Home MedEducation & Residency How To Match Into Competitive U.S. Residency Programs

How To Match Into Competitive U.S. Residency Programs

About a quarter of practicing U.S. physicians come from international medical schools and even with the shortage of physicians in the U.S., international medical students find it challenging to match into U.S. residency programs.

This post will highlight everything you need to know about matching into a competitive specialty.


Are High USMLE Scores Important To Match In a Competitive Specialty?

A common question asked by applicants is if a score of 250+ in USMLE Step 1 and a score of 260+ in Step 2 CK gives one a good chance of matching into a competitive specialty.

From the NRMP data, a big difference can be seen between those who match and those who don’t match. The scores of those who match for most specialties are higher than the scores for those who don’t match but for some competitive specialties you might see that the score for those who don’t match is the same as those who match or maybe with one or two points difference.

A study done to compare plastic surgery applicants who were International Medical Graduates (IMGs) versus American Medical Graduates (AMGs) showed that there was no difference in USMLE Step 1 and Step 2 scores between those who match and those who did not match. The more surprising part is that those who matched into plastic surgery as IMGs had lower scores than AMGs who did not match.

So if not scores, then what?

One will assume that as an IMG you need to have higher scores compared to U.S applicants in order to match into competitive specialties but the data shows that there is a huge difference in the number of publications, presentations, and abstracts. It is observed that IMGs who match into competitive specialties have almost three, four, or five times the number of publications compared to U.S applicants.

This points to the fact that these applicants spend some time doing research in a research lab or working with mentors to get that number of publications and while they’re doing that they establish connections that help them match into these competitive specialties. The value of research goes beyond publications. It goes beyond just having some extra lines on your CV. Besides having all these publications and presentations, research helps you establish connections with people who can get you into a residency spot.

Are all Publications Valued Equally?

You may ask what happens if an applicant does 15 publications consisting of only abstracts and case reports, will that be useful for application? It is important to know that both the number and quality of publications matter.

The way NRMP reports the results of research output, which could be a presentation where you go to a meeting and present your work either as an oral presentation or poster, abstracts which are the the the work that was accepted to a meeting but it’s not the full-text article and publications is quite interesting. They clump all these things together, although there is a huge difference in the amount of work required for publication compared to an abstract or presentation.

When these things get clumped together and you see for example 10 or 12 on the NRMP report, that doesn’t mean 10 publications, it means one paper could have been made as two abstracts and each abstract was presented once. So you can get five of these by one single project or one single publication.

The Importance of Clinical Rotations

Clinical rotations are extremely important when applying for residency in the U.S because residency is a clinical job. It is not a research job so you need clinical experience in the U.S.

Different countries have different health care systems and program directors and the selection committee will make sure that you are aware of how this system works. The way to know that is to do clinical rotations in the form of electives or observerships to make sure that you are fit within this system, you know how things are going and you can be a successful resident.

It can also help you get letters of recommendation which is also a very important requirement. The NRMP data shows that letters of recommendation are one of the most important things for program directors to rank applicants.

Volunteering and Work Experience

Work and volunteer experiences are not as important as Step 1, Step 2, and letters of recommendation but they’re still important. It is important to have some interest outside medicine or the specialty you’re applying to as this makes you unique.

If you have done some contributions to your community or you’ve traveled somewhere and helped people outside your country, adding that to your CV is a good idea

PH.Ds and Other Graduate Degrees

These are not a significant determinant of whether you match or not because if you look at the data it seems that the matching rate is similar but one factor that might be affecting this result is the small number of applicants with a master’s degree or a Ph.D.

It definitely gives you extra tools and skills that can help you when you’re doing your research as a resident or as a faculty afterward. So definitely having a master’s degree would be an extra positive on your CV.

However, it is important to understand that we have limited time to graduate, do research, publish papers, do clinical experience and establish connections. So the question is, is pursuing a master’s more important than going for a U.S. clinical experience and establishing connections? It is important to weigh your options when choosing to go for a post-graduate degree.

What Guarantees a Match into Residency?

There are a lot of applicants who checked all the boxes, got high scores in the Steps, have good research experience, USCE, and received a lot of interviews but did not match. One potential reason, asides others, is the interview skills of the applicant. Some people are not accustomed with the stress of an interview for a job. They find it hard to show they great qualities during an interview. This can be a limiting factor to matching.

How To Get into Research

Getting into research involves many factors that require an individualized approach. There is no one single advice that you can give to everyone. An approach given to someone who just graduated from medical school and has great scores is different from someone who has been away from medical training or did residency in their home country, practiced for some years and now pursuing residency.

It has to be tailored based on your experience and what you have. Learn from someone experienced with doing research to find the right research pathway for you. There are people who did research for over two years and got nothing out of it, so it is important to be in the right place, with the right people, doing the right thing. This requires an individualized approach with someone who is experienced to help you get where you want to be.


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