In order to know how to get into residency programs as an IMG, or international medical graduate you must first understand the difference between an IMG and a non-international applicant. IMGs have slightly different requirements, and must face additional obstacles, such as visa applications, language barriers and cultural differences. If you are wondering what makes residency applications so challenging for IMGs and what to do in order to boost your chances of acceptance, you’ve come to the right place!

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International VS Non-International Applicants Is It Difficult to Get into Residency Programs for IMGs? Top Tips for Getting into Your Top-Residency Choice as an IMG Conclusion FAQs

International VS Non-International Applicants

The factor that determines if an applicant is considered international is not their citizenship, but the geographical place where they studied medicine. More precisely, an international medical applicant is a medical graduate who completed medical school in a country other than the USA and Canada, meaning that an American citizen will be regarded as an international applicant if they completed medical school abroad.

Application Requirements

International applicants will face some different requirements to apply to a residency program. First, they will need to send an application to receive an ECFMG (Educational Commission for Foreign Medical Graduates) certification to allow them to take the USMLE step 1 and USMLE step 2, which non-international students traditionally sit for during medical school. In order to obtain their medical education credential, IMGs should be able to provide:

Most institutions in the United States use the Electronic Residency Application System (ERAS) to screen residency applicants, while Canadian programs use CaRMS. The ECFMG coordinates ERAS applications for international students, which means that without obtaining the ECFMG certification through one of the ECFMG pathways, international applicants are unable to apply to most residency programs.

Requirements in Canada are a bit different:

  • Canadian citizenship or permanent resident status
  • Passing the Medical Council of Canada Qualifying Examination (MCCQE Part 1)
  • Passing the National Assessment Collaboration Examination (NAC)
  • Demonstrating Language Proficiency 

Visa/Residence Permit

So far, requirements for international and non-international applicants seem fairly similar, but this is only the beginning. Besides facing their residency application, international applicants must face a different and equally intimidating kind of application: their visa. This requirement is not necessary for US citizens who completed medical school in other parts of the world. Programs in the US care more about your education than your citizenship, so being a US citizen doesn’t necessarily make you a more competitive candidate. In Canada, on the other hand, being a Canadian citizen or having a permanent residency status is mandatory.

International medical graduates usually apply for the J-1 visa, also known as exchange visitor visa. IMGs who wish to apply for this visa must be certified and sponsored by the ECFMG, and present additional documentation such as a letter from a US training program and a statement of need from the health department of their home country. J-1 visa applicants also need to demonstrate that they have no intention of abandoning their original residence and that they are only staying in the US for a limited period. This can be stated, for example, through ownership of a property, or family ties. After completing their training, J-1 visa holders are obligated to return to their home country for a minimum period of 2 years to transmit the knowledge and skills acquired during their time in the US.

Each institution has different criteria regarding the types of visas they accept, the number of attempts to pass the USMLE, and the medical school graduation year. Some residency programs are friendlier than others and your chances of acceptance as an IMG will vary.

Worried about how to stand out in your residency applications as an IMG? This infographic is for you:

Is It Difficult to Get into Residency Programs for IMGs?

It is no secret that getting into a residency program as an IMG is harder than as a non-international applicant. When it comes to matching a residency program, it is only logical that success rates will be slightly lower for IMGs, especially in the most competitive residencies. Some specialties are highly sought after by non-international applicants, making it harder for international applicants to make the cut, while others present higher IMG acceptance rates because there aren’t enough non-international applicants to fill all available spots.

According to the AAMC, 23.1% of residents and fellows in the USA are international medical graduates. Here’s how that percentage varies according to the specialty:

Top Tips for Getting into Your Top-Residency Choice as an IMG 

1.   Apply Strategically to Programs that Are IMG Friendly

When deciding how many residency programs to apply to you should consider that you won’t have the same chances of acceptance in all of them. Some programs are likelier to accept you as an IMG, while others are far more competitive, or don’t even accept IMGs due to visa-related issues. IMG friendly programs are those programs that have consistently presented high IMG acceptance rates within a certain period of time.

According to the National Resident Matching Program, the top five specialties for students and graduates from international medical schools were:

  1. Internal Medicine
  2. Family Medicine
  3. Pediatrics
  4. Pathology
  5. Neurology

Applications are exhausting and time-consuming, so investing your energy and resources on the ones with the higher chances of acceptance will increase your motivation and allow you to achieve better results. 

2.   Get Clinical Experience in US or Canada 

Getting hands-on experience in the country where you want to pursue your residency is an essential step to show that you are prepared, committed, and qualified to transition into the American or Canadian healthcare systems. Residency programs want to make sure you are familiar with their health environment and that you are going to be a good fit, so doing externships, rotations, clerkships, or sub-internships will play a key role in your residency application.

Getting clinical experience will help you make valuable connections and start growing your own professional network. It will also help you find potential writers for your ERAS letter of recommendation and CaRMS reference letter, among other residency application requirements. If you are no longer a student, you can also find volunteering opportunities, or jobs in health-related environments, such as community clinics, care homes, etc.

But getting clinical experience in a foreign country is easier said than done. Not all hospitals offer externships, so you will have to research your options and start contacting institutions yourself. There are also paid placement services that will take care of this for you, but you have to make sure the service you end up hiring can really help you meet your objectives. 

3.   Get a Reference Letter from a Referee Who Is a Canadian or American Professional

Unfortunately, letters of recommendations from professionals from your country of origin won’t help you much unless your referee has some degree of international relevance in the medical field. At least one of your letters of recommendation should be written by a medical professional from the US or Canada. This will increase the credibility of your letter, as the residency admissions committee will be able to verify the legitimacy of your referee more easily, not to mention they will probably recognize the institution, or even the writer’s name. If your letter comes from an institution that they have never heard of, they might find it unreliable.

