The application process and Match prospects are different for international medical graduates. IMG and veteran of the Match, Victor Kolade, MD, MS, FACP, offers a few tips and tricks for applicants.
- Victor Kolade, MD, MS, FACP, internist at Guthrie Robert Packer Hospital
- Brendan Murphy, senior news writer, American Medical Association
- Todd Unger, chief experience officer, American Medical Association
Dr. Kolade: I don't remember how many programs I applied to the first time, might've been 1, 2, 3, 5—I really don't remember. But realizing that if my finances improved from that time to the next year, I could probably apply to more programs. That would be one thing. I no longer had to go sit in a friend's house to go do the applications. So, anything that allows you to have more resources to give your best at the next Match you can work on.
Unger: That was Dr. Victor Kolade, an internist at Guthrie Robert Packer Hospital in Pennsylvania.
On this episode, Dr. Kolade shares his experience applying for residency as an international medical graduate. Here’s AMA senior news writer, Brendan Murphy.
Murphy: Hello and welcome to Making the Rounds. I'm Brendan Murphy, senior news writer at the AMA. Today, I'm talking with Victor Kolade, MD, MS, FACP. Dr. Kolade is an internist at Guthrie Robert Packer Hospital in Pennsylvania. Dr. Kolade, welcome. How are you doing today?
Dr. Kolade: I'm doing very well, thank you. Appreciate it, Brendan.
Murphy: We're so glad to have you on the show today, to get your perspective on how current IMG applicants should approach the Match. I think a good place to start is, can you tell us about your circumstances as an IMG applicant? Where did you do your medical training? Why did you come to the States? Those types of details.
Dr. Kolade: Thank you very much. So let's start there. I am a U.S. IMG. I was born in DC several years ago and went back with my parents when I was about six—spent the ages 6 to 26 in Nigeria—and that included med school for me. My dad's a surgeon at the tail end of retirement at this point, and he was the inspiration for doing medicine. He said, "Try it out. If you don't want it, can't do it, let it go." But I did do it and I'm here now. And as far as coming back, because I could probably have stayed in Nigeria, my junior brother is there till now. But there was a season when I felt like I saw myself coming back to the States. So, by this time, I think I was in medical school or something. So here was my tool. I mean, my top game was to be a doctor in the United States. So here we are.
Murphy: And you’re U.S. IMG. Last year, the match rate for U.S. IMGs was about 68%. Non-U.S. citizen IMGs, it was 60%. So, you still face a bit of an uphill climb doing that. How did you approach the match process? How many programs did you apply to? Were you applying to multiple specialties?
Dr. Kolade: Good question. Full disclosure, I attempted the Match twice. The first time I wasn't particularly ready. I looked at family medicine in that season, maybe did a few applications, didn't get any interview opportunities. Tried unsuccessfully the SOAP, as it was called then. No, I think it was just called Scramble, and we now know it as SOAP, the supplemental application that you can do. So, I put more effort in the SOAP—it feels like—than I put in the original application, but none of them went through. So, the following year I switched to internal medicine. I don't think I remember exactly why I did that. I think part of it is that if you look at the data, the odds of matching in internal medicine are higher for IMGs than they are for family medicine, that may have been part of it. But that was a switch that I made. I was more deliberate with my applications. I remember doing 16 applications at the time, way back then. I got three interviews, and I was able to match. I believe I matched my top choice.
Dr. Kolade: So full disclosure, I was an intern on 9/11. So that means my successful match was the 2001 Match, and my unsuccessful match was the 2000 Match.
Murphy: You said you weren't ready the first time through. What changed the second time you applied?
Dr. Kolade: Maybe I was doing a little bit better, resource wise. So, taking that into the kind of barriers that people might face. Of course, I know that now people are able to successfully enter the Match and run it while they're outside the country. That wasn't my experience. When I came back to the States, I had one step in hand and one step needed to be completed. So, first assignment was to get that second step done—and then put the application together, get references, the different things that need to be done with the application. But then applications take resources. So, depending on what you're doing, what kind of work you're doing, how much income you have, how much support you have otherwise, then maybe you don't actually have spare funds to apply.
