Lessons for Foreign Medical Graduates from the 2016 Main Residency Match


During the 2016 residency matching process, the National Resident Matching Program (NRMP) monitored the outcomes for all graduates of foreign medical schools. Specifically, they kept track of match success, specialty preference, ranking information, and applicant characteristics. The data they collected provides valuable information for future applicants. If you are a foreign medical graduate looking to apply to a U.S. medical residency program in the future, there are several key lessons that you can take away from the NRMP report.

Program Ranking Choices: The More the Better

The NRMP report can be particularly helpful if you are a foreign medical graduate trying to figure out how to best to rank programs on your application. According to the NRMP, foreign medical graduates who were successful in matching to their preferred specialty were more likely to have ranked a larger number of programs within their preferred specialty. Specifically, the NRMP reports that, on average, foreign medical graduates who were matched had longer lists of contiguous ranks than those who were not — 6.3 continuous ranks for matched foreign medical graduates, as compared to only 2.5 for those who were not matched.

As a foreign medical graduate, you might be tempted to limit the number of programs you rank within your top-choice specialty area and add a greater number of programs in non-preferred specialty areas that you think will be easier to get into. While the NRMP does recommend applying to a mix of competitive and less-competitive programs, the data suggests that applying to more programs within your specialty area of interest could increase the odds that you will be matched at all. Instead of spending your time trying to locate the less-competitive programs, you should focus on polishing your application show that it demonstrates that you are truly passionate about the your top-choice specialty area.  

At the same time, if you do plan to apply to a particularly competitive specialty, it can be helpful to identify an alternative specialty and rank your preferred programs within that specialty area, according to the NRMP. Based on the data, whether or not you choose to do this will probably not have a significant effect on your odds of getting matched. The mean number of distinct specialties ranked by foreign medical graduates who got matched in 2016 was 1.3, whereas the mean was 1.4 for those who were not matched — practically no difference at all. So you shouldn’t be worried that identifying an alternative specialty will reduce your odds of getting matched.

The Importance of Test Scores

Another key takeaway from the NRMP report is that there are two tests that can make a significant difference in determining whether or not you get matched: the USMLE Step 1 and the USMLE Step 2 CK. For both of these exams, the average score for foreign medical graduates who were matched was substantially higher than the average for those who were not matched. It is also important to note that, among the foreign medical graduates who were matched, those who matched to their preferred specialties had higher scores, on average, than those who matched to programs in non-preferred specialty areas.

On the USMLE Step 1, the mean score for foreign medical graduates was 233.8, with a standard deviation of 17.0. The NRMP notes that this is “well above” the minimum passing score in 2016, which was 192. Similarly, on the USMLE Step 2 CK,  the mean score for foreign medical graduates was 238.8, with a standard deviation of 15.6. Again, this was considerably higher than the 2016 minimum passing score of 209.

Looking at this data, there are a few key lessons for foreign medical graduates. Most importantly, it makes sense to dedicate a lot of time and energy to studying for the USMLE Step 1 and USMLE Step 2 CK exams. However, if your scores aren’t as high as those reported above, don’t despair! The data are all based on averages, and there are lots of other places in your application where you can make up for a lower score and show that you are ready for success in a US medical residency program.

Also, even though the data shows that the USMLE Step 1 and Step 2 CK can significantly impact the matching process for foreign medical graduates, you should not forget the importance of the USMLE Step 2 CS. It may not play as large a role on your application, but it is still considered by application readers. Moreover, it is essential for ECFMG certification, so you need to make sure you are ready to pass when test day arrives. Similarly, if you make the choice to take the USMLE Step 3 before you begin your residency, you need to make sure that you are well-prepared so that your score reflects your knowledge and abilities in the field of medicine.

As 2017 comes to a close and the 2018 residency match draws near, FMG Portal is here to help! Contact us today to learn more about what we offer!


Medical Specialty Spotlight: Nephrology


Kidney disease is a growing problem around the world, but if you are looking to specialize in nephrology, one of the best countries to train in is the United States. According to the National Institutes of Health, about 14 percent of the American population has chronic kidney disease (CKD), as compared to only 10 percent of the world population as a whole. In total, about 661,000 American have kidney failure. About 468,000 of these patients are on kidney dialysis, and about 193,000 have a functioning kidney transplant. According to the American Journal of Kidney Diseases, the prevalence of CKD in the United States is expected to increase by 27 percent by 2030.

