrics, and emergency medicine.

225 - reasonable goal score for family medicine and psychiatry.



How to calculate your probability of matching into a specialty with a given USMLE Step 1 score?


See the charting outcomes document here and look at the second graph listed for each specialty to see a plot of probability of matching versus Step 1 score for US and non-US IMGs. For example, for family medicine ("FM"), see Graph FM-2 on page 88 of the document. This graph shows that US and non-US IMGs with USMLE scores above 230 and 250 respectively have a 75 percent chance of matching into family medicine. The flat slope of Graph-FM-2 tells us that FM "does not care too much " about Step 1.



How many programs should I rank?


Rank each program that you would be willing to attend, in the order you would prefer to attend them. The only reason not to rank a particular program is if you would rather not match than be forced to match into that program.



Take home advice


The most important take homes are to have reasonable goals, maximize your USMLE scores, apply to many programs, and, rank all the programs you would be willing to attend. For which specific factors on your application are most important at getting a residency interview and determining your rank on the rank order list, check out this blog post.



More advice


MedSchoolGurus has extensive experience working with US and non-US IMGs in the context of the residency match as well as in preparation for Shelf and USMLE exams. If you need further guidance, check out our webpage at medschoolgurus.com. If you are interested in individualized 1:1 guidance, email us at info@medschoolgurus.com to schedule a free 15 minute consultation.