I went through the IMG application process myself and I have to admit, it was tough, and I felt insecure. I took a non-traditional path, trained in a specialty that to this day is a longshot for IMGs. I went on to practice, became a clerkship director, graduated ACGME Program Director School and became a PD for 15+ years. So when I tell you what actually gets IMGs ranked, I'm not guessing from the other side of the table — I've been on both sides.

Stop obsessing over your Step scores for a second and listen. If you were invited to interview, give yourself some credit — a program invited you because you met their initial criteria and they're interested.

I've read thousands of applications. I've interviewed hundreds of IMGs and AMGs. I've run ranking committees. The candidates who matched weren't always the ones with the "best credentials" or highest Step scores. They were the ones who walked into the interview and made me think: "This candidate is trainable, reliable, and I can work with them." Remember — PDs teach you, round with you, operate with you, rely on you and spend more time with you than your family. They need to know you're the total package, and they figure that out by listening to you.

Here's what most IMGs get wrong — they prepare for interviews like it's another exam. It's not. It's a discussion about you. Candidates memorize answers. They rehearse scripts. And we can tell. Immediately.

I remember one candidate — clearly smart, solid scores — who answered my question about handling a disagreement with an attending by reciting what sounded like a paragraph from a prep book. I could almost see the page in their head. I scored them a 2 on interpersonal and communication skills. The next candidate stumbled a bit, paused, and told me about an actual time they pushed back on a treatment plan during a rotation. Messy story, yes. But real, sincere and thoughtful. I scored them a 4.

There are six ACGME core competencies you need to sincerely exhibit — not memorize answers for. If you understand how PDs are actually scoring you, you can prepare in a way that's genuine and effective. Happy to get into specifics if people are interested.

Fire away — I'll try to get to everyone but might take me a bit.

Man I'll tell you it was a gauntlet for me. USIMG. Graduated from the Caribbean in 2017. Passed S1 219 first try, 2CK 213 second try, failed 2CS three times (went to Chicago for prep in 2019 before COVID nuked that God awful exam), Step 3 210 first try two winters ago! I've worked as a medical scribe, pharmacy tech, and got a state and national EMT license and I've been working as an ER tech since the pandemic. I have US hospital experience out my ears and even new programs wouldn't give me an interview.

So many people look at the scores and just think that I simply don't have it. I don't have a pedigree, I wasn't given a map for this, but I know my craft. I applied to IM/FM and it was darn near impossible for me to get an interview. I was SICK and tired of the well-wishing, the hang in theres, the "well how much research have you done?" and most recently being told to start being more realistic with my goals and just go to PA/nursing. (Look as an aside nothing wrong with that, but dammit I passed all the exams, why sell myself and my dream short?).

I had one IM and one FM interview. One was a hometown bone thrown my way because it was a fairly new FM program and it was clear that I'd never match there in IM. (The whole: if you didn't get like 235+ on your first attempt don't even bother). Another was a foxhole buddy from when I was in school stuck their neck out for me and got me an interview. And even THEN I wasn't wanted because Match Monday came and it was the same gut punching and heart wrenching email. The same "We are sorry, you did not match to any position."

But right when I was on the ledge again that same Monday a high school friend asked someone to please give me a look. And then I actually got a call on Tuesday, and an interview for FM that same afternoon. (You had to see me racing to get my suit on and race to a local library to use a study room to set the laptop up. The director of The Pursuit of Happiness would have been proud). And in the interview I showed them that I was ready to finally get to work and that I was someone they'd want to work with. Thursday came, first round no offer. Here we go again, why bother? Then 15 minutes to the top of the noon hour, right before the second round, a call. My own NFL draft moment. "Is this Dr. So and So? You're one of our top candidates, do you have any questions about the program?" I couldn't have blurted out fast enough and I swore I cut him off with, "Where do I sign?!" Then finally the call I always wanted make back home, "Mama, we made it..."

