Posts Tagged ‘IMG’

Those without interviews

January 30, 2012 1 comment

For those of you who are without interviews you need to take a step back and really evaluate yourself as a candidate.

The fixable reasons for no interviews are the following:

No US clinical experience
Application submitted after October 1
Not ECFMG certified at time of application
Application only to a limited geographical area
Not applying to enough community hospital programs

Non-fixable reasons for no interviews are the following:

Poor scores (below 210 on Step 1 or 2 or any exam fail including Clinical Skill exam).

If this is not your year, think about what you might be able to do to fix the problem. You can’t change your scores if they are low. A good score on Step 3 will not rescue a poor score on Step 1 or Step 2 or a CS fail.

Now I know of a candidate this year with low scores who got a pre-match and several candidates with amazing scores who got pre-matches. Hopefully many more of you will match this year.

Anyway, if your scores are over 210 and you have no interviews but you have no US clinical experience, well you need to get some US clinical experience and reapply. If there are things you can fix (other than scores/ attempts) then fix them.

Observerships at places that take IMGs may be helpful. If you do an observership at a place that takes primarily IMGs then the program gets to see you for days at a time and get a sense of you as a person. The observership wont allow you to see patients and show your clinical skills but people can get to know you. You may very well get an interview at that program if they liked you. Observerships at university hospitals give you an opportunity to see a big hospital in action.

The process is difficult and will only get more difficult over time. In the past, about 75% of applicants got in to a residency over 5 years of applying.

If after fixing what is fixable and you have applied without interviews then it is time to start thinking of doing something else or going home to practice.

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.

Observership List

January 3, 2012 4 comments


I am thrilled to announce the launch of a HMS Global Academy Course for IMGs. Founded by Harvard Medical School, the HMS Global Academy is an online learning destination offering high-quality courses to learners everywhere.


I am the director and instructor for the HMS Global Academy Course on the Introduction to the Practice of American Medicine. This is a self-paced inexpensive online course with lectures on topics that are geared towards IMGs who are applying to residency through the match. We have recorded and produced the course with the goal of assisting IMG applicants to be as successful as possible in attaining a residency match.  You can enroll here.

Observership List

As promised, here is an up-to-date list (as of June 2016) of observership opportunities at programs that open to international graduates. I have confirmed that these programs do have observership programs.  Most of these are internal medicine related but I have included some surgery observerships. I advise you to do observerships in several places if possible and focus on those programs that have a history of taking IMGs.

Observerships at Large University Hospitals
Dana-Farber/Boston Children’s Cancer and Blood Disorders Center
Cleveland Clinic International Physician Observer Program fee $500
Cleveland Clinic Global Clinical Observer Program designed for 12 “highly qualified participants” for “a four-week shadowing experience” fee $1000
Johns Hopkins “We recommend that you directly contact the department you’d like to observe”
University of Pittsburgh Critical Care Medicine
Sparrow Hospital/Michigan State University Program
Beth Israel Medical Center, University Hospital for the Albert Einstein College of Medicine
University of Chicago Center for Global Health Clinical Observer.  Requires faculty sponsorship.
University of Texas Health Science Center Houston offers observerships once a faculty sponsor is identified.  Application is here and requires a fee to apply.
University of Texas MD Anderson Cancer Center (Integrative Medicine, Anesthesia/Critical Care)
University of Texas MD Anderson Cancer Center (Pulmonary Medicine)
Thomas Jefferson (applicant must have letter from Thomas Jefferson Faculty member to be accepted)
George Washington University Hospital
University of Miami Observership Program (Foreign nationals may be eligible for a 3-month Observership Program) Contact Olivia Cata (
University of Washington
UCLA Family Medicine three month Observership program.  Geared towards candidates who speak Spanish.

