If you’re hoping to get into a school in the United States as an International Medical Graduate (IMG), it’s important to know IMG friendly states. Why? Because you already know competition can be stiff, and while it’s best to apply an ethic of patience and persistence, it’s also essential to have a strategy. You might, for example, decide to contact medical students in residency to discuss how they secured a spot in an IMG friendly state. However, you can’t always rely on personal anecdotes when you’re collecting research or for when you explore residency match services. It takes more than just hearsay to find out which states give you a better chance of filling a spot in a residency program. In this blog, we give you the information you need to make confident choices for your future, explain what types of schools have a tendency to select international medical graduates, and show you what the requirements are. Keep reading if you want to find out what an IMG friendly state is and what those entail.
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What is an IMG-Friendly State?
An IMG-friendly state simply refers to any state in the United States that have a tendency to accept international medical graduates. States that have a history of an established program with a strong likelihood of matching with IMGs are then considered IMG “friendly.”
An IMG friendly state can either be substantiated by the number of IMGs, or by the percentage. By the numbers, New York is one of the most populated states for international medical students. However, it's important to emphasize that just because there are programs and states that don’t necessarily meet the “IMG-friendly” criteria, that doesn’t mean you can’t apply to them. Because there are many factors involved in which state you're trying to get a medical residency in, including specialty, geography, and competition, it can help to discuss these variables with an IMG residency consultant.
Top ten IMG friendly states according to NRMP (by number of US and non-US IMGs with percentage matched among all applicant types)
New York has the highest number of medical schools of any state at 18. And because New York is such a populous and diverse state, the competition for residency programs can be intense. However, because New York is the “friendliest” IMG state by number of IMGs, international applicants are statistically more likely to find success in this particular geographical location. Among specialties chosen by IMGs in New York, internal medicine residency is by far the most common, with pediatrics and family medicine residency being second and third by a significant margin.
New York State doesn’t impose a limit on the number of USMLE attempts an applicant can have, and there’s also no limit as far as completion of the USMLE sequence goes. To apply for residency, requirements include less than 12 weeks of clinical clerkships outside of the country, or in cases where applicants have more than 12 weeks of clinical clerkships, earned medical school state approval by the New York State Education Department.
Here are five IMG friendly residency programs in New York State:
- Brooksville University Hospital and Medical Center Internal Medicine Residency Program
- St. Barnabas Hospital
- SUNY Upstate Medical University
- SUNY Health Center at Brooklyn
- Bronx-Lebanon Hospital Center
Florida is the second most IMG-friendly state by number of IMGs. As with New York State, the choice of specialty was also internal medicine by a significant margin compared to others. The medical board of Florida requires two years of residency training, but institutions can vary on what they prioritize as far as candidate credibility goes. Make sure you visit the websites of each institution to find out more about what each school offers and desires.
Here are five IMG friendly residency programs in Florida:
- Florida Atlantic University Charles E Schmidt College of Medicine Internal Medicine Program
- Oak Hill Hospital
- Brandon Regional Hospital
- Blake Medical Center
- Jackson Memorial Hospital/Jackson Health System
Michigan is the third friendliest state for IMGs by the numbers. Michigan is another popular institute for IMGs who want to specialize in internal medicine, family medicine, and pediatrics. Remember, program requirements can always vary by institution, but for the most part, the accredited length of training is three years. At the Detroit Medical Center/Wayne State University Internal Medicine Residency program for instance, successful applicants will have an USMLE step two score at a preferred minimum of 221, with a graduation date that doesn’t exceed five years from the application date.
Here are five IMG friendly residency programs in Michigan:
- Detroit Medical Center/Wayne State University Internal Medicine Residency program
- Oakwood Hospital
- St. John Hospital and Medical Center
- Providence Hospital and Medical Center
- Hurley Medical Center/Michigan State University
Pennsylvania is another “friendly” option for IMGs. By the numbers, internal medicine has the highest number of IMGs among all other specialties. However, radiology-diagnostic is the only specialty in Pennsylvania that contains exclusively IMGs. At one of the popular schools for internal medicine, Albert Einstein Healthcare Network Program, the preferred minimum score for USLME step two is 200, and the accredited program length is three years.
Take a look at some of the IMG friendly programs in Pennsylvania:
- UPMC Medical Education
- Abington Memorial Hospital
- Wright Center for Graduate Medical Education
- Mercy Catholic Medical Center
- Robert Packer Hospital
Wondering why clinical experience is so important for an IMG?