The two most common causes of CKD are high blood pressure and diabetes, with almost half of CKD patients reporting that they have been diagnosed with one or both of these conditions. That’s why CKD is so common in the United States — because of the high prevalence of cardiovascular disease and diabetes. However, its is important to note that changing lifestyles in developing countries are also raising the rates of these diseases worldwide, especially as the number of elderly individuals in countries like China and India grow. Therefore, in the future, there will probably be a high demand for nephrology specialists around the world.

If you are looking to become a nephrologist — that is, a physician specializing in the treatment of kidney disease — it just makes sense to complete your residency and fellowship in the United States, given the high rate of CKD in the country and the likelihood that it will rise in the future. Read on to learn more about the educational pathway to becoming a nephrologist.

Internal Medicine Residency: The First Step on the Path to Nephrology Career

Because nephrology is a specialization within the field of internal medicine, the first step to becoming nephrologist (after finishing medical school) is to complete an internal medicine residency program. These programs last for three years, and they are particularly popular among foreign medical graduates. Of all the foreign medical graduates who were matched to residency programs in the United States in 2015, 67.3 percent were matched to internal medicine programs, according to the National Residency Matching Program (NRMP).

In an internal medicine residency program, you can expect to gain a broad background education in the diagnosis, treatment, and management of disease and disorders that affect all of the internal body systems — including the renal and urinary systems. In addition to your clinical and didactic training, you may also have the opportunity to engage in research. If you are hoping to become a nephrologist, you may be able to conduct advanced research in nephrology, which can help you prepare for the specialization later on in your career.

Once you finish your internal medicine residency program, you will be prepared to take the American Board of Internal Medicine (ABIM) certification exam. After you pass the exam, you will be eligible to apply for a fellowship in nephrology in order to pursue your dream of becoming a specialist in the field.

Completing a Nephrology Fellowship Program

During a nephrology fellowship program, your studies will focus specifically on kidney-related diseases and disorders. As previously mentioned, CKD is the most common kidney disease in the United States and around the world, but as an aspiring nephrologist, you will also gain expertise in other kidney conditions, including:

  • Kidney stones
  • Polycystic kidney disease (PKD)
  • Acute renal failure
  • Glomerulonephritis
  • Pyelonephritis
  • Bartter syndrome
  • Dent disease
  • Nephronophthisis
  • Gitelman syndrome

Depending on your area of interest, a nephrology fellowship program can last anywhere from two to four years. If you choose to focus your fellowship on clinical training, it will typically last for two years. In addition to learning about the treatment of the conditions listed above, you may also have the chance to learn about cutting-edge clinical treatment options, such as home-suitable dialysis. You will also gain expertise in related areas of clinical care that you will likely encounter in your practice, such as geriatric care and palliative treatment.

Alternatively, you can choose to focus your fellowship on research — either clinical research, translational research, or basic science research. For aspiring researchers, a nephrology fellowship typically lasts three to four years. If you choose the clinical research pathway, you may be able to earn a master’s degree over the course of your training. As a nephrology research fellow, some of the topics you might study include:

  • Epidemiology of kidney disease
  • Public health strategies to improve access to CKD treatment in developing countries
  • Drug development for rare kidney disease
  • Cancer-related signaling pathways in kidney cells

After you finish the fellowship program, you can take the optional Nephrology Certification exam offered by the ABIM to demonstrate your expertise in the field. From there, you start your career as a nephrology-focused clinician, researcher, your researcher/practitioner.

If you are a foreign medical student or graduate, getting a job as a nephrologist might seem like a long way off, considering the years of preparation that are required, but it’s never too early to start preparing yourself! A clinical externship in nephrology can be a great way to get a feel for the field and establish connections with medical professionals in the United States before you apply for an internal medicine residency. Contact FMG Portal today to learn more about how this opportunity and the other ways we can help you get matched!