And then, of course, in the season that I went into the Match, you had all in-person interviews. So, for instance, if you ask me where all the 16 programs that I applied to are, they probably were in the New York City area where I lived at the time, and I knew I could get to via the subway. I didn't own a personal computer for either of the matches that I did. I remember going to a friend's house that I went to church with to do the SOAP. I was like, "Guy, let me into your house and let me use your computer and the internet. Let me try the SOAP out." So that's how I did that back then. We got our first PC when I was an intern already. So, the more resources you have, the more that you can do. I think part of what we'll be talking about as we go through this session is, put your best foot forward all the time.
Murphy: And as an IMG applicant, applying to 16 specialties, getting three interviews is a pretty good ratio. In 2022, the average IMG applicant submitted 139 applications. As you said, the process is much different now. Interviews can take place virtually. So that definitely eliminates a barrier to applying to many applications. But it is still costly to apply to many programs. Now, looking back on your own experiences, how did you evaluate programs? What did you look for in programs that you were applying to? You said geography was a factor. Are there other factors you'd like to highlight?
Dr. Kolade: Well, I will say that I looked at salary. I remember, and it probably was that second season, so my more successful season of interviewing. I have an uncle that practices pediatric surgery in California to this day, and he's been there for years. And he said to me in that season, "I have a program director friend here that would probably take you. Would you come to California?" And I thought, I am in New York. At that time, looking at their data, it might've been from FREIDA or the AMA handbook that I did the search, or the NRMP handbook, whichever one, but you can find the salary information within a public domain.
So, their salary out there for California was about $12,000 per year less than what my top program in New York was offering. So, I said to myself, am I really going to move myself from New York to California, spend $1,000 or $2,000 that I don't think I have, to move there and earn less? I didn't think it was a good proposition. Of course, factor in the fact that cost of living is probably higher in most California areas than it is in New York City. So that was one thing, I was coming from relatively low in terms of resources. Not that I was looking for a gold mine to result as part of getting into residency but wanted to be able to do basic things. So that was one thing, looking at what the math was going to be like.
Murphy: You mentioned you had three interviews. What was the interview process like for you?
Dr. Kolade: Interview process was interesting. I think the interviews differed a little bit, one from another. So, I remember one interview, not for my top program now, but I went out to Queens, New York, for this interview. And we're having this discussion, I think I'm meeting with the vice chair of the department and he's asking me didactic questions. So, you sometimes wonder what you're going to be asked in an interview, whether it's going to be clinical information or nonclinical information. The programs want to get to know you, the programs want to get to know how you function and operate. At the same time, they want to be assured that you can process clinical knowledge. Some of that information comes from your scores and perhaps your letters, but they may or may not pick you up on it.
So I'm talking to a vice chairman that is interested in endocrinology and he's asking me a question about diabetes. And there used to be, I don't know if it still exists, I haven't gone to check it online anymore. I think this was pre-UpToDate for people that are familiar with the database called UpToDate. There was an open access database and that's where I did a lot of my studying from. So I'm spouting out the information I got from eMedicine. And for a minute it's flowing well out of my mouth in terms of, “Okay, he's asked me a question I can answer.” And the guy says, “No, that's not right.” And it turned out that the information I was looking at wasn't up-to-date.
So, the moral of this story is, you may find different websites that say different things. You may even find publications, journal articles and so on that say different things. You need to be careful about the fact that information turns rapidly over in our information system here in the U.S. And you're better off searching for the guidelines for different conditions. The American Diabetes Association, for instance, puts out a guideline every year called the Standards of Diabetes Care for the Management of Diabetes. And we need to look at that rather than look at papers that may have been written five or 10 years ago. So that was one interesting thing that came out of the interview for me.
Murphy: Are there interview questions that might be unique to IMG applicants? And what might they be?
