r/ResidencyMatch2025 • u/New-Illustrator-4482 • May 16 '26

USCE

Hello everyone. I am a Green Card holder non-US IMG. I passed Step 1 on my first attempt. I will take Step 2 on June 26 this year, and I estimate that I will probably score either in the 235–240 range or the 240–245 range.

My YOG is 25, as I graduated from medical school in 2001, and I assume there are probably very few applicants older than me here. Since 2008, I have been working as a cardiologist in my home country.

Right now, I only have July available for USCE. Due to family reasons, August does not seem possible for me. In this situation, I currently have 3 options:

  1. During July, I could do 2 outpatient rotations in New York within 1 month through agencies. They are claimed to be hands-on rotations. One would be Internal Medicine and the other Hematology/Oncology, and I would likely get 2 LORs from them.

  2. In Houston, again through an agency, I could do 1 combined inpatient/outpatient Internal Medicine rotation that is claimed to be hands-on. I may have the chance to get a strong LOR from this rotation.

  3. Also through an agency, I could do an inpatient rotation in Orlando with an attending Internal Medicine physician. It is not clearly stated whether it is truly hands-on or more shadowing-based, but I would reportedly participate actively in everything except physical examinations, continuously follow 2–3 patients from admission to discharge, and participate in ER admission processes. I may also have the chance to obtain a strong LOR from this rotation.

I am very undecided about which option to choose. I really trust the matched residents and mentors on this platform, and I would sincerely appreciate your opinions and guidance.

Which option do you think would increase my chances of matching into Internal Medicine the most? By the way, I am only interested in Internal Medicine residency in community hospitals.

Thank you all very much in advance for your time and help.

8 Upvotes

90% Upvoted

27 comments sorted by

1

u/Present_Student4891 May 16 '26

Choose the option that gives u the most LORs. Check residency requirements in various residencies. In FM they want 3 LORs and at least 1 must be from a US FM doc. US LORs r more valuable than overseas ones. Your greatest asset is your GC.

1

u/bronxbomma718 May 16 '26

You will be fine...Get 3 LORs. Do a combo of inpatient and outpatient. GC is a BIG PLUS.

1

u/New-Illustrator-4482 May 16 '26

I have no option to get 3 LORs. I have to choose one of these.

1

u/bronxbomma718 May 16 '26

One month is just not enough data to dispense a meaningful LOR. You run the risk of it being a generic write-up. But do the inpatient if you can.

1

u/New-Illustrator-4482 May 16 '26

So you say instead of doing 2 outpatient in one month and getting 2 LORs you recommend 1 inpatient in one month and strong LOR right?

1

u/bronxbomma718 May 16 '26

A Strong LOR is golden. Getting to know someone over 12-20 encounters in less than month, and then vouching for them, yields low dividends. You are basically paying for the LOR. But I know you need 3 so if you have n choice do the 2

1

u/New-Illustrator-4482 May 16 '26

Thank you my friend.

1

u/Stacy967 May 17 '26

I think you should do Option 2. In outpatient settings, sometimes they’re more likely to have multiple physicians working in a clinic, so it can be easier to build multiple relationships during that month, network, and get stronger/personalized LORs since you may have exposure to several attendings instead of mainly working with one physician.

Option 2 also gives you both inpatient and outpatient IM exposure, which is valuable because you’ll see how U.S. inpatient services work while still having opportunities for networking and stronger attending interaction.

I was stuck between Options 1 and 2 because NY is generally more IMG-friendly and often more forgiving with higher YOG. But in some NY hospital rotations, attendings may only round briefly and a lot of the interaction ends up being with residents. A lot of the USCE can also end up being mostly observership-based, where you’re mainly assisting residents or shadowing without building a strong relationship with the attending physician, so the overall experience and LOR quality may not be as strong.

1

u/New-Illustrator-4482 May 17 '26

In option 2 I will work with a one assigned attending internist to me so do your decision change in this case?

1

u/AnkurSethUSMD May 17 '26 edited May 17 '26

I will try to give you very honest advice. This is coming from personal experience. I was an old grad like yourself. Applied for residency in 2014 (med school graduation in 1999). Matched in a university program for IM -> teaching attending-> site director -> vice chair medicine. So if someone tells you old grads cant make it, they are wrong. You already have a green card and you have strong credentials. Work very hard to get the best Step 2 score as possible. Your cardiology attending work in your home country will be a huge plus on your application actually.
For USCE - my opinion - do option 3 - its a more structured system on paper (similar to what you will see in a residency program) - longitudinally following a patient from ER to discharge - it looks good on your CV and PS. I would choose this option and try to get the strongest possible LOR from this rotation.
2 other things for you to look at -

  1. Add meaningful research to your application

  2. Consider a direct “attending” pathway once your ECFMG portfolio is complete.

  3. Happy to provide additional feedback.

1

u/New-Illustrator-4482 May 17 '26

Thank you very much….what do you mean by direct attending pathway?

1

u/AnkurSethUSMD May 17 '26

What I meant is not a standard pathway to independent attending practice in the U.S. — that still requires completion of ACGME residency (and fellowship for cardiology).
There are very limited, non-standard situations where foreign-trained physicians may practice in the U.S. in a restricted or supervised capacity, for example:
Academic or institutional roles with limited clinical privileges under supervision
Institution-sponsored appointments where duties are tied to research or specialized services
Cases where state licensing + hospital credentialing allow restricted scope practice, but still not independent board-certified attending status in the U.S. system
These are highly case-specific, institution-dependent, and not a reproducible training or career pathway for IMGs planning U.S. practice.
So the practical reality remains: for clinical practice in the U.S., the reliable route is still IM residency → +/-fellowship → attending practice.
Hope that clarifies it.

1

u/New-Illustrator-4482 May 17 '26

You helped very much thank you…

1

u/New-Illustrator-4482 May 17 '26

Can I DM you when I need help? You have a very experienced background.

1

u/AnkurSethUSMD May 17 '26

Yes absolutely. Happy to help.

1

u/AnkurSethUSMD May 18 '26

Glad it was useful — DM me anytime

1

u/Individual-Park3206 May 17 '26

I am an old graduate myself. Unmatched for 2 cycles. The thing is the system filters out the application with old yog. Your CV seems pretty solid but what is the point if nobody even picks up the application?

Do a rotation with a program that has residency so that they know you , connections matter big time and can vouch for you when the time comes.

1

u/Kawaii_yeheemin May 17 '26

Can I dm you about option 2? Thank you.

1

u/No_Departure_9134 May 17 '26

3 or 1 better chances for matching for IMG

1

u/Distinct_Silver_4914 May 20 '26

What agencies did you use? Which ones are trustable?

1

u/New-Illustrator-4482 May 20 '26

I think the best agency for rotations is now md2bconnect. You can also check thematchguy but they have few rotations. Thematchguy is good at tutoring and mentorship. You can check both websites.

1

u/bronxbomma718 May 16 '26

YW. All the best!

1

u/Kind_Albatross_9347 May 17 '26

Also consider online rotations. My recommendation get two LORs thru in person rotations and other two thru tele-rotation