Choosing a Medical Residency: Regions of the United States


The United States is one of the largest and most diverse countries in the world. A few weeks ago, we talked about the differences between medical residency programs in urban and rural areas. However, it is important to note that even within the category of “urban” or “rural,” there are significant differences between different parts of the country. Within the geographic borders of the United States, you can find an example of almost every climate zone, and there are distinctive cultural differences between regions as well.

During your residency, the characteristics of the region in which you live can affect both your lifestyle and your work as a physician. This is especially true if you are pursuing a residency in one of the more general medical residency subjects — such as family medicine or pediatrics — since the types of cases you encounter can depend largely on the cultural circumstances of the region. Therefore, if you are a foreign medical graduate looking to get matched to a residency in the United States, it can be helpful to learn more about the different regions of the country so that you can apply to programs in places where you will feel comfortable living and where you will have the chance to work on cases that fit in with your medical interests and career goals.

The East Coast

The East Coast is one of the most densely populated areas of the country. As a result, you can find more medical residency programs in this region than any other, and you will find most of them in urban and suburban areas. The East Coast is home to some of the largest cities in the country, including New York City, Boston, Philadelphia, and Washington, DC — each of which has its own unique culture. However, they do share some general characteristics, such as highly diverse populations, good public transportation, and easy access to restaurants and grocery stores.

If you live on the East Coast, you can expect to experience four distinct seasons. Summers are hot, and winters can be very cold. In the northern areas, you might get a lot of snow in the winter, but further south, heavy rain is more common. Both spring and fall on the east coast are considered to be beautiful. In general, the culture on the East Coast tends to be more formal than in other areas of the country.

The Midwest

The Midwest, also known as the Great Plains, refers to the inland states between the east coast and the Rocky Mountains. Some of these states include Ohio, Iowa, Illinois, Michigan, and Minnesota. Although large portions of these states are rural, there are also a few major cities, such as Chicago and Detroit. Like the states on the east coast, you can expect cold winters and hot summers in the Midwest states. People in the Midwest are especially well-known for being friendly.

One of the most significant health issues that you will face if you work as a physician in the Midwest is the opioid abuse epidemic. The misuse of opioid medications (such as morphine, oxycodone and hydromorphone) is a growing problem in all parts of the United States, but it is especially concentrated in the Midwest. As a medical resident in the Midwest, you may treat overdose cases or individuals who are seeking treatment for addiction, so if you are interested in pharmacology, psychiatry, or any other drug-related area of medicine, a residency program in the Midwest may be of interest to you.

The South and Southwest

As in the Midwest, the South and Southwest regions are mostly rural, but with a few major cities, such as Atlanta (in the South) and Houston (in the Southwest). The climate in these states is much warmer and more humid in the summer, but Southerners also enjoy milder winters. The South is famous for its hospitality and its delicious comfort food.

Two medical issues that are more prominent in the South than in any other part of the country are obesity and smoking. Southern states like Mississippi, Louisiana, Alabama, Kentucky, and West Virginia have some of the highest numbers of people who meet the criteria for obesity and who say they smoke regularly. As a result, physicians are challenged to treat patients with many obesity-related medical conditions (such as type II diabetes and heart disease), as well as health problems caused by smoking (such as lung cancer).

The Mountain West and the West Coast

The Mountain West region includes the states that are between the Midwest and the West Coast. Some of the states in this region include Colorado, Utah, Idaho, and Montana. Because of the Rocky Mountains, much of this region is rural, although there are a few large cities, such as Denver. The Mountain West is known for its dry climate. In the winter, there is often snow, especially in the high country. In the summer, you can expect a daily temperature swing, with warm days and cool nights.

Outside of the East Coast, the West Coast is the most populous area of the country. Most people on the West Coast live in California, where the climate varies considerably. Southern California is warm and sunny, while Northern California is overcast and cool for most of the year.

The Mountain West and West Coast states are well-known for being among the healthiest in the United States, with low rates of smoking and obesity, and high rates of activity and exercise. However, the outdoor adventure opportunities in the states — like hiking, rock climbing, and skiing — can cause traumatic injuries. If you are interested in treating sports- and outdoors-related injuries — in either an emergency room or a rehabilitation setting — this region could be a great place to work. California is also particularly well-known for cutting-edge technological advances, so a residency in this area could be of interest if you are interested in medical technology research and development.