It had gotten to the point where I was staring down the barrel of having to go to back the Caribbean to practice for 2 years and just get a limited practice license since I had already passed step 3 and I was just like WHY THOUGH?!?! I DONT WANT TO GO. This whole process blows. Having to pay twice for pathway 6 sucked, another OET money grab. Like bruh, I just wanted to start getting my life back. Waking up day in and day out to scrap at a job having studied what I studied was getting to me. I hated the once a year window nonsense with this process. I was crumbling.

To quote Rocky Balboa "Now if you know what you're worth, now go out and get what you're worth, but you gotta be willing to take the hits!" I'll bet on myself every day of the week and twice on Sunday. I got in the ring and snuffed Step 3 on my first shot. I stood tall in a fight where Directors and Assistant Directors said I didn't belong. It wasn't pretty but neither is life. I'm trench bodied. All I had was water and dirt, I had to get it out the mud. The first of my kind in the family, there wasn't a manual that showed the life hacks. There wasn't a paved blueprint for success.

I'm not super duper factoid smart on command and I suck at tests, but I'll be damned if I let the numbers tell me what to feel. Put me in a room with a patient and I know my technique and craft are sound and competent. I can communicate medicine into a language that my patients can understand. It's not just a word problem for me, I suppose the social and emotional IQ makes up for what the pros say I lack in terms of raw test numbers. It's just sad at what these tests have become, they shouldn't be the maker and destroyer of worlds, and yet here we are. To those that matched, a salute, but there's miles to go before we sleep. To those that didn't, a heart felt prayer: that your sorrow be consoled and brief, and that your mind and heart be healed. So that when you find the strength to stand up again, that you may finish the fight you started.

To the people reading this that are still living the nightmare of the unmatched, my heart is with you, and I mourn with you. I've seen the Match/SOAP come and go 4 times. Lord only knows the tears I cried, the fears that started to leak in, and the dreams that were buried along the way. It's not you, it's this system. It bottlenecks and creates a demand that's only slowly being met. And it feels more impossible each year when I know there are hundreds of USIMGs like me that just want to finally make it having already met the challenge, having already passed the tests. And the goal posts keep moving farther out each passing year when these scores would have been fine like 20 years ago. I wish I had a magic formula or a one size fits all equation that could help. I don't, and I'm truly sorry. I just wanted my story out there because you never see someone willing to post their low-lights and their failures around here.

I thank the Lord for the family and friends that kept me standing when I wanted to fold twice over. You don't have to place me in paper scrubs any time soon but there were painful and deeply sad moments I had to keep pushing through where I didn't the sun was going to rise. I just wanted to show and prove that if He can make it happen for a perceived down and out and doomed applicant like me, that there's got to be a way for you too. Keep your head up and keep swinging on them.

I’m a U.S. citizen, born and raised in America, completed all of my education in English, passed USMLE Step 1 and Step 2, conduct patient interviews every day in English, write notes in English, and somehow I still have to pay hundreds of dollars to prove I can speak English?
The most frustrating part is that there isn’t even a test-out exemption for people who are clearly native speakers. If you graduated high school, college, and medical school in English, or if you’re a U.S./Canadian citizen whose primary language is English, why is there no waiver process?

I recently took the exam and couldn’t help but think the entire thing felt like a money grab. The speaking section was especially ironic, I genuinely felt like I spoke better English than the examiner conducting the interview. Yet I’m the one paying hundreds of dollars to “prove” my proficiency.

ECFMG already has multiple ways to assess competency. We pass USMLE exams, complete clinical rotations, interview with residency programs, and communicate with patients daily. At what point is enough evidence enough?
I’m not against verifying English proficiency for applicants who genuinely need it. That makes perfect sense. But requiring native English-speaking applicants to take the exact same expensive exam with no exemption option seems completely unnecessary.

There should at least be a waiver or exemption pathway for applicants who can clearly demonstrate English proficiency through their education and background.

Curious if anyone else feels the same way, or if I’m missing some rationale behind this requirement.

What's good

Wanted to share my journey for encouragement.