New Jersey is an East coast state with a significant proportion of IMGs in residency programs. By the numbers, popular specialties include internal medicine, family medicine, and pediatrics. If we’re looking at percentages, the highest proportion of IMGs can be found in specialties such as neurology, pediatrics, and internal medicine. Residency programs tend to be community-based, which means graduates will gain experience in a variety of clinical settings such as physician offices, hospitals, and community clinics.
Here are some of the popular residency programs in the state of New Jersey for IMGs:
- Capital Health Regional Center Internal Medicine Residency program
- Jersey Shore University Medical Center
- New York Medical College at St. Joseph’s Regional Medical Center
- Atlantic Health
- Monmouth Medical Center
The number of IMGs in Texas residency programs with IMGs remains one of the highest in the country. Despite the potential for regional bias, IMGs make up about half of students in specialties such as integrated thoracic surgery, anatomical and clinical pathology, and just under half for neurology. By the numbers, we also notice a significant proportion of IMGs in specialties such as internal medicine, family medicine, and pediatrics.
There are a variety of community-based and university-based programs in Texas, as well as other hybrid programs. The Texas State Board of Examiners also requires two years of residency training and grants up to three attempts on the USMLE examinations.
Consider some of the friendliest programs for IMGs that might want to do their residency in Texas:
- University of Texas RVG (DHR) Internal Medicine Residency Program
- Las Palmas de Sol Healthcare
- University of Texas Health Science Center School of Medicine at San Antonio
- Driscoll Children’s Hospital
- Texas Tech University Health Sciences Center Paul. L Foster School of Medicine
California is another friendly state for IMGs but beware, some of the most popular primary care specialties chosen by graduates in residency programs such as internal medicine and pediatrics have some of the lowest percentages of IMGs among other “friendly” states, despite having some of the highest number of students. Specialties with the greatest percentage of IMGs include anatomical and clinical pathology, family medicine, and internal medicine. The Medical Board of California requires a minimum of three years of postgraduate training and a maximum of four attempts on the USMLE exam.
Take a look at some of these friendly California residency programs:
- Eisenhower Medical Center Internal Medicine Residency Program
- University of California (San Franscisco)
- Kern Medical Center
- Riverside Community Hospital/University of California Riverside School of Medicine
- San Joaquin General Hospital
Although not as “friendly” as most of the other states listed above, Ohio still fortifies itself as one of the top ten friendliest states for medical school graduates. Ohio also has some of the most diverse residency program options with a variety of community-based, university-based, and hybrid programs. Like other states, the most popular specialties by the numbers are internal medicine, pediatrics, and family medicine. By percentages, IMGs fill the greatest proportion of members in specialties such as anatomic and clinical pathology, pediatrics/medical genetics, and internal medicine.
Consider some of the most popular programs for IMGs in Ohio:
- Cleveland Clinic Foundation Internal Medicine Residency Program
- Fairview Hospital
- University of Toledo
- St. Elizabeth Health Center
Illinois is another popular IMG friendly state for graduates who want to specialize in internal medicine, family medicine, or pediatrics. Some of the highest percentages of IMGs are among specialties that include anatomic and clinical pathology, neurology, and internal medicine. The Illinois Medical Licensing Board is also among the most flexible of states when it comes to USMLE completion, offering up to five attempts to finish with a passing grade, with a maximum of seven years to complete each step. The board also requires a minimum of two years of postgraduate training, like most other states.
Check out some of these popular programs for IMGs in Illinois:
- John H. Stroger Hospital of Cooke County Internal Medicine Residency Program
- Southern Illinois University
- MacNeal Hospital
- Louis A. Weiss Memorial Hospital
- Presence St. Francis Hospital
The number of IMGs matched to residency programs in Massachusetts remains stable throughout the years, ranking among the top ten friendliest state for IMGs. By the numbers, Massachusetts also diverges from most of the other popular specialties in other states, showing the highest number of matches for internal medicine, clinical and anatomic pathology, and anesthesiology. Taking percentages into account, thoracic surgery also has one of the highest proportions of IMGs.