American or Canadian referees will also be able to write stronger letters of recommendation, due to the fact that they are familiar with what admissions committees expect. They will know exactly what to say to catch their attention and provide a killer reference. This is why gaining clinical experience in the US or Canada is so important, as it will help you find those referees who will help you secure a spot in your residency program of choice. 

4.   Get Stellar USMLE and MCCQE Scores

USMLE stands for United States Medical Licensing Examination and it consists of 3 steps towards obtaining your medical license. Passing USMLE step 1 and USMLE step 2 is a requirement to become certified by the ECFMG and your scores will play a vital role in your residency application. The Medical Council of Canada Qualifying Examination (MCCQE), on the other hand, is a requirement for those students applying to residency programs in Canada.

Some programs have minimum score requirements, and many of them use test scores as the first filter to weed out applicants at the early stages of the review process. If your USMLE or MCCQE part 1 scores don’t meet the standards of the program you’re applying to, it is likely that you won’t make the cut. If you still haven’t taken these exams, there is still time for you to increase your chances of success by preparing yourself in advance. Getting the help of an advisor or taking a USMLE prep course can make a positive impact on your final score.

Some additional tips:

5.   Ace Your Interview

There’s a misconception that you can’t really prepare for an interview. Some people believe you just have to be yourself, and if you have enough confidence and experience in your field, you should be able to tackle any interview without difficulties. But this can’t be further from the truth. In fact, interviews require a lot of practice and implementing the right answer strategies. Your medical residency interview is the only chance you will have to show the admissions committee the part of you that can’t be found in your application documents.

As an international medical graduate, you will feel the additional pressure of demonstrating that you are ready to adapt to the American or Canadian health systems. Your IMG residency interview prep should include a thorough research of common residency interview questions and how to answer them. You must be able to convince them that you are a good fit for that institution, and that your skills and experience will make great contributions to the program. Remember that having a bad interview will decrease your chances of acceptance significantly, and you won’t get a second chance to make a good first impression.

6.   Carefully Plan Your Rank Order List

Your rank order list (ROL) is the list of residency programs you would like to apply to, in order of preference, the first one being your dream program, and the last one being your least desired one (although it still should be a program you’d like to attend). Similarly, programs will elaborate their own ROL, and a sophisticated algorithm will place applicants into their most desired programs, according to their ROL.

Make sure to elaborate your ROL taking into consideration those programs where you have higher chances of acceptance as an IMG. You should be aware of your competitiveness as an applicant and choose programs that match that level of competitiveness.

Looking for more guidance as an IMG? This video should help:


While it is true that getting into residency programs as an IMG represents a bigger challenge than applying as a non-international graduate, it is not impossible, and it is certainly an opportunity worth fighting for. As an IMG you should make sure you meet all the requirements to apply for residency programs and find out which programs would be more suitable for you as an international graduate. Some specialties are friendlier for IMGs, given their higher acceptance rates. Before planning your residency abroad, make sure you gather enough clinical experience in the US or Canada, and start making connections. Finding professionals who are willing to write recommendation letters for you will be a key aspect of your residency application. Lastly, work hard on your exam scores and residency interview, as they represent major steps in the admissions process that will determine whether you get accepted or not. Keep in mind that reaching out to a consultant is also a good option, which can make a big difference when it comes to navigating the whole process!


1. What’s the difference between an international and a non-international applicant?

Regardless of your citizenship, to be considered an international medical graduate you must have completed your medical school education outside the US or Canada. This means that IMGs can also be American or Canadian citizens who chose to study abroad. Similarly, students of other nationalities who completed their medical studies in the US or Canada are considered non-international applicants.

2. Is it harder to apply for residency programs as an IMG?

IMGs have to face challenges that non-international applicants don’t. Their chances of acceptance will always be slightly lower, they will have to meet a series of additional requirements, and they will have to adapt to a whole different set of medical standards. Getting accepted as an IMG is a bit harder, but not impossible!

3. What kind of visa do IMGs need to apply for residency the US?

IMGs usually apply for a J-1 visa or exchange visitor visa.

4. How can I obtain ECFMG certification?

In order to become ECFMG certified, you will have to pass the USMLE step 1 and USMLE step 2, the ECFMG Clinical Skills Assessment, and provide medical school transcripts from an institution listed in the World Directory of Medical Schools.

5. How can I get clinical experience in the US and Canada?

Get in touch with institutions who offer externships and rotations. Certain paid placement services can help you apply to these programs, but you can also resort to your own contacts in your field who may be able to assist you by suggesting institutions or opportunities they might know about.

6. How many residents and fellows in the US are IMGs?

According to recent AAMC reports, out of a total of 139,857 residents and fellows, 32,291 were IMGs, representing 23.1%

7. What are the friendlier specialties for IMGs?

The National Resident Matching program reported that internal medicine, family medicine, pediatrics, pathology and neurology are the top 5 specialties with highest rates of IMG acceptance.

8. Who should write my letter of recommendation?

Ideally, your letter of recommendation should be written by a professional from an American or Canadian institution. Recognizing where the letter is coming from will make it more reliable and it will be more likely for the admissions committee to take it into consideration. The only circumstance in which getting someone from your home country to write your letter will help you, is if they have an international reputation and the admissions committee might recognize their name or their institution.

To your success,

Your friends at BeMo

BeMo Academic Consulting

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