IMG-friendly residency programs are US-accredited graduate medical institutions that are more willing to accept international medical graduates. Such programs have a history of accepting applicants that have been educated in another country, resources to help them gain admittance, and ultimately become licensed to practice medicine in the States.
It’s important for applicants that attended medical school in a foreign country to find IMG-friendly residency programs to apply to, as this can significantly increase their chances of landing a residency in the States.
To place our discussion of IMG-friendly residency programs in context, let’s begin by examining what residency generally entails, and what makes landing a US residency a bit more difficult for IMGs. This background will enable you to navigate the US residency application process more efficiently, understand why it’s important to apply to IMG-friendly residency programs, and ultimately, get into the US graduate medical institution of your dreams.
Let’s begin!
Challenges Faced by IMGs Applying for US Residency
Before IMGs can apply for residency in the States, there are a couple of hurdles they have to overcome. First, they need to pass the United States Medical Licensing Examination (USMLE), which is an endeavor in and of itself. They must also obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG). They are then usually eligible to apply for a residency position in a US-accredited program, so they can become licensed and board-certified to practice medicine in the States.
The process of applying for residency is tougher for IMGs, as it involves navigating additional challenges such as visa requirements, cultural and language adjustments, as well as adapting to the American healthcare system.
Choosing the right residency program is crucial for IMGs aiming to build a successful medical career in the United States. The journey can be challenging, with numerous hurdles that are unique to IMGs, including:
1. Limited Residency Spots
The number of residency positions available is limited, and currently, many programs have preference for US medical graduates.
2. Visa Issues
Securing a visa, and the correct one, can be a complicated and lengthy process, adding an extra layer of complexity. Furthermore, not all residency programs provide visa support, in which case they cannot take on IMGs who need a visa.
3. Cultural and Educational Adjustments
Adjusting to a new healthcare system and culture can be challenging, requiring additional support and adaptation.
4. USMLE Scores
Achieving competitive scores on the USMLEs (particularly Step 2) is tough, and the language barrier only makes it harder. Additionally, the standards are often set higher for IMGs, so it’s especially hard for them to be a strong applicant.
5. Lack of US Clinical Experience
Many programs prefer applicants with clinical experience in the US, which can be difficult for IMGs to obtain.
Key Factors of IMG-Friendly Residency Programs
Finding an IMG-friendly residency program is essential, as it increases not only your chance at matching to said program, but it also raises your chances of succeeding in residency.
Programs that understand and address the specific needs of IMGs can significantly ease the transition into the US healthcare system. They often offer resources and support systems designed to help you overcome the cultural and educational adjustments necessary for effective practice in the US.
Here’s what to look for:
1. High Acceptance Rates for IMGs
This is perhaps the most significant statistic to look at when you’re looking for IMG-friendly residency programs. After all, if a program has been around for 20 years and has never accepted IMG applicants, it’ll likely pass them up next time as well.
Programs with high acceptance rates for IMGs demonstrate a commitment to diversity and a willingness to integrate international graduates into their system. Examples of specialties and institutions with notable acceptance rates include internal medicine programs at community hospitals and some university-affiliated hospitals.
Researching programs with historically higher IMG match rates can guide you toward more welcoming environments with mentors and upperclassmen who share similar backgrounds and experiences to better support you.
2. A Supportive Environment
IMG-friendly residency programs offer mentorship, orientation programs tailored for international graduates, and resources to help you acclimate to the US healthcare system. These might include language support, cultural competency training, and social integration activities. Programs that emphasize inclusivity and provide resources for professional development create a nurturing environment for IMGs.
Choosing accredited programs is vital, as it ensures the quality and recognition of your residency training. Accreditation by bodies like the Accreditation Council for Graduate Medical Education (ACGME) signifies adherence to high standards.
Programs with a good reputation not only enhance your learning experience but also positively impact your career advancement opportunities. A reputable program often has a robust curriculum, excellent faculty, and a track record of successful graduates, IMGs and US grads alike.