Choosing Between Regions of the United States

As an aspiring medical resident, it can be a challenge to figure out which region(s) of the country you would be comfortable living in. One way to experience life in the United States first hand is to complete a student elective or graduate externship before you apply. Not only can this give you a better idea of what it is like to live in a particular region of the United States, but it can also give your CV a boost and connect you with physicians who could possibly write letters of reference for your application.
FMG Portal offers student electives and graduate externships in a wide range of fields. Contact us today for more information!

Medical Subspecialty Spotlight: Bariatric Medicine


If you want to dedicate your career to the prevention and treatment of obesity, you may want to consider an educational track that leads you to subspecialize in bariatric medicine. Physicians who choose this subspecialty work with adults and/or children who are overweight or obese. As a bariatric medicine specialist, you would help your patients manage their weight and the associated complications, and you would devise prevention strategies for at-risk patients who want to avoid becoming obese.

Understanding Obesity

According to the World Health Organization (WHO), “Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health.” More formally, overweight is defined as having a Body Mass Index (BMI) of 25 or above, while obesity is defined as having a Body Mass Index (BMI) of 30 or above. Being overweight or obese puts patients at a higher risk for a wide range of other health problems, including:

  • Heart disease
  • Stroke
  • Type II diabetes
  • Cancer
  • High blood pressure
  • Osteoarthritis
  • Gallbladder disease
  • Sleep apnea
  • Asthma

Obesity is a growing problem around the world. The WHO estimates that the population of obese individuals has doubled since the 1980’s. In 2014, an estimated 1.9 billion adults were overweight, with 600 million of them meeting the criteria for obesity. In the same year, the WHO estimated that 41 million children under the age of 5 were either overweight or obese. Obesity is a particular problem in the United States. According to 2011-2014 data from the Centers for Disease Control and Prevention (CDC), 36.5% of adults in the United States were obese, and 17% of children between the ages of 2 and 19 were obese.

The Bariatric Medicine Subspecialty

Given the increasing severity of the obesity epidemic in the United States and around the world, many American medical schools have started offering fellowships in bariatric medicine. To get a bariatric medicine fellowship, you need to have previously completed an ACGME-accredited U.S. medical residency program in a relevant specialty area. Some of the residency specialty areas that schools accept include:

  • Internal Medicine
  • Family Medicine
  • Pediatrics

These three residency focus areas provide the general medical education that you need in order to succeed in a career as a bariatric medicine specialist. In each one of these programs, you learn about diagnosing and treating patients with a wide range of conditions, which is important bariatric medicine specialists work with overweight and obese patients who have highly diverse physical and mental health histories. Importantly, these three residency specialties were also the top three specialty areas in which foreign medical graduates got matched in 2015, according to data from National Resident Matching Program (NRMP).

What to Expect from a Fellowship Program in Bariatric Medicine

After completing your residency, you can apply to a one-year fellowship program that focuses on bariatric medicine. It is important to note that most fellowship programs that focus on bariatric medicine are officially titled Obesity Medicine and Nutrition Fellowship programs.

Because obesity is such a complex health condition, bariatric medicine fellowships tend to be highly interdisciplinary. You will likely study prevention and treatment strategies that involve nutritional programs, behavioral changes, pharmacological interventions, and bariatric surgery. Upon completion, you will be prepared for the board certification exam offered by the American Board of Obesity Medicine (ABOM).

Getting Into a Fellowship Program

So far, there are only a few Obesity Medicine and Nutrition Fellowship programs in the United States, so entrance is competitive. However, you can boost your chances by demonstrating your commitment to a career in the field. Here are a few things you can do as a medical graduate and as a medical resident:

  • Complete a graduate externship program in bariatric medicine before you apply for a U.S. medical residency. Not only can this boost your odds of getting matched to a residency program in the United States, but it can also indicate to future fellowship application readers that you know what you are getting into and and are ready to take on the challenge of a career in bariatric medicine.
  • Do bariatric-medicine related research while you are a resident. Many U.S. medical residency programs in internal medicine, family medicine, and pediatrics allow you to do conduct scientific research as part of the program. Whether you do lab research on pharmaceutical treatments for obesity, or population studies on obesity risks in certain demographic groups, having already done research on bariatric medicine may give you an edge over the other fellowship applicants.
  • Complete a fellowship in a related field. At some schools, in order to enter the Obesity Medicine and Nutrition Fellowship program, you need to have already completed another one-year fellowship in a related subspecialty area, such as endocrinology, gastroenterology, critical care medicine, or nutrition. Be sure to look into the requirements of the programs you are interested in before you apply.

