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As a program director, I hear about a lot of wonderful candidates who unfortunately were not successful in the match. As these kinds of conversations unfold, it always becomes clear to me why these residency hopefuls did not match. For example, I learned about a candidate who graduated from an excellent international medical school with fairly good USMLE® scores and reasonable clinical experience who only ranked 3 programs! Another candidate failed the USMLE® CS portion twice and was going for a third. I couldn’t help wondering why this candidate didn’t take immediate stock after the first failure.
I’m a believer in second chances and moving forward confidently. However, in the business of obtaining a residency position, there are certain realities that cannot be ignored. Data are abundantly available to help residency candidates maximize their chances for success. Paying attention to these reports and obtaining a knowledgeable mentor will go a long way toward helping you achieve your ultimate goal – to become a licensed physician in the United States.
A recent report released in January 2014 by the NRMP and ECFMG about the match outcomes for IMGs in the 2013 match reveal the characteristics of the successful IMG applicant to his or her preferred specialty (1). There are no real surprises to be found here. The successful IMG applicant ranked more programs, had higher USMLE® Step 1 and 2 scores, had fewer attempts at these exams, were U.S. citizens, and spoke English as a native language. The mean USMLE® Step 1 score for those U.S. IMGs who matched was 217 compared with 204 for those who did not match. For non U.S. IMGs the mean score for those who matched was 227 compared with 213 for those who didn’t match. The mean USMLE® Step 2 scores among U.S. IMGs and non-U.S. IMGs who successfully matched were 224 and 233 respectively, and for those who did not match, the U.S. IMG and non-US IMG mean scores were 209 and 218 respectively. Overall, 48% of U.S. IMGs matched to their preferred specialty; the percentage ranged from 59% in Anesthesiology to 28% for Emergency Medicine.
The preliminary match data available for the 2014 match do not reveal much of a change from last year’s data. In the 2014 match, there were more IMGs in the match which is not surprising given the All-In Policy implemented two years ago. The percentage of U.S. IMGs who matched was essentially stable from last year at 53%, compared with 52.8% last year. The percentage of non-U.S. IMGs who matched was 49.5% compared with 47% last year. Of those matched applicants this year, 54.2% of U.S. seniors got their first rank compared with 49.8% of independent applicants. Competitive specialties including Dermatology and Radiation Oncology were filled entirely with U.S. seniors. Specific details about the preliminary 2014 match data can be accessed from the NRMP web site and further analysis still needs to be done to provide information about step scores and other candidate characteristics.
The following are recommendations to improve your chances for the 2015 match expected to be more competitive given the proliferation of new U.S. medical schools and relatively stable residency slots.
- You must pass all the USMLE® steps and CS the first time and based on the above data, you must prepare for these exams carefully to maximize your scores. While step scores are by no means the only criteria, they represent a first cut for invitations to interview in many programs.
- It is important not to take an excessive amount of time studying for the exams since PDs review time spent away from clinical activities to study – remember that programs are accredited by their ABIM board passage rate, and candidates will want to demonstrate the ability to manage standardized tests within a reasonable time frame.
- Research and choose your specialty wisely and have a back-up plan. You need to be honest about what your ultimate goal is. Do you want to be a practicing physician or take a shot at a very difficult residency to obtain? If you choose poorly, you may find yourself without a spot and an additional year out of medical school (see below). At the very least, consider safety specialties, unless you can’t imagine doing anything else but your first choice.
- Remember that programs evaluate how much time has elapsed since the candidate has graduated from medical school. The longer the period of time, the less likely it is to obtain a U.S. residency program.
- Obtain good advice at every step of your application to residency. Do not try to wing it – you may make a mistake that could have been easily avoided with the right counseling.
1. National Resident Matching Program and Educational Commission for Foreign Medical Graduates. Charting Outcomes in the Match for International Medical Graduates, 2014. National Resident Matching Program and Educational Commission for Foreign Medical Graduates. 2014