Kenneth V. Iserson, M.D., MBA
Professor Emeritus, The University of Arizona, Tucson, AZ

While about 25% of U.S. physicians were trained outside the United States and Canada (i.e., international medical graduates; IMGs), simply being allowed to apply to residencies can be a long and daunting process. As an IMG, you must apply through the Educational Commission on Foreign Medical Graduates (ECFMG; They will verify your medical school documents, permit you to take the United States Medical Licensing Examination (USMLE), facilitate the visa process, and provide the certificate required to apply for residency. Note that USMLE Step 2CS requires demonstrating clinical skills as well as written and spoken English proficiency.

Once you have an ECFMG Certificate, you still must apply for a residency position. In recent years, only about 53% of U.S.-citizen IMGs and 49% of other IMGs who applied for first-year residency positions matched through the National Residency Matching Program (NRMP). In contrast, about 94% of students from U.S. M.D.-granting schools successfully matched. With the expected increased number of U.S. medical students vying for a relatively fixed number of residency positions, IMGs will have a much more difficulty matching in coming years. 

IMGs with a better chance of obtaining a residency: 

  • are U.S. or Canadian citizens,
  • are native English speakers,
  • are more recent medical school graduates, and
  • have good USMLE scores.

Most of the residency positions IMGs obtain are in Internal Medicine, followed by Family Medicine. Those who desire to enter other, more competitive specialties often work at a training program as an assistant or in research to improve their English or to show the faculty their talents. This works especially well for those with special skills, often gained from prior advanced training.

Those IMGs who are not able to get a residency position often retrain in other medical professions, such as paramedic, respiratory therapist, nurse or physician assistant.

Understanding the process, good preparation, and applying to to programs with a high number of IMGs will maximize any the chance of getting a residency position.

For more information about IMG residency applicants, see the two free videos at:


Based on: Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition
Tucson, AZ: Galen Press, Ltd.


Sign up and be the first to get exclusive offers, sales, events, and more!

Yes, I would like to receive email newsletters with the latest news and information on products and services from Thieme Medical Publishers, Inc and selected cooperation partners in medicine and science regularly (about once a week). I agree to the use and processing of my personal information for this purpose. I can opt out at any time by clicking the "unsubscribe" link at the end of each newsletter.

Further information about data processing and your corresponding rights.

*Required field; all other fields are voluntary. We only use this information to personally address you in your newsletter.