International Medical Education

Matching residency programs and international medical graduates

Tim Mullaney , Contributing Writer

International medical graduates (IMG) have comprised a growing contingent of Match applicants in recent years. They have achieved notable success but also have accounted for the majority of unmatched applicants. While the 2016 Match results still are forthcoming, recent history suggests that the outcomes and experiences for IMGs are tied to a few key interview and ranking strategies.

Match trends for IMGs

The Match rate for IMGs has been trending upward, but in 2013, the majority of unmatched applicants were IMGs. Of all 8,388 unmatched applicants, 27.9 percent were U.S. citizens who attended an international medical school, and 46.4 percent were non-U.S. citizen international medical school graduates, according to an analysis done by researchers at the National Resident Matching Program (NRMP) and the University of California, San Diego.

A firmer understanding of the matching process could increase the IMG match rate, as a significant proportion of unmatched IMGs approached the interview and ranking process differently from matched applicants, according to the analysis of 2013 data. The study authors considered responses to the NRMP Applicant Survey and other data sources.

4 ways IMGs can boost their odds of matching

Among the takeaways, these are four strategies that more IMGs—and other applicants—could adopt to improve their odds of matching:

  • Attend all interviews. Of unmatched U.S. citizen IMGs in 2013, 11 percent did not attend all interviews. That percentage rose to 17 percent for unmatched IMGs who were not U.S. citizens. By not attending all interviews, IMGs “failed to capitalize on every opportunity to market themselves,” the study authors noted. The authors acknowledged that further research is needed to determine why IMGs may not be attending interviews, as geographic, financial and cultural considerations could come into play.
  • Rank all programs at which they interview. Among unmatched U.S. citizen IMGs, 7 percent did not rank all programs at which they interviewed. For unmatched non-U.S. citizen IMGs, 22 percent declined to rank all programs at which they interviewed. By looking at the rank order lists of unfilled programs, the researchers determined that 70 unmatched IMGs who had a preferred specialty would have matched if they had ranked an unfilled program that had ranked them. Along the same lines, ranking programs at which the applicant did not interview is another unsuccessful strategy that was more often employed by unmatched IMGs compared to matched IMGs.
  • Rank all programs they are willing to attend. Among U.S. citizen IMG applicants who matched, 52.3 percent ranked all the programs they would be willing to attend, but only 40 percent of unmatched IMG applicants did so. For non-U.S. citizen IMG applicants, 40.1 percent of matched applicants ranked all programs they would be willing to attend, compared with only 31.1 percent of unmatched applicants.
  • Do not rank programs based on a perceived likelihood of matching. Due to how the matching algorithm works, it is not advisable to rank "Of all 8,388 unmatched applicants based on a perceived likelihood of matching with them, the authors said. But 36.3 percent of unmatched U.S. citizen IMGs and 33.5 percent of unmatched non-U.S. citizen IMGs did so in 2013. Only 19.5 percent of matched U.S. citizen IMGs and 18.1 percent of matched non-U.S. citizen IMGs adopted this strategy.

There are numerous other interview and ranking strategies that IMG applicants could benefit from utilizing more often, the findings suggested. These include ranking a mix of competitive and less competitive programs, and ranking one or more programs in an alternative specialty as a “fall-back plan.”

Overall, some IMGs may benefit from a more complete understanding of how matching works. This may be one reason that IMGs sometimes turn to for-profit companies that claim to increase the chances of matching—but program directors by and large “disdain” these companies, the study authors stressed. IMGs instead should seek out education that will enable them to “champion their own capabilities,” they wrote.

Resources to help

The AMA offers a variety of resources to help IMGs be their own best advocate while navigating the interview and ranking process. These include access to FREIDA Online®, the AMA Residency & Fellowship Database™ (which has information on more than 10,000 accredited graduate medical education programs), a guide to the medical residency interview for IMGs, advice from current residents and a sample residency interview.

The AMA is dedicated to supporting and advocating for its IMG members, who are 38,000 strong. And the number of IMGs seems destined to grow, the NRMP figures show: The number of U.S. citizen IMGs in the Match increased 33 percent between 2011 and 2015, and the number of non-U.S. citizen IMGs who matched last year (3,641) set a new record.