Understanding the US Residency Matching Process

Although thousands of international medical graduates (IMGs) apply to the match each year, it can be difficult to find the right information regarding the residency match process. The reason being that anecdotal information predominates and it might not always be clear how one person’s experience relates to you. Maybe you went to a different school, or are interested in a different specialty, or had different USMLE scores, or have limited research experience. Whatever the case, it always feels like the available information is incomplete. The National Residency Matching Program’s publicly available data can help you get a better sense of your chances. In this video, I will be helping you interpret data from the National Residency Matching Program.

Let’s start with some quick background. First, you need to know your status. If you are watching this video, chances are you are either enrolled in or graduated from a medical school outside of Canada and the US. As such, you will be classified as an international medical graduate or IMG. There are two types of IMGs: the first category groups US citizens or permanent residency card holders enrolled in or graduating from a medical school outside of Canada and the US. These are your US IMGs. The second category is made up of non-US citizens and non-US permanent residency card holders. These are your non-US IMGs. Take note that the IMG label has to do with the location of your medical school and not your nationality. For example, a non-US citizen enrolled at a US medical school is considered a US medical graduate and not an IMG.

So, why does this matter? Well, if you are an IMG, you can only register for the United States Medical Licensing Exam (USMLE) if you meet the Educational Commission for Foreign Medical Graduates (ECFMG) eligibility criteria. What’s more, chances of success during the match vary significantly depending on your status - that is, IMG or US medical graduate. While match rates among US MGs regularly exceed 90%, IMG match rates will never exceed 70%. In fact, US IMG match rates in the majority of specialties will be less than 50%.

Let’s take a look at the data. I made a few graphs from the NRMP data using Tableau Public so we can all see the big picture. Feel free to pause the video at any time or if you want to play around with these figures, please click on the corresponding link in the description below. First, let’s check out the number of positions available. Internal medicine is a clear winner with 9,809 spots in 2022; up more than 600 spots since 2021. Family medicine is next up with 4,916 spots and pediatrics with 3,016. Vascular surgery, interventional radiology, and radiation oncology had the fewest number of spots.

You are probably thinking to yourself, is the number of available spots a good indicator? Well, no. It is not. So, let’s take a look at the number of applicants per available spots. Now here, we see there are only three specialties with fewer applicants than spots. Interestingly, radiation oncology is one of them! We equally notice that the majority of high applicant ratio specialties are surgical. Looking at the 2021 data, that is the blue dots, we can see a somewhat consistent trend. Now, considering that this data includes US medical graduate data and we previously stated that they had higher match rates than IMGs, let’s take a look at non-US IMG match rates by specialty. We notice immediately that the surgical specialties have some of the lowest non-US IMG match rates while pediatrics, pediatric neurology, emergency medicine, and internal medicine have some of the more favorable match rates in this cohort.

I hope by now you understand two things. First, that the match might be a difficult process but it is by no means impossible. Second, that the amount of effort needed to match is dependent on the specialty. Hence, if you are going to put your best foot forward, you will need to work on the measurables and intangibles. The measurables include your USMLE Step 2 Clinical Knowledge scores, your research experience, US clinical experience, leadership experience, and graduate/postgraduate qualifications. The NRMP IMG charting outcomes is an amazing resource for this purpose. Bear in mind that no single metric can guarantee you will match. The truth of the matter is, many programs will not consider IMGs irrespective of their measurables. Therefore, it is your duty to make sure that the programs you are applying to will consider your application. This information will be department specific as it is not uncommon to see within the same institution that one department will interview and rank IMGs while another department will not. One of the easier and cheaper ways to do this is to check the list of residents on the department website. Since, departments that have previously matched an IMG are more likely to match an IMG. Similarly, the more IMGs there are in a program, the more likely you can match in that program. So, type the following query on Google: resident+specialty+program. You can find a full list of programs by specialty on the NRMP website.

Regarding the intangibles, they will include your network and your ability to connect with faculty and residents. The most obvious way your network will come through for you is via your letters of recommendation. However, your network will be even more effective if your mentors and sponsors can make calls to program directors on your behalf. It goes without saying that the effectiveness of said calls will depend on your mentor’s or sponsor’s relationship with the program director. The other important intangible is you. Every interaction you have should showcase your affability, availability, and ability. Do not make the mistake of neglecting interactions with junior residents, administrative staff within the department, or nurses. Simply put, people should love being around you. Take a genuine interest in people and try to make their lives and work easy.