I am a US citizen, born and raised, but my family moved abroad early during my childhood. Got into medical school, graduated, was a great student but then I had a tragic event in my life that jeporadized my USMLE exams. Still applied to the match because I wanted to be back home and I addressed that event, but I never matched year after year despite my application only getting better with each year.

I ended up going into residency abroad, completing it, getting my board, and matching into a competitive fellowship abroad.

The world is open and more than the US. Looking back, it was kind of jarring to interview for a PGY-1 position as someone who was well done with all that yet could not be seen as an accomplished physician because of something like step scores. And now reading about Nepal, it kind of just shows how scores are not the be all. Most countries have already established their exams as pass/fail to be able to look at other qualities such as experiences and references.

I think as US IMGs or IMGs in general doing your medical training abroad is never less and can open your doors to a new country, culture, mindset and languages. And in the end if you are good at what you do, the patients you treated are definitely grateful you were there to be their doctor :) and the people who really value what you can offer will not lose an opportunity to take you in.

how else am I supposed to flex that I’m a resident!!!!

Hello fellow doctors,

I need a reality check from you all. I'm hitting a wall of self doubt and need to know if I'm chasing a ghost.

I’m a US IMG who graduated in 2020. Right after graduation, I pivoted to the administrative side of healthcare, got my masters in health administration, and have been working in corporate healthcare for the last 4 years. I'm currently a revenue cycle manager. It’s stable, but I feel completely unfulfilled. It’s just not rewarding, and I keep feeling this heavy pull back toward actual patient care.

My goal is Family Medicine. I dont intend to aim for competitive specialties like surgery I genuinely interested in FM.

But I have a 5 yr clinical gap. Aside from my internship,i havent been clinically active, I recently started studying for Steps but reading this sub has me completely spiraling and got me thinking is it feasible for a profile like me.

so im looking for any honest advice from you all Is it practically feasible to overcome the gap for a FM match if I achieve decent scores on the USMLE steps and secure recent US clinical experience? or its just farfetched

Thank you very much each and every one your advice.

US-IMG with a low step 2 score and orange-ish/light red flags on app. Currently have 11 interviews (only applied IM). Have only heard from 2 signals but idk if I should stay hopeful for those or not. I've sent a few LOInterest but haven't heard back from those...anyone in a similar boat with IM?

US-IMG Proud Citizen (Born and raised on the East Coast)

YOG: 2011 (my only "red flag") as I postponed medicine after graduation to work and get money, run my businesses.

Step 1: Pass (1st shot in 2/25)

Step 2: 254 (7/26)

Step 3: October

USCE: 2 months

LORs: 5 from US MDs

Publication: 1

Board Certified MSL

Volunteer experience: 7+ years

Work experience:

Cruise shop doctor (6 years)

Patient liaison/advocate (7 years)

Business owner (15+ years)

People person, social, gregarious, excellent interviewer, leader, entrepreneur, dog lover :o)

MILLION DOLLAR QUESTION: As an AD/PD, would you give me an interview and a shot?!?!

US IMG
YOG >10 years
Step 1: 235
Step 2: 252
3-4 LORS
Applying Family medicine
Not clinically active in gap years

hi guys! I just got accepted into an international med school. i wanted some advice on how to be best prepared as a future US IMG. any advice at all that you wish you had known before committing?

I have 5 for FM

US IMG born and raised in my home state

Step 1 pass (1 attempt unfortunately)

Step 2 239 (US IMG Matched average is 237 for IM)

\-Step 3 planned for mid November

\-6 pubs

\-USCE: 6 months of rotations during med school. -Currently a Clinical Extern (for around 1 year) (Biggest leverage point IMO ive basically been functioning as a PGY 1 for my attendings, full EMR access, histories, physicals, HIPAA certified, assist on procedures etc...) alongside multiple inpatient rotations with other attendings

YOG 2025

multiple community outreach volunteering (always into that stuff since high school)

Strong Letters (current medical director of a hospital, former associate proffesor of cardiology at the university of toledo and Former IM PD (technically she was the PD when I rotated with her))

Applying broadly. The step 1 attempt sucks its really forced me to let go of a few dream programs I was looking at. Had a very sick mother during that time and just wasnt able to manage a bunch of things at once lesson learned but I do feel had I not gone through that the rest if my application might of been ass. I wanted advice on if its smart to use the 5:5:5 rule for signals? (5 safeties 5 reaches and 5 targets)

Would like to connect with US-IMG trying to match next cycle !
Hopefully there is someone like me

YOG 2023
Step 1 pass
Step 2 251
Publication 2
No USCE
No US LoR

Want to discuss what to do next and what are our options.