If you want to pursue a career in bariatric medicine, FMG Portal is here to help. We offer graduate externships in the field and other services that can improve your chances of getting into a U.S. medical residency program. Contact us today for more information!

Choosing a Medical Residency Setting: Urban or Rural?

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As a foreign medical graduate, there are many factors that you must consider when applying to medical residency programs in the United States. With so many different residency programs available at universities and medical centers, it can be hard to narrow down the list, even after you have identified your specialty area of interest. One of the factors that you should take into account is the setting of the residency program — that is, whether your choose a program in an urban area, a rural location, or a small city / suburban area. The setting that you choose can make a big difference for your residency experience, in terms of both your medical work and your life outside of the program. Read on to learn more about what you might expect from U.S. medical residency programs in urban and rural areas.

Choosing a Medical Residency in an Urban Area

U.S. medical residency programs in urban areas offer distinctive opportunities for foreign medical graduates. In cities, you can find lots of hospitals, outpatient care centers, and community health centers, so your clinical rotations may take place at many different sites around the city. This can give you a broader range of experiences than you might get from a residency program in a rural area or a suburban setting.

Many of the cities in the United States are also characterized by significant racial and socioeconomic diversity. Indeed, a 2015 study by the  Brookings Institution found that the 50 largest cities in the United States had a significantly larger gap between the rich and the poor than smaller cities and rural areas. Therefore, if your residency is in an urban area, you might have the chance to work with patients from a wider range of cultural and economic backgrounds. Depending on your country of origin and the city in which you choose to work, you may have foreign language skills that can come in handy when working with the diverse populations of American cities.

Choosing a residency program in an American city will also significantly impact your lifestyle outside of the program. One of the benefits of living in a large city is that you will never need to worry about being bored — from restaurants to museums to concerts, there is no limit to the cultural experiences you can find in American cities! However, one of the drawbacks is that living accommodations are more expensive in American cities, so you may need to live with roommates. At the same time, public transportation systems are better in cities than in rural areas, so you may not need to own a car.

It is important to note that there is no “typical” American city, so if you are looking for a residency program in an urban area, you should do additional research about the cities you are considering. As of 2015, the 10 most populous metropolitan areas in the United States were:

  • New York City, New York
  • Los Angeles, California
  • Chicago, Illinois
  • Dallas – Forth Worth, Texas
  • Houston, Texas
  • Washington, DC
  • Philadelphia, Pennsylvania
  • Miami, Florida
  • Atlanta, Georgia
  • Boston, Massachusetts

Choosing a Medical Residency in a Rural Area

The opportunities that you would get as a medical resident in a program in a rural area are different from those that you would get in an urban area, but they can be just as educational and fulfilling. According to the Centers for Disease Control and Prevention (CDC), health risks for Americans in rural areas are significantly greater than for those living in rural areas, so as a medical resident, you may have the opportunity to gain experience with more serious cases. Here are a few statistics from the CDC about health disparities in rural areas that can provide insight into some of the challenges that medical residents in rural areas face:

  • Compared to Americans in urban areas, rural residents are more likely to die from heart disease, cancer, chronic lower respiratory disease, and stroke.
  • Death from unintentional injury is 50% higher in rural areas than in urban areas — primarily due to motor vehicle crashes and opioid overdoses.
  • Children living in rural areas are more likely to have mental, behavioral, and developmental disorders than those living in urban areas.

Because there are fewer physicians in rural areas, residency programs in rural areas are more commonly available in the broader specialty areas of family medicine, pediatrics, and internal medicine. That’s good news for foreign medical graduates, since the NRMP reports that these were the top three areas in which foreign medical graduates got matched in 2015.

