US International Medical Graduates (USIMGs) and Residency Match

US International
Medical Graduates (US IMGs)

US International Medical Graduates are medical students who are US citizens and attended medical school outside of the US. An example of US IMGs are US citizens who attended medical school in the Caribbean, United Kingdom, and beyond. US IMGs are typically in a unique position as residency candidates who do not have to apply for visas but are still categorized as IMGs.

See Non-US IMG

US IMGs by the Numbers

General Facts and Statistics for the 2024 Match

Average USMLE® Scores for Matched US IMGs
USMLE Step 1: 222

USMLE Step 2 CK: 233
Match Rate: 67.8%
Research Experience:US IMGs averaged 2.5 research experiences, with 84.7% reporting at least one research experience

Publications:US IMGs reported an average of 4 publications per applicant, 83.7% reported at least one publication
Work Experience:US IMGs averaged 5.3 work experiences, 88.6% reported at least one work experience
Volunteer Experience:US IMGs averaged 4.7% volunteer experiences, 88% reported at least one volunteer experience

Key Trends and Additional Information

Applicant Numbers:The total number of applicants, including IMGs, has continued to increase for the 2025 Match. There were 4,587 active U.S. citizen IMGs in the 2025 Match, a decline of 3.5% from 2024. However, their PGY-1 match rate increased to 67.8% (up 0.8 percentage points).

Being a US International Medical Graduate (US IMG) carries specific benefits and challenges that can impact the residency application process and career progression. Here’s a closer look at some of these factors:

Benefits of Being a US IMG

Visa Exemptions: US IMGs do not face the often complex and restrictive process of obtaining a work visa in the United States, unlike their non-US counterparts. This can simplify their transition into residency and reduce bureaucratic hurdles.
Comparable Education: Many Caribbean and other international medical schools attended by US IMGs offer curricula and training standards that are comparable to those in U.S. medical schools. These programs are typically designed to prepare students for practicing medicine in the U.S., including preparation for the USMLEs.
Flexibility from Diverse Clinical Experiences: Experience in healthcare systems outside the U.S. can provide US IMGs with unique perspectives and adaptive skills, which are valuable in diverse clinical settings. This international exposure can be a significant advantage in a medical landscape that values cultural competency and adaptability.
U.S.-Based Clinical Rotations: Many international medical schools offer clinical rotations in the U.S., which are crucial for familiarizing students with the U.S. healthcare system. These rotations are often completed in hospitals that also host residency programs, providing networking opportunities and a platform to demonstrate clinical skills directly to potential residency directors.

Challenges of Being a US IMG

Perception Issues: Despite the quality of their education, US IMGs may encounter biases or misconceptions about the credibility of international medical schools. This can affect their chances in the highly competitive Match process.
Competitiveness in the Match: US IMGs often face stiffer competition for residency spots, particularly in more competitive specialties. They need to demonstrate higher USMLE scores and more extensive clinical experience than their U.S. counterparts to stand out.
Limited Support Networks: US IMGs might lack the extensive alumni networks and guidance available to students from U.S. medical schools, which can be crucial for navigating the residency application process and career planning.
Regulatory Hurdles: While they don't need visas, US IMGs still must complete the Educational Commission for Foreign Medical Graduates (ECFMG) certification, which involves passing the USMLE exams and fulfilling other requirements.

Understanding these benefits and challenges is crucial for US IMGs as they prepare their residency applications and plan their medical careers. By strategically leveraging their unique advantages and effectively addressing the potential setbacks, they can enhance their prospects for success in the competitive medical field.

Top Five Specialties for U.S. Citizen Students and Graduates of International Medical Schools (U.S. IMG) in 2025 Main Residency Match.

Top 5 most US IMG friendly specialties

Internal Medicine (categorical)	1,145
Family Medicine	626
Emergency Medicine	315
Pediatrics (categorical)	251
Psychiatry	153

Most US IMG friendly states

State	# of US IMGs
New York	537
Florida	424
California	321
New Jersey	243
Texas	202

The Caribbean Myth

Many US International Medical Graduates (US IMGs) from Caribbean medical schools often face unique challenges and misconceptions regarding their education. These graduates receive medical training that parallels the education provided to their counterparts in the US, yet they are still categorized as IMGs when applying for residencies in the United States. This dual identity can lead to misunderstandings about the quality and content of their education, causing unnecessary worry and anxiety among Caribbean graduates.

