To understand how to get into residency programs as an IMG, or international medical graduate, first note that IMGs have slightly different application 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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How Hard is it to Get into Residency Programs for IMGs? How to Get Into Residency Programs as an IMG: Certification How to Get Into Residency: Tips from an IMG FAQs

How Hard is it 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 domestic 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 domestic applicants, making it harder for international applicants to make the cut, while others are very IMG-friendly residency programs.

A graduate of the Ross University School of Medicine, one of the medical schools in the Caribbean, and BeMo admissions expert Dr. Terrell Coring says getting into residency as an IMG requires a careful approach:

“Matching as an IMG requires a methodical approach. Personally, I did not find difficulty because I was guided to apply ‘smart’, meaning applying to programs that are IMG friendly and applying to IMG friendly specialties (Internal Medicine, family medicine, pediatrics, psychiatry, etc). Finally, I understood how important USMLE test scores are for IMG matching. Therefore, with decent test scores while applying to IMG friendly programs and applying to an IMG friendly specialty, the match process was not challenging.” – Dr. Terrell D. Coring, MD, Medstar/Georgetown Washington Hospital Center - Internal Medicine.


The latest match data reflects a fairly good outcome for both US IMGs and Non-US IMGs in the NRMP’s Main Residency Match. US IMGs have a match rate of 67.6%, while non-US IMGs have a match rate of 59.4% overall.

According to the AAMC, 22.9% of residents and fellows in US residency programs are international medical graduates. Here’s how that percentage varies according to the medical specialty:

How to Get Into Residency Programs as an IMG: Certification

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.

International medical graduates (IMG) will face some different requirements to apply to a residency program in the US or Canada. First, they will need to send an application to receive an ECFMG (Educational Commission for Foreign Medical Graduates) certification. IMGs can obtain certification through one of the ECFMG pathways and then sit the USMLE Step 1 and USMLE Step 2 exams. In order to obtain their medical education credential, IMGs should be able to provide:

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

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

Requirements in Canada are a bit different. IMGs applying to residency programs in Canada must:

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

IMG Visa/Residence Permit

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 (also known as US IMGs). In Canada, on the other hand, being a Canadian citizen or having a permanent residency status is mandatory.

International medical graduates in the US usually apply for the J-1 visa, also known as an 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.

How to Get Into Residency: Tips from 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.

To increase the chances of matching, many IMGs apply to a large number of programs, but this doesn’t mean you shouldn’t also apply strategically. When creating your residency rank order list as an IMG, though, don’t neglect to consider your own personal values in a residency program, though.

“When applying as an IMG, applying to superfluous of programs greatly increase your probability of matching … I applied to about 250 programs. There were a few factors that I considered when applying. Firstly, I based my decision on the program’s success in matching US IMG applicants. I also incorporated the success of the programs ability to recognize my graduating medical school. The success of the program to match their residents into a fellowship was important to me as well. Therefore, I favored programs that fellowship matched well. Lastly, I factored in geography in the programs I selected.” – Dr. Terrell D. Coring, MD.

Applying to a larger number of programs means a greater chance of success, but this comes with an additional cost consideration, Dr. Coring warns:

“I applied to as many programs that were financially possible. Hence, the cost of the match was a great limitation. The match is an expensive process and to increase your competitive odds, it is prudent that one cast a broad net.” – Dr. Terrell D. Coring MD.


Applications are exhausting and time-consuming, so investing your energy and resources on the programs 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, sub-internships or pre-residency fellowships for IMGs will play a key role in your residency application.

Getting clinical experience as an IMG 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.

Dr. Coring says his choice of where to attend medical school came with built-in clinical and networking opportunities—a big advantage when it came to applying for residency in the US.

“I attended a medical school that contracted with US hospital systems for clinical experiences. Therefore, these US clinical experiences were built into the program within my medical school. These clinical experiences within the US allowed for great letters of recommendation and great opportunities to network to increase my chances of matching within that health system.” – Dr. Terrell Coring, MD.


But getting clinical experience in a foreign country can be easier said than done. Not all foreign medical schools offer these opportunities, and not all hospitals offer externships, so you will have to research your options and start contacting institutions yourself.

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

At least one of your residency 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. If your letter comes from an institution that they have never heard of, they might find it unreliable.

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. 

“I took advantage of my clinical rotations [in the US] and was sure to identify the great letter writers prior to the start of the rotation. After identifying these letter writers, I was sure to perform well and discussed my desire for a strong letter of recommendation (LOR) at the mid-way point of the rotation. All of my LORs were from US Physicians after attending US clinical rotation.” – Dr. Terrell Coring, MD.


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

4.   Get Stellar USMLE and MCCQE Scores

Passing the 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.

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.

“USMLE test scores are vital in being competitive in the Match for IMGs. I utilized third party help in my preparation for the USMLE. Moreover, reading USMLE textbooks and practicing with a ton of practice questions was instrumental in my preparation.” – Dr. Terrell Coring, MD.


To prepare for these exams, you can enroll in a USMLE prep course or MCCQE prep course for international students, depending on which exam you need to complete.

5.   Ace Your Interview

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. A residency mock interview can be a useful preparation tool to practice questions!

Dr. Coring agrees that regular practice was key in preparing for his interview: “I practiced in the mirror and rehearsed the answers to the most popular questions, frequently.”

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.

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).

“Firstly, I wanted a program that had a great track record in matching residents into subspecialty fellowship. I also wanted a program with robust diversity in patients, disease pathology and colleagues. Lastly, I wanted a program that was located within the north and southeastern regions of the US. Therefore, I ranked programs according to these factors.” – Dr. Terrell Coring, MD.


Make sure to take into consideration those programs where you have higher chances of acceptance as an IMG. For instance, there are some more IMG-friendly states and IMG-friendly hospitals located in specific geographical regions of the US. You should be aware of your competitiveness as an applicant and choose programs that match that your background, stats, and values.


1. What is an IMG?

Regardless of your citizenship, if you have completed your medical school education outside the US or Canada, you are considered an international medical graduate or IMG. 

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

IMGs must face challenges that non-international applicants don’t. Their chances of matching into residency are slightly lower 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, around 22.9% of all medical residents in the US are IMGs.

7. What are IMG-friendly specialties?

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

8. Who should write my IMG letter of recommendation?

Ideally, your letter of recommendation should be written by a physician from an American or Canadian institution. Recognizing where the letter is coming from will make it more reliable. 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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