Dr. Kolade: Good question. I think that that is a place of curiosity, people asking questions to try to get a sense of the education people have gotten. I think people are comfortable with what rotations U.S. medical students do. They have some inkling of what D.O. students do, perhaps they don't have a lot of idea of what IMGs do. So, for instance, at least when I was in training, we didn't have duty hour reckoning. My current medical students log their duty hours per week and they're monitored. We didn't have those kinds of things. Some of the IMG applicants have worked in different settings after they've graduated. Most of them maybe have graduated two or three years before they're coming into the Match process, versus a lot of the U.S. students are matching as seniors. So, they have work experience that they can talk about. And sometimes when you hear what IMGs are talking about with their work experience, they don't seem real to the way that we practice in this part of the world.
So, I think those kinds of questions could easily come up as people read the bios and CVs that people have written. I mean, not that these are bad things, but I think just things that people should be prepared for. So, if somebody writes in his bio that he was seeing 40 patients a day in the job he took in the first year after residency, that's unusual for somebody who's first year out of anything over here. So, somebody may ask, "Tell us more about that. What did that mean?" Of course, one of the reasons that can happen is, at least for the season that I was working in Nigeria after graduation, I didn't use an EMR. So whatever you wrote down, whether copious or not is what you went by. And it's a different dynamic when you have an EMR. Of course, now people have gotten good with templates and they can move very fast. But most likely, people that are not held to a very high documentation standard are seeing more patients. So, things like that.
Murphy: So it's part of the onus on the IMG applicant to get a thorough understanding of the U.S. system of care?
Dr. Kolade: Absolutely right. As best as they can. And I know people do observerships, some don't. Some programs vary on what importance they attach to these observerships, and I think people should be watching for things like that. I hope people are not going into observerships just to show up and, yes, observe and do what they are allowed to do and to get letters. But I think people need to be looking at it, what does this look like? What will this feel like when I start to do it? How hard or easy is it to learn how to use the electronic medical record and so on? So, I think people need to be introspective as they do their observerships if they're doing them.
Murphy: Did you do an observership?
Dr. Kolade: I did not. Full disclosure, I did have a U.S. letter because I know that, at least back in the day, people used to be concerned about having at least one U.S.-based letter, and my uncle that I referenced earlier wrote the letter. Now of course, he hadn't worked with me and he's a surgeon. I was coming into internal medicine. But what he focused on in the letter was—in case you're not aware, this is a good school that he's come out of and I think he can probably do what is expected for him in a trainee role. So, I think that's how he wrote the letter, and that probably helped.
Murphy: You mentioned a couple of times that you have an uncle who's a surgeon in California. Mentors are important for anyone in the match. But with IMGs, who may not have as much exposure to our system of care, they might be extra important. How important were mentors to you in the residency application process? How did you find your mentors? And how do you recommend current IMG applicants find their mentors?
Dr. Kolade: That's a good question. I think one way to spring out, for instance, I'm talking about the family mentor there and what he did. So, whoever's close to you may be able to do something. Now, are they always going to be able to do everything that you hope or want them to do? Maybe not. So, for instance, even if I would've taken the offer and tried to interview in the California program, would I have been successful there? I do not know. So, it's not about the mentor delivering everything to you that you need. It's really about, as an IMG coming into this process, you have several needs. So, for instance, we're talking about getting a sense of how the system works and what does it mean to have an electronic medical record and manage an in-basket and things like that. So, there are many things that you want to try to find out about the system. That's one thing. So, ask as many people as will give you an ear that you have an idea of how it works.
I did have one mentor who was able to get me an interview with his program that was an off-cycle interview. I wasn't successful at that interview, but it was my first in-person interview and I think it prepared me for the other interviews that I did. So, every input from a mentor person counts. Full disclosure. Sometimes you will get information that you can't use. So yes, Brendan, you mentioned that it's common for people to make more than a hundred applications as they go through the process. Yeah, I was going to church with another gentleman who was applying in the same season, and he said, "This is what I did. And here's what I'm doing." I didn't have the resources to apply to a hundred programs.
So I think the way the Match financing was written then, your first fee covered 10 programs, and then you paid per program as it went on, something like that. So carefully screening the programs with the resources that are available. If the programs post information on their website saying that they're looking for certain score cutoffs with the exams, and you don't have them, they may not be your primary program to apply to. You try to avoid applying to programs where you would be screened out as they process the applications. I'll give an example. The program that I currently work in typically gets thousands of applications per year, maybe 3,000, 4,000. We have at the present time 12 spots. So you can imagine that there's a lot of filtering that goes into determining who gets interviewed. And then you have a rank process that you use to determine what order you set up the candidates to possibly come in if they rank you highly enough on their end.