3. Geographic Considerations
Obviously, choose a state and locale you want to live in, but know that some states and cities are more welcoming to IMGs due to their diverse populations and a higher demand for physicians. States like New York, Florida, and New Jersey have numerous IMG-friendly residency programs that offer a conducive environment for international graduates. These regions often have large immigrant communities and healthcare systems that value cultural diversity, making them ideal for IMGs looking to practice in inclusive settings.
New York has the highest number of medical schools of any state at 18. Because of this, there are many residency spots, as well as stiff competition for each position. New York also accepts many IMGs, and is often considered one of the most IMG-friendly states because of this fact.
Internal medicine, family medicine, and pediatric residencies in New York harbor many IMG trainees, so it’s worth your consideration. A good approach is to seek out states that have a large number of IMGs that apply and a good percentage of IMGs that match to residency programs within the state. Try not to restrict your geographical area in order to maximize your chances of matching at a US residency program.
According to data from the most recent NRMP match survey by specialty and state, the top 12 most IMG-friendly states* in 2023 were:
- New York (1557)
- Florida (717)
- Pennsylvania (600)
- Michigan (561)
- New Jersey (511)
- Texas (490)
- California (473)
- Illinois (366)
- Ohio (349)
- Massachusetts (258)
- Connecticut (247)
- Georgia (243)
* The numbers in parentheses are how many IMGs were accepted.
As for the acceptance rates, in 2024 the NRMP reported a 61.3% match rate among IMG applicants (67% for IMGs that are US citizens/residents and 58.5% for IMGs that aren’t) who submitted a certified rank order list, according to the PGY-1 main residency match.
IMG-Friendly Residency Programs by Specialty
As an IMG, you should also consider the fact that some specialties are more IMG-friendly than others. By doing so, you can take advantage of the varying match rates, visa support, and competitiveness of each medical speciality.
Certain specialties, like family medicine and internal medicine, tend to be more IMG friendly than highly competitive fields such as dermatology or radiology.
Naturally, you should still consider important factors such as work-life balance, career goals, geographic preferences, financial considerations, program characteristics, requirements, and research opportunities. Remember to use these parameters to guide you in choosing a specialty that aligns with your professional aspirations and personal circumstances.
For IMGs, it’s important to understand that during last year’s Match cycle, the NRMP listed internal medicine, family medicine, emergency medicine, pediatrics, and psychiatry as having the most IMG-friendly residency programs, based on the number of IMG applicants, as well as Match rates for IMGs.
Internal Medicine
Internal medicine is one of the most IMG-friendly specialties, has programs known for their structured support for IMGs, and high IMG match rates. (Be sure to check out internal medicine programs at community and some university-affiliated hospitals.) The field has many IMG-friendly residency programs that can provide mentorship, research opportunities, and a diverse patient population, which are beneficial for comprehensive training.
However, IMGs should still realize that although IM in general is good for IMGs, not every single IM program is IMG friendly. You should still do your research and understand that not all IM residency programs in the United States are IMG-friendly residency programs.
Family Medicine
Family medicine programs emphasize community and longitudinal healthcare, and often take on IMG residents as well. The strong community ties allow IMGs to gain experience in various settings, from urban academic health centers, to rural clinics.
Surgery & Other Competitive Specialties
While more competitive, some surgical and other programs are open to IMGs. It’s essential to research each program’s specific requirements and acceptance history.
Competitive specialties often require higher USMLE scores, substantial research experience, and strong letters of recommendation in addition to an impressive amount of US clinical experience.
Resources for Finding IMG-Friendly Residency Programs
It’s important to be aware of the resources available to find suitable IMG-friendly residency programs. There are a lot out there, but the two that come to mind are the AAMC Residency Explorer and FREIDA from AMA. Such residency program databases can help applicants narrow down their approach to applying for compatible programs.
IMG applicants can and should utilize these databases to find information about IMG-friendly residency programs, including program requirements, contact information, and links to their websites. Moreover, they can look at the collected data to see how other IMGs matched in years prior, as well as advanced match rate data and NRMP insights.
While researching programs, keep in mind that taking notes, bookmarking programs, and emailing your medical CV out to prospective program coordinators can be useful. Staying organized during this process will help to optimize the programs you’re eligible to apply to and maximize your chances at obtaining a coveted US-based residency spot.