The rural areas in the United States are located primarily in the Midwest, the South, and the West, each of which offers different cultural opportunities and lifestyle options. For example, in many rural areas in the West, there is easy access to outdoor activities like hiking, rock climbing, and rafting. On the other hand, the South is famous for comfort foods like fried chicken and pecan pie. Rural Midwesterners are known for being particularly friendly. On a more practical note, if you are living in a rural area, your housing will probably be less expensive, but you may also need to own a car in order to get around.

Clinical Externships in Rural and Urban Areas

Researching rural and urban areas in the United States can be helpful as you decide where to apply for a U.S. medical residency program, but there is no substitute for real-world experience. A great way to learn what life is really like in one of these settings is to complete a clinical externship. FMG offers clinical externships in many areas around the country, including rural and urban settings, as well as small cities and suburban areas. Contact us today to learn more about all of the resources we offer for foreign medical students and graduates!

Residency Specialty Spotlight: Pediatrics


If you want to dedicate your medical career to working with kids, a residency program in pediatrics may be the right option for you. According to 2015 data from the National Resident Matching Program (NRMP), pediatrics was the third-most popular residency specialty area for foreign medical graduates, behind only internal medicine and family medicine.

As a pediatrician, you could work with infants, children, and adolescents, ranging in age from birth to 21 years. Pediatricians are trained to provide preventive care and treat a wide range of conditions, including hereditary diseases, infectious illnesses, and traumatic injuries. You may choose to work in a primary care setting as a general pediatrician, or you may specialize your practice on a certain area of the field. It all starts with a pediatrics residency.

Pediatrics Residency Programs in the United States

US medical residency programs in pediatrics last for three years and provide general training in the wellness of infants, children, and adolescents. However, because pediatrics is such a broad specialty area, the programs can vary widely between schools. That means that when you are searching for residency programs, you should pay careful attention to what makes each one unique.

For example, programs may differ in the relative amount of time dedicated to clinical work in ambulatory and primary care settings. The location of a school often plays a role in this, since some schools are located in large cities where you may end up working at multiple hospitals and outpatient centers, while programs in rural areas allow you to gain extensive experience working at one or two locations. There are also programs that allow you to focus your studies by pursuing a certificate in an area of interest, such as global health, community health, medical education, or academic research.

In general, though, you’ll usually spend the first year of a pediatrics residency building a broad base of knowledge and developing basic skills in pediatric care, through a combination of clinical and didactic work. In the second year, you will have the chance to take on greater responsibility in clinical decision-making. You’ll probably also have the chance to pursue particular areas of interest through electives. Finally, the third year of a residency program will give you the chance to step into a leadership role in the clinic and prepare for your future as a pediatrician, whether you choose to focus on a specific subspecialty or practice as a generalist in the field.

Post-Residency Fellowship Options

Once you finish your residency in pediatrics, you can start your career as a general pediatrician or you can apply to a fellowship program. Almost all pediatrics fellowships in the US require an additional two or three years of study, although there are a few one-year fellowships available as well. Although this is not a comprehensive list, here are some of the options you could consider:

  • Adolescent medicine (3 years)
  • Allergy and immunology (2 years)
  • Pediatric cardiology (3 years)
  • Pediatric endocrinology (3 years)
  • Neonatal medicine (3 years)
  • Pediatric infectious disease (3 years)
  • Pediatric emergency medicine (2 years)
  • Pediatric sports medicine (1 year)

Getting Matched to a US Program

If you are interested in a US medical residency program in pediatrics, you might want to complete a graduate externship or student elective in the field. Not only can these experiences help you decide if pediatrics is the right specialty area for you, but they also look great on your CV. Many residency programs also require foreign applicants to submit a letter of reference from a US physician, and an externship program is a great way to make connections in the States.

FMG Portal offers student electives and graduate externships in many different specialty areas, including pediatrics. Contact us today for more information!

U.S. Residences have Additional Requirements for FMGs

Unlike U.S. allopathic medical school seniors, foreign medical graduates (FMGs) must meet additional requirements to be considered for U.S. medical residencies.  These additional requirements may be one reason that FMGs are not placed in the NRMP Match Program at as high of rate as U.S. allopathic seniors. To be fully prepared for the NRMP process, foreign medical graduates can educate themselves on typical U.S. medical residency requirements. The University of Washington’s internal medicine application site provides an example of the additional requirements that FMGs face when trying to match with a U.S. residency.