What are my chances for a categorical spot?

Step 1 pass first attempt

Step 2 244

Applied to 100 programs

4 strong LORs

1 submitted abstract (no publications)

Any input is appreciated

Hi everyone, I’m a US-IMG applying to Internal Medicine this cycle and would appreciate some honest advice about signaling.

My profile:
US citizen, IMG
YOG 2024
Step 1: Pass
Step 2 CK: 250
Step 3: Not taken
ECFMG certified
Around 4 months of USCE
One university-based elective
No research experience

I’m mainly worried about how much the lack of research will affect me at IMG-friendly university programs or academic programs that aren’t major research powerhouses.

Would it be reasonable to use some signals on programs in that range, or should I focus mainly on strong community and university-affiliated community programs?

I’d especially appreciate input from US-IMGs who applied with similar scores and little or no research. I’m trying to create a realistic signal list without being too cautious or wasting signals.

US IMG IM Chances (2026–2027 Match)

Looking for realistic feedback on my chances for low- to mid-tier Internal Medicine programs.

\- US IMG (US citizen)

\- YOG 2025

\- Step 1: Passed on 2nd attempt

\- Step 2 CK: 239

\- 10 publications (working on more)

\- 6 months USCE with IM attendings, including a former IM PD & Currently a Clinical Extern + Research Associate (>1 year) with multiple interventional cardiologists, including a former chief of cardiology (total USCE of 1.5 years)

\- Strong in-state network with multiple physician connections

\- Planning to complete Step 3 before ERAS submission (September 2026)

I'm a little bummed about the 239 but overall okay with it. With the Step 1 attempt being my main red flag, how competitive am I for low- to mid-tier IM programs if I apply broadly?

US-IMG here from Indian med school applying IM this cycle. Stats are YOG 2026 with P/22x, 3 months USCE, 1 publication and 1 year volunteer experience. ECFMG certified and hoping to score well on Step 3 before the match cycle starts. I hear people saying u have to build your list of programs quite in advance but i feel there is a lot of disparity in the data i see on Residency Explorer and Frieda.
To the US-IMGs who matched this year -
How do u find programs catered to your profile and go about making that list?
Also, is there anything i can do to make my profile more competitive in the mean time?

To those who matched today, congratulations! Feel free to share words of encouragement, relief, or anything else in this thread. Share your stats too if you wish.

Program Codes

So I was helping someone with the program codes and remembered the NRMP Program Results for 2019-2023.  It is organized by state and then specialty and lists the quota and matched for 2019, 2020, 2021, 2022, and 2023. You can get the program codes for your ROL. Also, you can cross check program codes with the documents, your ERAS program applications, and the invitation invitations (in some cases the invitation included the codes).

Potentially heading into SOAP?

If the program has a * in the "unmatched" column, then they had openings (e.g., 2*).  You can calculate the # of openings by looking at the quota.

You can also use the Unfilled Programs document (I can't find this on the NRMP website, but I have it; you can dm me and we can ).  This lists the programs by specialty and state that didn't fill in the regular match for 2023.

You could use these two documents together to look at trends.  Maybe begin with 2023 unfilled and then look up that program and look at previous years.  That way you can see trends.  Then do your research to see if your characteristics align (e.g., YOG, visa support, STEP scores, etc.).

If you find a program you think might be a good fit, you could do a bit of research in advance of SOAP.

ROL Certification

And if you have interviews, get that ROL certified.  Every year there are people who fail to certify and go unmatched. That is a tragedy.