If you consider the NRMP Data:
US IMG's have a 50% match rate overall.
79% percent of PGY1 anestehsia spots went to US grads.
Table 12 shows that there were 68 US IMG's applying for anesthesia. They had a 1.5% match rate. So, you'd best be considering a back up plan.
Perhaps I'm misconstruing the data, my apologies if I am, but I think it's amply demonstrated that IMG's, even US born, generally have a very tough time matching into anesthesia.
When looking at other NRMP match data like the 2009 data set, you have to compare your board scores with those of other IMG applicants, not the US grads.
The number of ranks needed to assure a 95% chance of matching for IMG's was around 20, so you'll need at least 20 interviews.
Regarding step I: The number of matched IMG's equalled the number of unmatched IMG's at board scores of 231-240. The number of IMG's matched exceeded the number unmatched once board scores exceeded 240.
For a score of 226, there were 18 matched compared to 47 unmatched.
The data for step II are pretty similar.
IF you chart the probability of matching as a function of Step 1 score, with a score of 260, the probability of matching was 80%. So, to answer your initial question, a 226 is not competitive.
Is that 2009 data? even still doesn't make sense that only 68 IMGs applied for anesthesia.
the link someone posted above has the 2011 match data. First the tables are divided into US seniors and independent applicants, IA's are FMGs (i,e, an Australian native going to an Australian medical school, finishing residency there and working as a Consultant and then moving to the US or wants to move to the US) IMG, (US citizens going abroad for med school.) DO applicants to allopathic programs, US seniors who didn't match in previous years or are switching residencies. It showed that in 2011 there were 1404 anesthesia spots offered. 1136 number of US seniors applied, of those 1095 matched and 41 didn't match. There were also 476 Independent applicants (the tables don't tell us how many IMGs or FMG's or DO's or whatever applied ) Of the 476 IA's 242 matched. Not sure where you got that only
Average step1 score for IA's who matched was 229, and 213 was the average for those who didn't match. the average Step2 scores was 231 for those that matched and 216 for those that didn't. The average IA who matched had 7.7 ranks on their rank order list, (that could mean they had less than 7 interviews because some programs have categorical and advanced spots and thus would count as 2 ranks on the list. Those who didn't match only had 2.8 ranks. Graph on page 30 shows that having 4 or more interviews gives you a greater than 50/50 chance of matching. last year 37 IA's had 4 interviews of those 21 matched and 16 didn't. So you don't need to have 20 interviews to match and in fact chances are you won't get any where near 20 interviews. To have a 90% chance of matching you need to have 13 to 14 contiguoug ranks which could mean 10 interviews if 3 of those programs offered both advanced and categorical spots.
OP, I guess it's getting much tougher to match in anesthesia, and unfortunately there's isn't much you can do in a short time that will improve your chances of matching. #1 obviously rock step2 and applying with a complete application on sept1 should be a given. You should have all your LOR's and Step2CK and CS scores uploaded to ERAS during the first week of september. Apply to as many programs as you can afford to, obviously it's a waste of money applying to places that have never taken an IMG, I would say you can save money by not applying to big names, unless of course you have something really special about you, (in 2010 a girl matched into Brigham and Womens from SGU) Of course her grades and bored scores were well above average but she also spent a few years living in LA, and was an extra in a few movies and was in a few commercials/tv shows, not to mention she was HOT, this field is dominated by men). You can also probably avoid applying to california (unless you're from there), NYC is getting tough too. #2 Schedule your anesthesia away rotations now, to get the dates that you want you have to schedule stuff 1 year in advance. Also do SICU or MICU rotation. Don't take a lot of fluff rotations during your 4th year, I did a surgical sub-I, ICU (ours was a mixed unit), and cardiology, as some of my electives. Anesthesia is huge on the ICU, I did a total of 6 weeks in the unit where I helped taking car of surgical, medical and neurosurgical patients. it would be like any typical rotation, we would take care of 1 to 2 pt's and present them on rounds and write notes and follow up on consults did scut work. I worked my ars off and preformed better then some interns on that rotation and that got me an impressive LOR from the Chair of ICU, anesthesia programs really liked that and asked me a lot about seemed to them like an extensive ICU experience. I also Joined the ASA during my 3rd year and read the abstracts of the journals.
Do a few away rotations and kick butt,. How to kick butt, Start IV's on pt's in the pre-op, Do the pre-op, present the pt to the resident or attending. Read baby miller to not be clueless about the drugs, be more vigilant then the resident/attending, if an IV bag is about to run dry get a new bag, you notice that the ETCO2 is getting low or high ask why they would want to keep it that high or low in this situation, this points that out to them and doesn't make them feel stupid because the medical student noticed that before them. Be proactive, help push the pt into the room, help applying monitors, help by taking the stretcher out of the room. know where the storage area is and be able to get stuff if something is needed, like more LR or an NG tube or an LMA. While in the OR if you remember reading a study from the anesthesia journal that relates to the case in some way bring it up, I would do this all the time, and found out that not too many people read our journal, probably program dependent. Learn to chart vitals and help by charting. Lastly never turn down a procedure and if alone with an attending or a senior resident ask to do as much as you can. I did spinals, intubations, IV's, felt the resistance and then loss of resilience to an epidural, and saw a bunch blocks. Talk to attendings and residents about getting involved with research, maybe you'll get lucky and there might be a paper ready to be published someone just needs to do some busy work and you might get a publication which might help with some programs.
Basically work your butt off for the next year and if you're lucky you'll match into anesthesi, because plenty of people do all this and still don't match, because what everything comes down to is do the attendings and residents think you'd be a good fit for the program, (it's like rushing a fraternity people need to like you.) You can do everything perfect and still not match, so have a back up plan, for me it was IM prelim year and then work my butt off to transfer into categorical IM and do a CCM fellowship. Hopefully your grades especially core rotation grades are awesome and you're not that far behind the ball, but your 226 is bellow average. good luck.