If applying to the University of Washington medical program, FMGs have to meet these requirements (in addition to the typical personal statement, transcripts and letters of recommendation).

Must be a permanent resident of selected states OR sponsored by faculty

Because most foreign medical graduates are not permanent residents of Washington, Montana, Wyoming, Alaska or Idaho, most applicants will have to meet the second requirement, faculty sponsorship. The faculty member must write a letter explaining how he or she knows the foreign medical graduate and what qualifications the FMG possesses. Foreign medical school graduates may be able to find a link to a University of Washington faculty member through their medical school. Another option for FMGs is to try to obtain a clinical clerkship or internship with a University of Washington faculty member. This can be a difficult requirement to meet and it is only the first of three.

Must have 2 weeks of clinical clerkship at an LCME-accredited medical school OR four months of residency at an ACGME-accredited program

The University of Washington also specifies that these clerkships and residencies must be at a Puerto Rican, Canadian or U.S. location. Foreign medical graduates that have only worked in their native countries will not meet this requirement. To be able to apply for residency at the University of Washington, FMGs will need to obtain one of these clerkships or residencies. For the LCME clerkship option, there are 155 qualifying schools. For the ACGME residency option, FMGs can select from schools listed on the ACGME list.

Must apply through the ECFMG ERAS Program

The online ERAS application program certifies that FMGs meet the same clinical standards as U.S. allopathic seniors. There are three exams that FMGs must pass in order to apply through this program. It is likely that foreign medical graduates will have to visit the U.S. for at least one of these exams. Therefore, it is imperative to have enough time to meet these requirements before the application and interviewing process for NRMP begins.

Many U.S. medical residencies, including the University of Washington, have additional requirements for foreign medical graduates. FMGs should examine what requirements are needed long before the fall application and interview process. Some requirements, like a 4 month residency or 2 week clerkship, require travel and take weeks or months to complete. By researching these additional requirements early, FMGs can be prepared for the NRMP matching process.

NRMP Matches 52.4% of Foreign Medical Students to U.S. Residencies in 2017

The National Resident Matching Program, or NRMP, announced the largest number of medical residency applicants and placements in 2017. The program places medical school students and graduates in residencies using a Nobel-prize winning algorithm. To be included in the program, medical school students submit applications and interview with programs starting in the fall and continuing through early winter. The program directors and applicants then rank their order of preference. The algorithm matches applicants to residency programs. This successful program continued in 2017 with over 35,000 medical school student and graduate applicants.

In 2017, these medical school students and graduates competed for over 31,000 positions. 94% of U.S. allopathic seniors were successfully matched. This is a consistent number from year to year. However, the placement rate for non-U.S. citizen international medical school graduates and students (also known as FMGs) is much lower, only 52.4%.  Over 7,000 FMGs applied in 2017 and less than 4,000 were placed. NRMP notes that this is the highest match rate since 2005, so 52.4% is better than average.

The lower match rate of international medical students suggests that these students may need additional support to successfully match with U.S. residency programs. Comparing the experiences of U.S. seniors and foreign medical students might illuminate some difference that account for the lower match rate. U.S. allopathic seniors follow a standard process for medical residency matching. They know when to take their USMLE (United States Medical Licensing Examination). In many cases, their medical school can support and guide them through the process. For foreign medical students, their medical school might not be able to provide the support and guidance needed to obtain a residency in the United States. The medical school’s process might be set up for medical residency in the local area.

U.S. students might also have an advantage during interviews. Resumes are written and interviews are conducted in their native language. Additionally, many U.S. school provide workshops on resume writing and interviewing. Foreign medical students may not have access to this support.

Hand-on clinical experience might also help U.S. students rise through the ranks. Many medical schools including clinical experience as part of the curriculum. These schools partner with U.S. hospitals and clinics for training. Foreign medical students may have clinical training in their native country. However, interviewing residencies may be more comfortable accepting students with training at known U.S. institutions.

It seems as though foreign medical students are at a disadvantage when it comes to medical residency placement. However, additional support can enable international medical students and graduates to be successfully matched to a U.S. residency. Hands-on clinical experience in the U.S., resume advice, and interview preparation are likely to increase the chances that a FMG will be matched with his or her preferred medical residency.