“The Goldilocks Approach”
My general advice for selecting programs is to have a “Goldilocks approach,” one that’s neither too ambitious nor too conservative, but just right. Seek out and apply to a few programs that are “reach” programs, competitive programs which you hope to attend, but know that the road is difficult because they require high Step scores, have a low IMG acceptance rate, a high research publication count, etc.
The majority of your application should go towards attainable programs, those which are more in line with your scores and publications and have a decent shot at joining. And finally, save a few applications for some safety programs, those you likely have a shot to interview at (you easily meet the USMLE Step score, there are minimal or no research requirements, etc).
Using a Goldilocks approach when applying for IMG-friendly residency programs can significantly enhance your chances of matching into a suitable program as this balanced strategy helps to maximize your opportunities without overextending yourself or underselling your qualifications. It ensures you are not solely targeting programs with high competition where the odds are stacked against you, nor limiting yourself to less competitive programs where you might not fully utilize your potential.
By carefully selecting programs that fit your qualifications and goals, you can increase your chances of securing interviews and matching into a program that aligns well with your career aspirations and personal needs. This balanced strategy also allows you to present yourself confidently and authentically, leveraging your strengths while demonstrating your realistic understanding of the residency landscape.
Want more advice on program selection? Or perhaps you’d like an experienced set of eyes to review your ERAS application? Schedule a FREE consultation with myself or another residency advisor for personalized assistance!
6 Tips to Help You Match Into IMG-Friendly Residency Programs!
I want to end the post with a call to action to strengthen your application as an IMG! I recommend the following:
1. Achieve high scores on the USMLE Step 2 exam.
These scores often play a significant role in the selection process. Aim to score above the average for the specialty you’re applying to, as this can significantly enhance your chances of having your application reviewed and getting an interview.
Looking for a Step 2 Qbank? Meet the combined Step 2 & Shelf Exams Qbank with 5,500+ practice questions that most closely match what you’ll see on your USMLE Step 2 and all of your shelf exams. Get started with 7-day FREE access!
2. Gain hands-on experience through observerships, externships, or clerkships in the US.
These experiences provide familiarity with the US healthcare system and can lead to strong letters of recommendation, which programs value in their trainees.
3. Build connections within the medical community.
I personally know and have heard of so many positive outcomes for IMGs doing this. You must reach out to seek these opportunities, because things are rarely handed to you. You don’t need to believe my stories, but I at least implore you to read other popular medical blogs and residency forums. There you will, without a doubt, see the success stories of your predecessors and colleagues.
Furthermore, don’t be shy, attend conferences, join professional organizations, and engage with alumni networks. Seek mentors who have gone through similar experiences and can offer valuable advice, such as insights into the application process and interview preparation.
4. Be prepared for your interviews.
Know how to answer questions about your background, clinical experience, and why you chose to pursue residency in the US. Practice articulating your experiences and motivations clearly and confidently. Show enthusiasm and a willingness to learn. Research each program thoroughly and prepare thoughtful questions to ask during the interview.
5. Read success stories and testimonials.
Read about the experiences of successful IMGs and when you’re successful, share your story too. Doing so can be inspiring and educational. Many have shared their journeys, detailing the strategies and steps they took to match into good residency programs. These stories highlight the importance of perseverance, strategic planning, and seeking support. It’s important to continue to share your stories of success, as it’ll help those behind you, just as you were helped from those ahead of you.
6. Seek insights from program directors, who provide valuable information on what they look for in IMG candidates.
Many directors appreciate diversity and the unique perspectives that IMGs bring to their programs. Understanding the qualities and experiences that directors value can help you tailor your application and interview approach.
Final Thoughts
Navigating the residency application process as an IMG presents unique challenges. By strategically selecting IMG-friendly residency programs that fit their qualifications and career goals, IMGs can increase their likelihood of securing interviews and ultimately matching into a program that aligns well with their aspirations.
Be sure to reach out if you have any questions, and good luck on your quest to get a residency position in the US!
Looking for more (free!) content for IMGs? Check out these other posts on the Med School blog:
