International Medical Graduate (IMG)

Getting into the market as an International Medical Graduate (IMG)

The USMLE certification gives you a broad spectrum of choices when it comes to the next best step! Most people will start the matching processes, which we discuss below; others, however, explore alternative options. It really depends on how you see your professional future, the amount of time you have to give dedicate your new job, the pressure you’re able to handle. In order to discuss the details, let us analyze closer one by one.

IMG Matching to a residency program.

Good news are, if you’re reading this and you are an IMG, your chances are very similar to those who went to U.S. Medical schools. According to the ECFM bulletin from March, 2017 (meaning, that these applicants applied in 2016), here are a few key facts to keep in mind:

  • There are more jobs out there. To put it into figures, the increase of residency spots is not falling, it’s been rising, at least since 2002. Between the periods of 2002 and this year’s, 2017, match, more than new 8,200 positions were open. And to compare 2016 and 2017, the trend does not change: in one year’s time, 989 new positions became available.
  • Slightly less IMGs are applying. Again, in that one year’s time, the number of IMGs who actually applied for the matching process decreased by 435.
  • S. Medical Students and IMGs — the stakes are relatively the same. Respectively, out of all applicants, 52.4% (U.S.) and 53.3% (IMGs) matched.
  • Two times more IMGs get matched than U.S. graduates. The news is even better for those who come across the ocean, or simply from abroad: the absolute number of IMGs matches is actually higher than the U.S. graduates — respectively, 6,630 and 3,814. Now think about this a simpler way: Two times more IMGs matched than U.S. graduates.

Now, this all sounds good, but you’re thinking, how many of these IMGs were actually U.S. citzens?

International Medical Graduate Matching, 2017 (Source: ECFMG)
Total applicants Matched Positive result (%)
IMGs (total) applied 12,355 6,591 53.3%
IMG-s non-U.S. citzens 7,284 3,814 52.4%
IMG U.S. citzens 5,069 2,777 54.4%

Now, just by analyzing this table it becomes very clear: the race is equal for everyone, whether you have studied in the U.S. or abroad. Your USMLE scores along with your letters of recommendation will do the trick for you, so our advice: focus on the test, the market has never been this democratic.

This might, obviously, have a lot to do with tuitions in the United States. Tuitions in several countries in Europe cost merely the price of the transport ticket for the whole semester, for example, in Germany a student will pay around 200-300 Euros for the transport ticket for the whole semester. The same goes to all Scandinavian countries. When it comes to countries in Eastern Europe, the scenario, may, however, vary. In Russia, for instance, foreigners usually cannot get a “free ride”, specially if they are studying in English; if one is to study in Russian, however, the situation shifts, and you might be getting that free ride.

Other than that, another contributing factor is that the U.S. Medical License (USMLE) itself has a good reputation outside the United States. If you haven’t got started check out our USMLE Step 1 Course comparison here. It is automatically accepted in countries like Australia, the UK, New Zealand, Canada, Israel. Not to mention a series of international hospitals out there who are willing to hire U.S.-trained doctors. So for the ones who would like to pick where they’re headed next, or just have a few other options, this is still the best one in that context.

But the matching process is relatively long. It starts in July, and you will know the outcomes only by March of the upcoming year — so, about 9 months. What should you do exactly with that time in your hands?

Here are a few other options we have set out for you.

Research positions.

You might want to consider applying for a PhD, research position, not only in the U.S. Of course requirements vary from program to program, but news flash: the vast majority offer fully funded programs. If you have a research background and publications on the same subject as the program, chances are even higher they would have you. Also something to keep in mind: even thought requirements do vary, all programs will require or at the very least, look very positively at, recommendation letters. You might want to ask the right teachers for this, since after applying you will not simply upload recommendation letters, but rather an email will be sent to your referee and he/she will email that letter to the application commission. Keep that in mind and make sure to warn your referees about this.

Pharmaceutical companies

One can also work as a consultant for pharmaceutical companies. This job requires the best of your diplomatic skills, as you will most likely be presenting new drugs and treatment venues to practicing doctors. But then again, this might actually be a great networking experience. You might also get started in a program in which you will be responsible for literature overviews or proofreading.


A lot students actually try tutoring for several of the following reasons: you are able to manage your own time, if can be done remotely, you will be reviewing materials that you have studied for years and are very well acquainted with. You may go on about this by approaching a USMLE prep center or by placing ads of your to get your own clients. Motivation skills are highly necessary for this option, so we could even call it a USMLE-coach. Just keep them studying!

If you’re willing to fill up your time with either of those you’re not, the choice is, ultimately, dependable on you and the amount of time you might need to dedicate for residency program interviews. Experience shows that most of them start around October, so if you have chosen a program of your likening and the hospital is ready to tell you they would like to have you as a member of their staff, as early as possible: then this is what we call a pre-match, and the rest of the process is pure formalities. Long story short, the hospital will choose you in the application process, from your side, you will choose them. By March, if none of your plans have changed, the ECFMG will match you with that program.

This scenario is most of the times only possible if you have made a really good impression during your interview, if you have had an observership in that hospital and last but not least, if someone recommended you to them personally. If none of these are your case, then you might want to focus on your observership/internship experience.

Now, remember, the ECFMG will require 3 recommendation letters for your residency match application. Now, if you’re a IMG this might be a little more complicated, but fortunately you have two options before you: First, you can apply directly to the hospital with your USMLE scores; second, you may outsource this via a company that provides internship spots for IMGs, the last option will obvious cost money, so you might want to look into several companies and check their feedback online to make sure you’re not putting all  your eggs in one basket. The company’s job is solely to connect you to a doctor, from there on, you will schedule a period for your elective rotations.