Caribbean medical schools are known to be rigorous, often following a curriculum similar to those used in the US, including teaching in English and preparing students for the same USMLE exams that US medical students take. Despite this, some may still view these graduates differently, primarily because of their international status rather than the quality of their education.

For Caribbean IMGs, it's important to effectively communicate the equivalency of their education and clinical training to residency programs and peers. They should also focus on dispelling myths and clarifying any misconceptions through open dialogue and by showcasing their clinical competencies and academic achievements during the residency application process. This approach can help reduce the stigma and ensure they are evaluated on their merits rather than their school's geographic location.

Residency programs value non-Caribbean IMGs over Caribbean IMGs.

It's a common misconception among Caribbean IMGs that they must limit their applications to programs explicitly known as Caribbean-friendly. However, this approach is not necessary. All IMG-friendly residency programs are open to considering candidates from a wide range of international medical schools, including those in the Caribbean. It’s crucial to base your residency program choices on accurate information and thorough research, not on rumors or assumptions.

The nature of the residency application process is dynamic, and programs are continually evolving in their acceptance criteria and diversity of their residents. By not applying due to concerns that a program hasn't historically accepted Caribbean IMGs, you might miss the opportunity to be a trailblazer for your peers. Presenting a strong application might not only secure a position for yourself but also pave the way for future applicants from your institution.

Therefore, expand your scope and apply to a variety of programs where you meet the criteria. This proactive approach can potentially alter a program's perspective on Caribbean IMGs based on your performance and integration into their system. Always remember, each application you submit could be the one that changes the course for you and others following in your footsteps.

Click for more Caribbean IMG information

Tips for US IMGs

It’s always important to have confidence as a residency candidate. Although it may be tempting to become over-confident as a US IMG, you must maintain the perspective of an IMG applicant. Below are some tips and recommendations to help you maximize your application.

Leverage Support from Your Medical School

Review Academic Documents: Engage with your medical school to review and ensure the accuracy of essential documents like your medical school transcript and Medical Student Performance Evaluation (MSPE).
Utilize Available Resources: Determine how your medical school can support you through the application process, from document preparation to providing guidance on meeting US residency requirements.

Diligently Prepare Your ERAS Application

Letters of Recommendation (LoRs): Obtain specialty-specific LoRs that reflect your competencies and readiness for the specialty you are applying to.
Personal Statements: Write compelling, specialty-specific personal statements that clearly articulate your interest in the specialty and how your experiences have prepared you for it.
MyERAS Application: Thoroughly complete all sections of the MyERAS application. Pay special attention to the descriptions in the Hobbies and Experiences sections; provide details that highlight your unique skills and attributes.
Error Checking: Ensure your application is free from errors. A well-polished application indicates professionalism and attention to detail.

Strategically Select Residency Programs

Research Program Requirements: Even as a US citizen, you are considered an IMG if you graduated from a medical school outside the US. Focus on applying to IMG-friendly programs. Review each program's requirements carefully, especially those concerning IMGs and visa policies.
Broaden Your Applications: While it is crucial to apply to IMG-friendly programs, also consider a broader range of programs where you meet the criteria. Each additional application increases your chances of matching.

Apply Widely but Wisely

Number of Applications: It is recommended to apply to a minimum of 100 programs per specialty to maximize your opportunities. Though costly, this approach can significantly enhance your chances of securing interviews and, subsequently, a match.
Cost Consideration: While applying widely is advisable, be mindful of the financial burden. Plan your finances accordingly or seek financial advice or assistance if necessary.

Maintain a Balanced Confidence

As a US IMG, it's essential to remain confident yet humble. Recognize that even as a US citizen, if you've obtained your medical degree abroad, residency programs will still consider you as an IMG. This perspective will help you tailor your application appropriately.

By following these tips, US IMGs can create a strong application package that showcases their qualifications and alignment with prospective residency programs.