Is matching for residency the only route to practise medicine in the US as an IMG?

[electiveresearch2]

Hi all,

I was wondering about the routes for practising medicine in the US for IMGs. So far it seems there are 2 potential routes:

1) Get matched to a residency programme.

2) Apply for a fellowship once you are already part-way through training in your home country and then possibly get a job after that

Is number 2 possible, or is the only way by starting from scratch in residency? And are there any other routes I am unaware of?

If it's important, I am from the UK.

Thanks in advance!

---

Members don't see this ad.

 

[phdtomduk]

There is only one route to practicing medicine as an IMG in the US– matching to a residency. Even IMGs who have completed residency/fellowship or have been practicing physicians in their home countries need to complete a US residency in order to obtain a license to practice medicine in the US. The only* way to obtain a residency in the US is through the residency match.

*There are a very limited number of residency positions available outside of the match. These positions are almost exclusively in low-tier community hospitals and target IMGs who are not competitive in the regular residency match.

 

[electiveresearch2]

There is only one route to practicing medicine as an IMG in the US– matching to a residency. Even IMGs who have completed residency/fellowship or have been practicing physicians in their home countries need to complete a US residency in order to obtain a license to practice medicine in the US. The only* way to obtain a residency in the US is through the residency match.

*There are a very limited number of residency positions available outside of the match. These positions are almost exclusively in low-tier community hospitals and target IMGs who are not competitive in the regular residency match.

I see, thanks. Apart from USMLE scores, what do they take into account when matching you? I imagine publications, presentations, performance in medical school, letters of recommendation.. is there anywhere that publishes how each of these are weighed?

Also, is there a document of sorts that shows how competitive certain specialties are when matching?

 

[phdtomduk]

I see, thanks. Apart from USMLE scores, what do they take into account when matching you? I imagine publications, presentations, performance in medical school, letters of recommendation.. is there anywhere that publishes how each of these are weighed?

Also, is there a document of sorts that shows how competitive certain specialties are when matching?

They take all of that into account. There are lots of threads here talking about what residencies/PDs look for and a significant amount of information available on other websites about matching. Different specialties/programs assign different levels of importance to various aspects of your application. Research, for example, is essentially required for certain specialties and academic programs. Community programs likely care very little about research. Step scores are a must for all applicants, and particularly important for IMGs as it gives an objective measure of assessment. Performance in medical school is probably not too important, particulalry for IMGs since US PDs don't have a way to assess international medical school programs. Letters of recommendation are very important. IMGs typically need letter of recommendation from US physicians. These LORs are usually obtained during US clinical clerkships, which are critical for IMGs.

The NRMP publishes data on residency matches every year, including information on step scores, research, etc. broken down by specialty, IMG status, citizenship status, etc. This is the NRMP 2018 report. This is the IMG specific residency matching report.

You'll be able to see this from the data, but it is extremely difficult to match to the US as an IMG. It is pretty much impossible to match as an IMG to a competitive specialty. IMGs need high step scores just to match to even the least competitive specialties (i.e. internal medicine, family med, peds). IMGs have almost no chance of matching to orthopedic surgery/ENT/ophthalmology/dermatology/most surgical subspecialties. Every year the number of IMGs who match to these specialties are in the single digits and these candidates are absolute superstars who pretty much all have phds, with the majority having completed specialty training in their home country or having done research for many years in the US. If your heart is set on one of these competitive specialties, it is probably wise to not waste your time trying to go to the US.

 

[electiveresearch2]

They take all of that into account. There are lots of threads here talking about what residencies/PDs look for and a significant amount of information available on other websites about matching. Different specialties/programs assign different levels of importance to various aspects of your application. Research, for example, is essentially required for certain specialties and academic programs. Community programs likely care very little about research. Step scores are a must for all applicants, and particularly important for IMGs as it gives an objective measure of assessment. Performance in medical school is probably not too important, particulalry for IMGs since US PDs don't have a way to assess international medical school programs. Letters of recommendation are very important. IMGs typically need letter of recommendation from US physicians. These LORs are usually obtained during US clinical clerkships, which are critical for IMGs.

The NRMP publishes data on residency matches every year, including information on step scores, research, etc. broken down by specialty, IMG status, citizenship status, etc. This is the NRMP 2018 report. This is the IMG specific residency matching report.

You'll be able to see this from the data, but it is extremely difficult to match to the US as an IMG. It is pretty much impossible to match as an IMG to a competitive specialty. IMGs need high step scores just to match to even the least competitive specialties (i.e. internal medicine, family med, peds). IMGs have almost no chance of matching to orthopedic surgery/ENT/ophthalmology/dermatology/most surgical subspecialties. Every year the number of IMGs who match to these specialties are in the single digits and these candidates are absolute superstars who pretty much all have phds, with the majority having completed specialty training in their home country or having done research for many years in the US. If your heart is set on one of these competitive specialties, it is probably wise to not waste your time trying to go to the US.

