Everything You Need to Know About Residency as an IMG

With the increasing doctor shortage in the US, the demand for Medical Doctors can not be solely met by US Medical Graduates alone! For this reason, and many more, the acceptance of International Medical Graduates (IMGs) into US Residency programs has increased steadily in the past few years. According to a study done in 2017, nearly 30% of US Residents were IMGs. Although in the past there used to be a greater stigma regarding hiring IMGs, we are starting to see a significant shift in this mind-set. If you are already affiliated with a non-US medical school, or are considering applying, there’s a few things to keep in mind as you embrace your medical journey. Let’s discuss everything you need to know about applying to Residency as an IMG! 


Where Do You Stand?

There are few important things to keep in mind when comparing the statistics of matching as an IMG versus a US medical school graduate. Many of the categories that you will be ranked on are identical to the categories US graduates will be ranked on. A few additional considerations programs take into account as an IMG include ECFMG certification, visa status, the OET exam. Here’s a few things to consider when applying for Residency as an IMG: 


USMLE Exam Scores 

Of course by now you’ve heard it said a million times, the better the Step score, the higher the chance of obtaining a Residency. But something you may not have heard yet is that the average Step scores needed to obtain residency in certain specialities differs among US and IMG applicants. For example, the average step 1 score of applicants who matched for Family Medicine residency is a 221. This indicates that the IMGs that matched in this specialty likely had a score above 221 in order to be competitive. With the recent change of making Step 1 Pass/Fail, this puts a much larger emphasis on Step 2 scores as well as additional application requirements. A competitive score on Step 2 will be a huge factor for your match success. 


Letters of Recommendation 

Strong letters of recommendation (LORs) are a great way to show your worth as an IMG to Residency Directors. It’s recommended that each letter be submitted onto your ERAS and dated within 6 months of the application process.  However, what if you have already secured LOR’s in your rotations prior to that 6 month period of time? In this case, you can request your letter’s author to write it and hold on to it until you are ready to set up your application. It’s important to stay in contact with those who have written your letters to ensure they follow through with the letter submissions. In addition to this, programs prefer that the letter be directly submitted by whomever wrote the letter, rather than you submitting it yourself. 



Although publications are not considered mandatory to apply to match, they are highly recommended for IMGs especially. Many programs place a lot of value in a history of research and publications. As a result, they will likely choose a candidate with a high quantity of relevant research. The speciality you plan to apply to can also determine the importance to obtain publications. If you’re applying for a more competitive specialty such as dermatology or orthopedics, publications are absolutely necessary. Publications are a great way to help your application stand out and increase your chances of matching. Unfortunately, these papers can take a long time to actually publish. Therefore, it’s best to start looking into these opportunities as early as possible. 



If you happen to be an IMG that has not had the opportunity to get in a lot of face-time with program heads or directors in the US, this can be detrimental. If you have completed your clinical rotations elsewhere, it is recommended to look for shadowing experiences to further gain contacts with connected doctors. A great way to network in medical school is simply showing up, being present, asking thoughtful questions, and engaging with the health care team. Networking among other IMGs that have already matched is a great way to get solid advice and learn about programs they found to be IMG-friendly. 


Additional Application Requirements 

There are a few additional things that every IMG is required to submit for their residency application. Here’s a brief list of additional steps to complete your application: 


ECFMG Certification 

The Educational Commission for Foreign Medical Graduates (ECFMG) certification is by far the biggest difference in the application process for IMGs. This program of certification assesses whether you, an IMG, are eligible to enter graduate medical programs in the United States. Make sure to familiarize yourself with the ECFMG website and certification process in advance. The general requirements for certification include:

  • Passing Step 2 before the end of December
  •  Determining eligibility for pathways 
  • Completion of the OET exam 


The Pathways are a way to organize the circumstances with which you are applying to match. Pathways aid IMGs to obtain the ECFMG certification they need in order to be eligible for the match. Pathways came into effect in 2020, and they are still expanding these pathways to cater to IMG needs. There are 6 main pathways as of now. Each pathway differs based on variables in the applicant’s status. These variables include the accreditation level of your medical school and passing USMLE exams on the first try. For example, an IMG that was unsuccessful on their first attempt at Step 1 or 2 is eligble for Pathway 6. To learn more about the Pathways and determine which Pathway you are eligible for, visit the ECFMG Requirements Page


Occupational English Test (OET)

As of June 2020, the USMLE discontinued the STEP 2 CS (Clinical Skills) exam. This decision was influenced partly due to Covid delays and pre-existing issues with the exam. As a result, ECFMG has replaced this exam with the OET exam. OET completion is now mandatory for IMGs to satisfy their communication skills requirement and obtain ECFMG certification for The Match. To learn more about the OET you can check out our blog on how to prepare for the OET


Visa Status 

If you happen to be a non-US IMG, like myself, you will also have to obtain a visa. The visa you will likely require is called a J-1 visa. A J-1 visa is intended for participating in an approved educational program, such as Residency. It is very important for you to be aware of which programs accept a J-1 visa, because unfortunately some do not. Residency programs often take your visa status into consideration when evaluating your application. You should start this process as early as possible. Ideally, you should have your visa started or processing prior to application season.  


IMG Friendly Programs 

Finally, let’s discuss what programs you have the best chance at matching with as an IMG. Thankfully, there is a beautiful list of IMG-friendly programs available on Match a Resident. You can jot these programs down early and look into programs you prefer. These programs should be higher ranked when you complete your program selection on ERAS. Some of the most IMG friendly states include New Jersey, Florida, and California. Unfortunately, certain programs are not as willing to accept residents that are IMGs. Avoid wasting applications on programs that are less likely to consider you. The number of IMG friendly programs has increased exponentially in the past few years. 

Chat with others in the IMG community and learn more about where they successfully matched.


I know that was a lot of information to take in all at once. But I also know that each and every one of you possess the skills, determination, and tenacity to MATCH as an IMG. Feel free to leave a comment and tell us about your IMG Success Story! Good Luck Future Doctors!

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