So the more people you can hook up to, to get information, the better. As far as mentoring goes, let me quickly mention that although I was not aware of the opportunities for mentoring either through the AMA or I'm an internist, so ACP is my specialty organization. Those are useful avenues to follow, meaning you don't have to know these people. You go in the database, and you sign up for mentoring. And if the mentor works with you then you can ask a lot of questions and you can get a lot of valuable information back. That's what I would say.
Murphy: So, the fee for residency applicants this year is—up to 10 programs for a specialty costs $99. Additional 11 to 20 programs costs $19. 21 to 30, $23 each. 31 or more, $27 each. And that can add up quite a bit. If you're applying to a hundred programs, that will be in excess of $2,000. So that is good context and that is helpful to know. And maybe, for some, that does cause people to be selective about where they apply. So, on the actual Match Day your second time through, where'd you match and how'd it feel after an unsuccessful first attempt?
Dr. Kolade: I matched to Kingsbrook Jewish Medical Center in Brooklyn, New York. I was very happy. That was my top program that I chose. The interview had gone well, so I was very happy. My wife was with me. We were both in celebration mode, so it was good. And I went there and served my three years.
Murphy: Now you work with IMGs as a practicing physician, and I'm sure you're speaking to them as part of their application process. What are some of the logistical challenges that U.S. grads don't often confront that IMGs might? And how do you recommend they navigate them?
Dr. Kolade: Well, one is visa. Now that, I don't have personal experience with. And although I've listened to a lot of people talk about visas, I don't have the expertise to give lots of advice with that. So you have to figure out … there are two main visas that people would be trying to get. There's the J-1 visa, and then there's the H1B, or some people have access to an H1A. I think finding out, could be online, asking people what the best way to go with that and what that might look like. That may also be something that affects the programs that people can apply to, because programs can decide whether they will sponsor visas or not and they can decide what kinds of visas they'll sponsor because sometimes there are costs involved. I think the applicant bears a lot of the costs, but the institution typically has to retain the services of a lawyer to work on these applications.
Sometimes people are concerned that people may not arrive in time to start on July 1. So, the Match occurs middle of March. So, programs are selective in terms of what kinds of visas they offer. Some visas, I think the H visas perhaps, one of them is easier to work with than the other. So, programs tend to lean towards going the easy way. The one that isn't as easy tends to be more favorable for the IMG applicant. So, something to think about and look into.
Another thing would be location. With the advent of virtual interviews that COVID brought us, people have been able to do their applying completely from outside the States and only come into the country when they've matched and on the visa that is set up for them to come into a residency. Otherwise, what people were doing was either trying to come into the U.S. some other way or applying at home and then coming in for interviews. So maybe that's mitigated, to some extent, because now I think the rate of people succeeding, the numbers that you quoted earlier, Brendan, are higher than I remember. 68% success rate had a match for U.S. IMGs, and 60% for non-U.S. IMGs—that's higher than I remember. So that's good. I think it's one of the blessings we can attribute to the pandemic and the navigation that we did around that towards virtual interviews.
Murphy: When you need help navigating that visa process, where should you look, as an IMG?
Dr. Kolade: I think one of the places to look is probably what we call ECFMG. I think we call it Intealth now. So you can look there and see what kind of advice is there since we're throwing around names of visas, H1B, J-1. So, you could probably go on the U.S. website that has these visas. It could be travel.state.gov or some other, and then get basic information. Of course, if you are reading a webpage that's privately written, try to crosscheck the information in an official scenario before you go with it.
Murphy: The Match rate is higher than you remember, and it is improving for IMGs. Essentially, 7 out of 10 U.S. citizen IMGs match, 6 out of 10 non-U.S. citizen IMGs match. But still, that means four out of 10 non-U.S. citizens don't and three out of 10 U.S. citizens don't. You yourself were a second time applicant when you matched. What advice do you have about persistence in this process for IMGs? What advice? Is that good?