Many thanks indeed for your very detailed post - extremely helpful and much appreciated.

For the IMG matching report, I can't seem to find ophthalmology - am I missing something?

 

[phdtomduk]

For the IMG matching report, I can't seem to find ophthalmology - am I missing something?

It might not be included because IMGs just don't typically match to ophthalmology (or derm/ortho/ENT/surgical subspecialties etc.). All of the IMGs who do match to these specialties (and the numbers are typically in the single digits) take a route that looks something like:

foreign medical school --> foreign residency/fellowship --> phd (in either home country or at US institution to make connections --> multiple years of research at US institution to make connection

Ophthalmology is one of the most competitive specialties to match to even for US medical graduates. They all have sky high step scores and significant research experience, with many taking research year(s). Even with this, many US grads still fail to match to optho. The cards are so stacked against IMGs that IMGs pretty much never match. If you're set on ophthalmology, the US is almost certainly not going to happen for you. To even have any chance (and that chance would still be ridiculously small), you're probably looking at >5/10 years post medical school graduation of work before a successful match.

 

[electiveresearch2]

It might not be included because IMGs just don't typically match to ophthalmology (or derm/ortho/ENT/surgical subspecialties etc.). All of the IMGs who do match to these specialties (and the numbers are typically in the single digits) take a route that looks something like:

foreign medical school --> foreign residency/fellowship --> phd (in either home country or at US institution to make connections --> multiple years of research at US institution to make connection

Ophthalmology is one of the most competitive specialties to match to even for US medical graduates. They all have sky high step scores and significant research experience, with many taking research year(s). Even with this, many US grads still fail to match to optho. The cards are so stacked against IMGs that IMGs pretty much never match. If you're set on ophthalmology, the US is almost certainly not going to happen for you. To even have any chance (and that chance would still be ridiculously small), you're probably looking at >5/10 years post medical school graduation of work before a successful match.

I see... once again, many thanks

 

[NotAProgDirector]

Agree with above. Also, Ophthal is in the SF Match, not the NRMP. That's why you don't see it mentioned there. Their data is here: https://www.sfmatch.org/PDFFilesDisplay/Ophthalmology_Residency_Stats_2018.pdf

In any case, chances of getting an Ophthal spot as an IMG in the US are very small. You need to have stellar credentials and likely US connections.

 

[electiveresearch2]

Agree with above. Also, Ophthal is in the SF Match, not the NRMP. That's why you don't see it mentioned there. Their data is here:

In any case, chances of getting an Ophthal spot as an IMG in the US are very small. You need to have stellar credentials and likely US connections.

Thanks very much for this -- what's the difference between SF and NRMP? It's still a stepping stone directly after medical school, right?

Also would be grateful if you could explain what US Allopathic Seniors, US Allopathic Graduates, US Osteopathic Seniors, US Osteopathic Graduates are?

 

[phdtomduk]

Thanks very much for this -- what's the difference between SF and NRMP? It's still a stepping stone directly after medical school, right?

The SF and NRMP match are both residency matching programs, just run by different organizations. They serve the same function and the process of applying/matching is almost identical. The easiest way to think about them would probably be as just two different application systems. If you want to match IM or another NRMP specialty, you apply through NRMP. If you want to match urology/ophthalmology/another SF match specialty, you apply through SF Match.

Also would be grateful if you could explain what US Allopathic Seniors, US Allopathic Graduates, US Osteopathic Seniors, US Osteopathic Graduates are?

The match report defines these terms in the first few pages of the report, under "definitions." The definitions are copied below. Essentially US Senior/Graduate means senior/graduate of MD (i.e. allopathic) school in the US and US Osteo Senior/Graduate means senior/graduate from DO (i.e. osteopathic) program in the US. Unless you have US citizenship, you would fall into the Non-US IMG category.

• Senior student of U.S. Allopathic Medical School (U.S. Senior): A fourth-year medical student in a U.S. allopathic school of medicine accredited by the Liaison Committee on Medical Education (LCME) with a graduation date after July 1 in the year before the Match. U.S. seniors are sponsored by their medical schools.
• Previous Graduate of U.S. Allopathic Medical School (U.S. Grad): A graduate of a U.S. allopathic school of medicine accredited by the LCME with a graduation date before July 1 in the year before the Match. Previous U.S. graduates are not sponsored by the medical school.
• Student/Graduate of Canadian Medical School (Canadian): A senior student or graduate of a Canadian school of medicine accredited by the Committee on Accreditation of Canadian Medical Schools (CACMS).
• Student/Graduate of Osteopathic Medical School (Osteo): A senior student or graduate of a medical school accredited by the Commission on Osteopathic College Accreditation (COCA).
• Graduate of Fifth Pathway Program (5th Pathway): A graduate of a U.S. Fifth Pathway program.
• U.S. Citizen Student/Graduate of International Medical School (U.S. IMG): A U.S. citizen who attended an international medical school.
• Non-U.S. Citizen Student/Graduate of International Medical School (Non-U.S. IMG): A non-U.S. citizen who attended an international medical school.