Your supervising physicians are not obliged to write you a recommendation letter, therefore, it is important that you make it very clear since the beginning. And obviously, it goes without saying that you must make a good impression on them, take pains to study, this is a great opportunity to see all your First Aid pictures live; always ask questions during the rounds and it will come naturally to them to just write you a letter at the end without you even having to ask for it. Show your efficiency and interest, everything else will follow.

Hands on” experience. Here we a few companies that will place you with a hospital. Americlerships   Chicago Clerkships   FMG Affordable   Medclerkships   Residency Cube

Excel at the interview.

You’ve got your scores, you’ve got your internship and recommendation letters, now it’s time to suit up and meet your prospective colleagues. You all know this: feel enthusiastic about the job, a little bit of humor will help, don’t be a robot (try to mention some of your hobbies for instance, instead of listing all your publications all the time), try to find a personal connection, think of reasons why you would like to move to that city, think of why you’d love to work for that hospital (what kind of research, program have they got?). But we think the most important of all is to be polite, sharp and adequate, and feel absolutely enthusiastic about the interview, the possibility, your past professional experience — it’s easy to catch that from a candidate. A simple example would be: instead of saying: “I worked with Dr. A. for two months,” try: “I had the great opportunity to get to know Dr A. and benefited a lot from the time I had rotations with him, it was truly involving”. That, we all know.

But what kind of specific questions or nuances should you be waiting for? And specially if you’re an IMG, some of these might be a little unusual and outside your cultural comfort zone. Here are a few things you were not taught in your medical school: Icebreakers are important. It’s ok to be nervous, so try small talking (I’m glad I beat the traffic, or, I have tried out the latte from the canteen and it’s amazing). This is something people in the U.S. are very fond of. Don’t save on Good mornings, on weather talk, get ready for SuperBowl talks, and so on. This is common courtesy, even if you find it unnecessary. Note: be ready to be asked non-related questions, this is a why of testing how you react to unusual situations. We have listed some questions you might come across during your interview, if you brainstorm these, you’re ready to go!

What are typical International Medical Graduate Questions?:

Tell me about yourself

Why are you interested in this program?

Why do you want to be a physician?

Why did you choose your specialty? or What specialties interest you?

Why did you choose your medical school?

Tell me about X aspect of your medical school education.

What qualities/strengths make you a good physician?

What is a weakness or area for development?

Where do you see yourself in 5/10 years? or What are your long-term career goals?

Challenging, personal questions:

When it comes to the field of medicine, what is your biggest fear?

What do you have to offer that only you can bring to our program?

Describe yourself in one word.

How would you rate your medical school education? What would you change?

What’s the most recent work of fiction you’ve read? Tell me about the book?

Why are you interested in the program we offer?

What will you do if you don’t match?

Who is your role model? Why?

Tell me a good joke.

Tell me about a patient care mistake you made. What did you learn from it?

Tell me about a failure.

What would you say are your major strengths? Weaknesses?

Unexpected questions:

What bad things have you heard about our medical residency program?

Teach me something non-medical in under one minute.

If your house was on fire and you had time to save only 3 items, what would they be?

If you were an animal, what animal would you be?

What books have you read lately? Tell me about it.

Questions to make sure you are on the same page as the program you have applied to:

We have many good applicants. Why should we choose you?

Why did you choose to apply to this program?

What would you like to know about our program?

What do you feel you could add to our program?

What have you learned about yourself from previous jobs?

How do I know you can show initiative and are willing to work?

What are your interests outside of medicine?

Questions on your education background and perspectives:

Why did you choose this specialty?

Tell me about your medical education.

Tell me about your previous clinical experience in (specialty name).

Why are you so sure (specialty) is right for you?

Tell me about your experience with the USMLE exam(s)? (if candidate has so-so

score(s) or failed attempts)

Have you ever worked in an ICU (or other unit common to the specialty)?

Have you ever worked in an American hospital? Tell me about that experience.

Questions on your soft skills:

How do you get along with nurses?

Have you ever taught medical students?

Do you have any publications?

Are you interested in research activity? Please elaborate.

Have you ever made any presentations before a professional group?

Have you assisted in surgery? On what procedures? Tell me how you were


Have you held any leadership roles? Elaborate.

How would you describe your decision-making style?

Describe the most difficult decision you have ever had to make. How did you go

about it?

Questions to assess how you deal with stress:

Describe a difficult time in your life and how you dealt with it.

Do you have any beliefs or convictions that might interfere with your willingness to deal with the kind of clinical situations you are likely to be presented with in residency training? (Usually asked if program director fears religious beliefs may prevent applicant from performing abortions, birth control, etc.)

What do you do to cope with stress?

Describe the worst or most disappointing clinical experience you’ve had so far.

What factors would lead you to rank a program very highly?

What factors would lead you to lower your ranking of a program?

What kind of personality traits do you find most difficult to deal with in co-workers?

What challenges do you foresee that will potentially affect this specialty in the next ten years?

What kind of patient do you find it most difficult to relate to? What tactics would you use to establish optimal rapport with such a patient?

Sometimes it also comes down to questions you should ask:

What are your fellowship match rates?

Do residents and faculty members have good rapport?

What are your program strengths and weaknesses?

How often do residents leave the program and what are the reasons they give for doing so?

Is there are research project required during residency? If so, what does it involve and what type of support is available?

All things considered, you are ready to go towards your best next step! Good luck!

James Edge

James Edge

James is on a mission to uncover the greatest study guides and prep courses to ensure you pass your exam on your first attempt. He has personally assessed hundreds of study materials and developed courses himself.

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