Dr. Kolade: Okay, in terms of what do you do in that holdover season? I think what you do, rather than say to yourself, “Oh, this is a bad process and I don't know why this happened.” I think what you want to do is turn inward and look at the opportunities that you have to improve yourself. Some opportunities, or rather some areas for improvement may be directly obvious to you. I don't remember how many programs I applied to the first time, might've been 1, 2, 3, 5—I really don't remember. But realizing that if my finances improved from that time to the next year, I could probably apply to more programs. That would be one thing. I no longer had to go sit in a friend's house to go do the applications. I could do them in the library at work. I still didn't have a PC, but at least I had somewhere I could go. I just had to skip a number of lunches so I could do it. So, anything that allows you to have more resources to give your best at the next match you can work on.
The other piece of it will be, are there opportunities for additional education? So, some people get Master's degrees while they're waiting for their best opportunity they match. It could be an MPH. The master's that I have, I did after residency, but some people will do those kinds of masters. My master's is in epidemiology, things like that. Some people may do a master’s in healthcare administration. So whatever opportunities you get for further training, people appreciate that, from an applicant screening standpoint. And the other piece of that is if you're going into a scenario where you're studying in the United States, then there's a perspective you get of how students operate. You have an idea of what your competition is like, to some degree. Now, would you have a lot of other doctors in your program? Maybe not. I think there were four other doctors in the master's class that I was in. But of course, this wasn't a pre-residency class for me. But sometimes you have doctors.
Some residencies allow people to get an MPH while they are in the residency. For instance, if people are doing a preventive medicine residency, there usually is an MPH included in that. So, depending on what program you're doing and where, you may actually be rubbing shoulders with U.S. doctors, U.S. seniors going to apply and so on and so forth. Some people are doing MD/PhD programs. You may end up taking some classes with people like that. So, the more people that you meet, and you can ask questions from and you can project what the scenario you're trying to get into looks like based on their experiences that they talk about in class or to you, then that helps.
Murphy: You mentioned these opportunities to improve your standing. Is there the possibility to understand what might be the weak spots of your application?
Dr. Kolade: I'm glad you said that because I almost forgot to go with that. So, thank you. When you go into the Match and you read the rules from the NRMP, National Resident Matching Program, you will see something about post-interview communication. And what that's supposed to say, the spirit of it, the way I understand it is, you're not supposed to lobby programs that you've interviewed at, saying to them close to rank all their dates, "I've ranked you at the top of my list, I hope you'll do the same. And thank you for reading my email." So those kinds of emails or that kind of communication as a whole—it's discouraged, to the point where some programs say, don't get in touch with us at all after the interview. On the flip side, the human element of this process is such that if people know that you're interested in the program, they may view you more favorably than if they didn't. Now, fast-forward to where we are now, program signaling is used to express interest in the program. So maybe post-interview communication is truly not important.
However, there's nothing wrong with post-Match communication. Meaning, if you fail to match and there were some programs that you thought you had good vibes about in the process, nothing wrong with sending an email to the staff there and saying, "Are you able to tell me what transpired? Is there any advice you have for me in case I want to upgrade my application and come back to you in a coming season?” And sometimes, working on the program side now, we've been able to have those discussions with people, the kind of things that we've just said. If you want to go do a master's degree, go do it and come back. If you have research in hand from your medical school or the graduate days that you can publish that you haven't done anything with, do that. I mean, how can you improve your bio, have more line items on your bio than give a full accounting for who you are?
Another thing that I can drop here in terms of people being able to sell themselves in the application process is to realize that what you probably should be doing in the ERAS bio that you create, we think of CV—curriculum vitae—and it's all line items. Or you think of resume, where it's also very short and you're only putting the headers in there, "I went to med school from this year to that year, and that's the name of the med school. I did a master's from this year to that year."