Take a look at some of the popular programs in this state for IMGs:
- St. Vincent Hospital Internal Medicine Residency Program
- St. Elizabeth’s Medical Center
- Lahey Clinic
- University of Massachusetts
- Salem Hospital
Factors to consider when choosing a state
In your final year of medical school, you’ll most likely be trying to find a residency match using a site such as The National Residency Matching Program (NRMP). The match system uses an algorithm that cross-references the preferences of both students and programs to determine a match. But the question is, how do you choose what your preferences are? How many residency programs to apply to? What factors should you consider when you’re applying to residency programs as an IMG?
The first factor you might consider is the competitiveness of the programs. But whether you are applying to the most competitive or the least competitive residencies out there, you will need a strong application. Competitiveness is measured by the fill-rate of programs, which means the percentage of positions filled by senior students in medical school. Applicants can also consider the percentage match rates for IMGs to evaluate the likelihood of getting matched. For instance, according to the NRMP, internal medicine, which is one of the friendliest specialties for IMGs, had a 62.7% match for non-U.S. IMGs who ranked this specialty as their only choice. Other specialties are more competitive due to their lower match rates, such as neurology, which had only a 3.9% match rate for non-U.S. IMGs who listed this specialty as their only choice.
Another factor to consider when you’re ranking your programs for the match is location. Most applicants will want to consider things like climate, cost of living, and the pros and cons of living in rural vs. city areas. This mostly comes down to personal preference.
And you probably haven’t forgotten, but it’s also important to consider how much residents make on average and in each specific program. Salary can vary greatly depending on specialty and location, so you might want to research earning potential for the specialties that interest you most, as well on return on investment (ROI) expectations. The overall average salary for residents in most recent years is $63,400, but this subject to change depending on other factors.
One final aspect you might want to consider before you accept any offers is the benefits associated with a specific program. If, for instance, you care about vision, counselling, or dental benefits, you might want to inquire about what benefits a program offers before you decide to adjoin the program if you’re matched.
Preferred academic and non-academic achievements for IMGs
Being an IMG can present unique challenges compared to in-state applicants for certain programs. Besides the difficulties of completing the necessary medical school prerequisites to be considered for an interview, international students may also have to learn a new language and get familiar with the geography and cultural customs, as well as get accustomed to an entirely new healthcare system depending on where they’re applying from. Check out the following preferred academic and non-academic achievements for IMGs:
1. Perform well on licensing exams
The first step for international medical school graduates attempting to earn residency in an IMG friendly state is to complete the USLME step one exam. The score is recorded as either a pass or fail. If you’re applying to school in Canada, you will complete the MCCQE part I and the NAC OSCE. The NAC OSCE examination is scored on a scale from 1300 to 1500, with a passing score being 1374. The average step two USLME scores can vary widely depending on the specialty. For example, according to the NRMP, the average USMLE step two score for matched IMG applicants was 228 for family medicine and 235 for internal medicine. The minimum passing grade for the third part of the USMLE exam is 198. It’s important to earn a passing score on each applicable examination to get matched.
2. Get clinical experience in Canada or the US
One important way to help you succeed as a candidate is to complete clinical rotations. Clinical rotations refer to assigned shifts at an accredited healthcare institution. Doing clinical rotations before you start applying for residency programs can help a candidate get familiar with the healthcare system of the state in which they’re aiming to become a medical resident. There’s no universal healthcare system in the Unites States and many of the hospitals are privatized, which means patient care can be influenced by factors such as stakeholders, insurance, or health spending paid for by government programs. So not only do clinical rotations offer the residency candidate an opportunity to learn about the system in which they’re working, but they can also put their clinical skills into practice in order to prepare for residency interviews.
Check out more tips for IMGs here:
3. Obtain reference letters from Canada or the US
Reference letters, such as the ERAS letter of recommendation or the CaRMS reference letter, from physicians whom you’ve worked with in the U.S. or Canada can also go a long way in demonstrating your aptitude as a residency candidate. A reference letter is a document requested by the applicant from a referee who can vouch for you as a viable residency applicant. Here’s an example of a reference letter for an internal medicine residency, which is one of the most common specialties among IMGs:
August 18, 20xx,
Dear Program Director and Selection Committee Members,
I write this letter to express my support for Ms. Jane Doe as a resident at your institution and program for internal medicine. It has been my pleasure to work with Ms. Jane doe who worked with me and my staff at my clinic while I supervised her during her clinical rotation. I can confidently say that with her work ethic, strong clinical knowledge, and intuition, she will make an excellent doctor.
