What to do if you don’t match
Lets think about what you would do if you don’t match. This is the unthinkable! Unfortunately, the majority of applicants don’t match. Many IMGs I know just apply again, and don’t match again.
I’m not able to find data on the success of repeat applicants to the match. I imagine the success rate is quite low. I hear stories of people who come to the US, apply for the match without success and end up working in other positions where they do not use their medical training.
The best strategy in my opinion is to come to the US for a limited time and do rotations as a student, as a postgrad observer or for research. During that year or two apply for residency and hopefully interview and match. If you have low scores (<220) and do not match, I don’t advise spending anymore time in the US to improve your application or applying again. In general, it is time not well spent. If on the other hand, you are stuck in the US there are a few backup plans to consider. The bottom line is that if you have an option back home to work as a doctor, don’t give it up to come to the US unless you have terrific scores on your USMLEs. By terrific score I mean above 235 on step 1 and step 2 and pass of CS all first attempts. Remember that less than 30% of IMGs who apply land a residency spot.
What can one do with ECFMG certification in the US besides residency? Nothing. ECFMG certification is for residency and is useless without residency.
Can one work as a physician in the US without residency training? No, you can’t work as a physician in the US without a license and you need a residency to obtain a full license. The practice of medicine without a license is illegal. Can an IMG work in the prison system? Not without at least a year of residency and a full medical license which you cannot get unless you do a residency.
What can one do?
Other options for IMGs in the US who don’t match:
Research Fellowship with an eye on working in research long term – your medical degree means something but the income is not terrific.
Clinical research coordinator – your medical degree means something and there is some patient contact during the consenting process but the income is not terrific.
Non-accredited clinical fellowships – usually one or two years, may work for someone who is missing US clinical experience.
Welcome Back Initiative is a US non-profit with a mission “To build a bridge between the pool of internationally trained health workers living in the United States and the need for linguistically and culturally competent health services in underserved communities.” WBI was recently profiled in the AMA medical news site. One thing that they focus on is obtaining employment in the Health Sector not as a physician.
Nursing School – patient care and good income
Optometry School – patient care and good income
MPH – working in clinical research long term, your medical degree means something
PhD – for those thinking of research long term, your medical degree means something
Medical assistant – income not terrific but you are part of the patient care team (Physician Assistant programs are not IMG friendly)
Surgical assistant – income not terrific but you are part of the patient care team
Green card holders are eligible to enlist in the US military and can work in a health related field
Training outside the US (I don’t have any business or personal relationship with the sites below and have not investigated them nor do I endorse them).
The views expressed in this post are those of Kenneth Christopher, MD and do not necessarily reflect the views of Dr. Christopher’s employer Partners HealthCare.