But I think that your application is broader if you're able to narrate as fully as possible the different experiences that you had. So, if medical school was a season where you were going somewhere once a month to volunteer for something—it was something you all did as students, but you probably should be including that. If there was some free clinic or some free service that you were doing, or there was some rural rotation where you had a unique experience with public health that you did as part of your school season and the kind of things you were able to do, you should probably find a way to have narrative information on that in the bio that you create for ERAS. So, it's not just about having line items that say name of school and so on. You want to be able to, as fully as possible, account for the time and what you do and how you interact with people throughout the season that's covered by your bio.
Murphy: You have, we should mention, been on the program side of this as a physician. You also, of course, were an IMG applicant. So you've applied and you've worked with IMG applicants. What are some mistakes you'd advise IMG applicants to avoid?
Dr. Kolade: Please proofread your personal statement as carefully as you can. The fewer typos you have in a personal statement, the better. I think that people need to be careful about explaining gaps in their CV, because many times people are coming into the Match a number of years after graduation. So you want to be able to explain those things. On the U.S. side of things, the commonest reason that people have a gap between the time that they graduated from med school and the time they go into the Match is maybe a failure or something like that, occasionally it might be illness. But most people are going into residency right after medical school graduation. So, if you're coming into the Match five years, six years or more after the Match, you have a little bit of explaining to do. It doesn't have to be something complicated, but I think you should acknowledge it. It's something that makes your application stand out in a way.
Anything that's negative, if you had a failure on the exam and there was some real reason why that happened, you want to be able to talk through it, not because you necessarily have to justify it, but if that was a season in which you learned resilience and how to bounce back from an adverse event, then you can speak to it. You really are trying to keep your personal statement to one page. But I think key things that you want to do are cover things that stand out about your application, you want to give people a sense of why you're interested in this specialty that you're applying to.
If you have an idea, you may want to drop a hint about what you think you'll do after residency. So some people come into internal medicine for instance, because they want to do a specialty. They want to become cardiologists or some other specialist like that. Some people know that they want to teach when they're done with residency. Some people know that they want to work with underserved populations. If you have strong feelings about any of those, it doesn't take but a line or two to state that, and I think that is a way to round out your personal statement. So I think the personal statement is pretty important.
Please don't write long statements if you don't have to. If you have circumstances you have to explain, you might go over a page. But you're trying to write a page where you're trying to put things in there, you're trying to describe yourself as vividly as possible and give people the information they need. You want people to be done reading your personal statement and say to themselves, I want to be that gentleman. I want to be that lady. I'd like to have a conversation with them. So that's what you want people to come out of the personal statement with.
Murphy: You had built-in mentors. How would you recommend someone coming to this process without that built-in network goes about identifying their mentors.
Dr. Kolade: I'd say go on the AMA website. We do have a cadre of mentors within the AMA IMG program, and you can request mentoring there. And if you get a mentor to pick you up, you have a listening ear that can answer questions for you until you stop asking them. So, I think that's a good way to do that.
Murphy: Dr. Kolade, as he mentioned, is a member of the AMA IMG section. We've included the link to the page on mentorship he mentioned in the description of this episode.
Murphy: Well, that's all the questions I have for you. Do you have anything you'd like to add? Any other nuggets of advice for IMG applicants?
Dr. Kolade: I feel like we've covered all the things that we should have covered. I think the keyword that I would like people to take away is tenacity. Look at this Match process as if you're going into an election for something. You may win the election, and then it's easy. You may be the first runner up or second runner up, you didn't win the election, but you have a lot of momentum that you have to decide what you're going to do with it later. Getting a residency spot in the United States is not a right. It's a privilege. It's something you're running up against. And the same way you would strategize to win an election, you would need to strategize to win a residency spot. That's what I'll say.
Murphy: Tenacity indeed. I think any applicant should approach the process with tenacity.
Murphy: We appreciate you taking the time to join us today, Dr. Kolade. I'm sure these stories, and your story is a very unique one, will be very helpful to our listeners.
Dr. Kolade: Thank you so much. I appreciate the opportunity.
Murphy: I'm AMA senior news writer, Brendan Murphy. Until next time. This has been Making the Rounds.
Unger: Don’t miss an episode of this Meet Your Match series. Subscribe to Making the Rounds on your favorite podcast platform or visit ama-assn.org/podcasts. Thanks for listening.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.