The size of our clinic being relatively significant with multiple floors with different management and staff, my colleagues and I were impressed by Ms. Doe’s ability to communicate effectively and have a resourceful mindset in a demanding environment. Ms. Doe continued to develop as a professional and show her ability to listen to patients and answer their questions, and remained an essential component of our system of providing quality care. When Ms. Doe started learning how to take patient history, she immediately showed strong sympathy by engaging in brief conversation with each patient to establish trust and rapport. She has a keen sense of how to extract the right information from patients by setting the scene with a smile and a question about what brings the patient into the clinic.
In particular, it was with great interest that I observed Ms. Doe interacting with patients in a calm and professional manner, many of whom entered the clinic with distressing symptoms and difficulty communicating about what they were experiencing. In cases like these, it’s important to ask the right questions while maintaining a professional and directive ethic, which Ms. Doe was consistent and enthusiastic in performing. Being in a diverse and populated city, we see a wide range of patients with unique complaints and concerns, and Ms. Doe was always very culturally and socially aware. There was one particular patient who was having trouble communicating about her symptoms because of a language barrier. Ms. Doe was patient and used lots of hand gestures to communicate, pointing to the relevant areas of the body to glean a description of the areas affected.
As Ms. Doe and my colleagues and I worked together to deliver the most effective treatment for our patients, Ms. Doe was always willing to ask questions and assess our treatment options for each diagnosis, and I since I was so impressed by her eagerness, I was always willing to spend some extra time each day going over her progress. She and I went over several simulated patient interactions dealing with a wide variety of health concerns, and her responses were always quick and methodical.
I urge you to consider M. Doe as a candidate for your internal medicine residency program. She is quick to learn, excellent with patients from all different ages and backgrounds, and demonstrably passionate about medicine and quality patient care. I am confident she will be a strong asset and one of your best residents.
Dr. John Smith
1. What makes an IMG state “friendly”?
An IMG state is said to be “friendly” when the percentage or number of IMGs are matched at higher rates relative to other states. So, any of the states listed above would be considered “friendly” due to their tendency to match IMGs.
2. What should you consider when you’re ranking programs for the match algorithm?
Your rankings are subjective based on what you value in a program. For instance, when you are planning how to create your residency rank order list, you’re more interested in conducting research in your specialty. Important factors that most applicants should consider include location, salary expectations, likeliness to match or competitiveness, and experience in their specialty.
3. Do results of USLME matter for residency acceptance?
Yes, they do. Results of the USMLE help programs decide how to rank applicants based on their scores. Because the USMLE step one is now a pass/fail, step two is probably more important in most scenarios for most applicants, but especially IMGs. Because of potential regional bias, IMGs should aim to outperform in-state applicants on their USLME results. Based on NRMP data, USMLE step one scores are the most important factor in deciding whom to interview.
4. How is competitiveness measured for residency programs?
Competitiveness is usually measured by fill-rate, which refers to the percentage of positions filled by senior medical school students. Another metric for program competitiveness is the percentage match rates for specific specialties, which vary depending on the state and status of the applicant as an IMG, non-U.S. IMG, or in-state applicant.
5. What is a good USMLE score?
As mentioned before, the first part of the exam is scored as either a pass or fail. The second part, USMLE step two clinical knowledge has a minimum passing grade of 209. The minimum passing grade for step three is 198. Although these are the minimum grades you should aim for, you should also consider grade averages for different specialties. For example, IMG matched applicants for anesthesiology had an average score of 241.
6. What is community-based vs. university based?
University-based programs often involve more opportunities to conduct research within your selected specialty. Community-based programs often provide the student with more experience-based learning opportunities, where the academic pathway might steer towards tutorials and lecture to prepare you for a medical science career. There are also hybrid programs which combine aspects of both. Make sure you explore descriptions of programs to determine the type of pathway you’re potentially getting into before you decide which is best for you.
7. Should I apply to a program in a state that isn’t IMG friendly?
Of course, you can. States and programs that aren’t deemed IMG friendly can still be viable candidates for some applicants, but it all depends on factors such as USMLE performance, specialty preference, location preference, and other values that you factor into your rankings. There are some states where IMGs match at comparable or even favorable rates compared to U.S. medical school seniors in states that aren’t historically as friendly.
8. How can I determine the likelihood of matching to the programs and states I’m aiming for?
There are a number of ways you can approach this question. First, you can do the research on match rates based on specialty, USMLE scores, and country of graduation, or, you can use our residency match calculator, which does the work for you!
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