 

[electiveresearch2]

The SF and NRMP match are both residency matching programs, just run by different organizations. They serve the same function and the process of applying/matching is almost identical. The easiest way to think about them would probably be as just two different application systems. If you want to match IM or another NRMP specialty, you apply through NRMP. If you want to match urology/ophthalmology/another SF match specialty, you apply through SF Match.



The match report defines these terms in the first few pages of the report, under "definitions." The definitions are copied below. Essentially US Senior/Graduate means senior/graduate of MD (i.e. allopathic) school in the US and US Osteo Senior/Graduate means senior/graduate from DO (i.e. osteopathic) program in the US. Unless you have US citizenship, you would fall into the Non-US IMG category.

• Senior student of U.S. Allopathic Medical School (U.S. Senior): A fourth-year medical student in a U.S. allopathic school of medicine accredited by the Liaison Committee on Medical Education (LCME) with a graduation date after July 1 in the year before the Match. U.S. seniors are sponsored by their medical schools.
• Previous Graduate of U.S. Allopathic Medical School (U.S. Grad): A graduate of a U.S. allopathic school of medicine accredited by the LCME with a graduation date before July 1 in the year before the Match. Previous U.S. graduates are not sponsored by the medical school.
• Student/Graduate of Canadian Medical School (Canadian): A senior student or graduate of a Canadian school of medicine accredited by the Committee on Accreditation of Canadian Medical Schools (CACMS).
• Student/Graduate of Osteopathic Medical School (Osteo): A senior student or graduate of a medical school accredited by the Commission on Osteopathic College Accreditation (COCA).
• Graduate of Fifth Pathway Program (5th Pathway): A graduate of a U.S. Fifth Pathway program.
• U.S. Citizen Student/Graduate of International Medical School (U.S. IMG): A U.S. citizen who attended an international medical school.
• Non-U.S. Citizen Student/Graduate of International Medical School (Non-U.S. IMG): A non-U.S. citizen who attended an international medical school.

Interesting indeed.... ah missed that definitions page; thanks for that.

 

[phdtomduk]

Interesting indeed.... ah missed that definitions page; thanks for that.

.

 

[electiveresearch2]

No problem. I'm an American trying to figure out the Irish/UK medical school/residency systems, so I know how confusing it is to try and navigate foreign systems.

Haha, for sure. Well I am based in the UK and about to graduate; if you have any questions then there is a small chance I have the knowledge to help you, just PM

 

[rhomboid]

Just some quick notes:
1. Matching into residency is not the only route. Because you can get into residency without matching. These programs are called prematch programs and are usually less desirable.
2. It is possible to practice without completing a residency in US as an IMG. For example, in radiology, if you complete a 4-year fellowship, you might get a full licence. Or in medicine, if you are really distinguished clinician or researcher, the IM chair can endorse you and get you a limited licence. After three years it is possible to get a full licence. However this is rare and most people do not have enough credentials for it (e.g. publishing successfully with multiple high impact publications, faculty position...etc).

 

[electiveresearch2]

Just some quick notes:
1. Matching into residency is not the only route. Because you can get into residency without matching. These programs are called prematch programs and are usually less desirable.
2. It is possible to practice without completing a residency in US as an IMG. For example, in radiology, if you complete a 4-year fellowship, you might get a full licence. Or in medicine, if you are really distinguished clinician or researcher, the IM chair can endorse you and get you a limited licence. After three years it is possible to get a full licence. However this is rare and most people do not have enough credentials for it (e.g. publishing successfully with multiple high impact publications, faculty position...etc).

I see - thanks for the extra info and for confirming the post-fellowship possibility which I have heard a few times but which is not discussed much online.

 

[phdtomduk]

Or in medicine, if you are really distinguished clinician or researcher, the IM chair can endorse you and get you a limited licence. After three years it is possible to get a full licence. However this is rare and most people do not have enough credentials for it (e.g. publishing successfully with multiple high impact publications, faculty position...etc).

This is a little misleading. Although this path technically exists, it almost never happens and it certainly takes much more than high impact publications and a faculty position. Many IMGs and even some premeds have high impact publications and nearly everyone involved in academic medicine has a faculty position.

The only people who get around the US residency/fellowship requirement are world-renowned physicians, and these are exceptional cases where US hospitals are trying to recruit world-leading clinicians/researchers. These physicians are typically international leaders in their field with decades of experience and likely would not come to the US if they had to redo their residency/fellowship. Due in part to the surplus of US based talent, it is still extremely rare for a physician to come to the US via this pathway.