Matching to the United States as an International Medical Graduate

1. As an IMG, can I practice independently in the US without pursuing a residency?

Unfortunately, the answer is, “no” for most specialty. Generally speaking, some level of medical training in the US is required prior to obtaining qualification for independent practice. It means that, for the majority of specialties, a residency training is required. However, for certain specialties, an IMG with prior residency training may pursue a fellowship in order to qualify for independent practice. Such specialties may include, orthopedic surgery, radiology, and transplant surgery. However, such opportunities are quite limited.

2. What is the USMLE and ECFMG? How do I obtain these qualifications?

The USMLE (United States Medical Licensing Exam) is a 3 step examination to assess a physician’s medical knowledge and clinical skills. It is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME).

The Educational Commission for Foreign Medical Graduates (ECFMG) is a private, non-profit organization that, through its program of certification, assesses whether international medical graduates are ready to enter accredited residency or fellowship programs in the United States. You cannot match to a residency program without the ECFMG qualification.

After you have completed Steps 1 and 2 of the USMLE, you are eligible to apply for the ECFMG. You may complete Step 3 of USMLE during residency. Certain states require Step 3 to be completed before starting 3rd year of residency.

3. Should I do an elective or observership in the US before applying?

You should absolutely try to obtain an elective or observership position prior to applying for residency or fellowship positions. Currently, more and more IMG conduct such clinical activities in order to learn about the US healthcare system and become more competitive for the matching process. It also helps you obtain reference letters and prepares you for the very crucial interview process. Most IMGs will do 2-6 months of elective or observership.

4. How many residency programs should one apply for?

Usually IMGs will apply to 100 to 150 residency programs, but the number really depends on how competitive the specialty is. For those applying to more than one specialty, some colleagues have told me it could add up to 200-300 applications. It is a time-consuming, stressful, and expensive process. As the number of IMG applicants keep increasing, on average, each program will get 1000-2000 applications per year. In certainly specialties, such as internal medicine, there could even be 4000-5000 applications for a mid-sized residency program (10-12 residents/year). Therefore, ideally, you want to apply once only and give your best shot.