Observerships at hospitals with Internal Medicine Programs that have taken a large % of IMGs
Griffin Hospital Program
Cleveland Clinic (Florida) Program
Mercy Health Partners/Mercy Hospital St. Louis
MedStar Montgomery Medical Center – observership offered only after the match to matched candidates
Wayne State University/Detroit Medical Center Program
St John’s Mercy Medical Center Program
University of Texas Health Science Center at San Antonio Lower Rio Grande Valley RAHC Program IMG physicians currently enrolled in training programs
Drexel University College of Medicine/Hahnemann University Hospital Program Offers a Structured Physician Refresher/Re-entry program which is expensive
Hurley Medical Center See information under “Do you allow applicants to observe in your hospital before the interview?” USMLE steps 1 and 2 must be > 220.
Mount Sinai Medical Center Miami Beach Florida International Post Graduate Observership Course, 4 weeks in Cardiology, Infectious Disease or Internal Medicine.  USMLE steps 1 and 2 must be > 235. Application is here.
Good Shepherd Medical Center Observership in Internal Medicine, contact 903-315-5171
Einstein Medical Center Philadelphia

Other Observership opportunities
Children’s Hospital Boston
Florida Hospital Medical Center Program
contact Nicole Yates, Residency Coordinator
Baptist Health South Florida
Washington Hospital Center
Harbor Hospital
University of South Florida
Methodist Hospital, Houston TX
Allegheny General Hospital–Western Pennsylvania Hospital Internal Medicine Residency Program call International Services (412) 359-5269 or e-mail:
Jackson Memorial Hospital/Jackson Health System Program
Moffitt Cancer Center – Tampa, FL and here
Children’s Hospital Boston
Brigham and Women’s Hospital Radiology

General Surgery Observerships
Association for Academic Surgery (lists 68 Hospitals with Surgery related Observerships)
Cleveland Clinic Florida
Cleveland Clinic
Einstein Medical Center Philadelphia
Mount Sinai, New York

Other Surgery Observerships
NYU Orthopedic Surgery
MD Anderson Cancer Center Thoracic & Cardiovascular Surgery
Children’s Boston Congenital Cardiac Surgery, Pediatric Otolaryngology, Pediatric Surgery
Orthopedic Surgery Hospital for Special Surgery New York requires faculty host
University of Pittsburgh Surgical Critical Care
Plastic Surgery Major Toronto Hospitals

Updated 06/02/2016. If you do find a link that no longer works please send a message to

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.

IMG Friendly Internal Medicine Program List

December 20, 2011 2 comments

For those of you new to the matching game and those of you who are looking ahead to next year I wanted to share a free list of IMG friendly Internal Medicine Programs posted by I don’t have a personal or professional relationship with sama but have not seen such detail on IM programs posted before so I thought it best to bring the list to your attention.

While not complete in every detail, the list includes programs that have historically matched IMGs. Note that the contact person and phone numbers may not be up to date. The urls that I tried worked. Some of the programs only take a few IMGs some programs take mostly IMGs. The university programs will take fewer IMGs than the community hospitals. Some university programs take very few IMGs, some take more.

The list was put together by I have not verified the content or information on the list. It is up to you to decide where to apply and what Program criteria fit you. Look at the “Internal medicine programs according to percentage of IMGs” list as well to see which programs have high percentages of IMGs.

The list is meant to be a starting point in your quest for an interview in internal medicine. I hope that the information is helpful.

The following links are excel and word files where you can find the information. Alternatively you can visit the sama site here.

IMG Friendly Programs Application List

Internal medicine programs according to percentage of IMGs

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.

Slow Elimination of International Medical Graduates

November 21, 2011 4 comments

According to the American Medical Association, IMGs make up one fourth of the physician workforce in the United States and more than one quarter of resident physicians. In addition, IMGs are more likely than graduates of US medical schools to serve in medically underserved areas and in primary and critical care.

I see on forums people lamenting that the reason that they are not getting interviews for residency is that there are now more AMGs because more medical schools have opened in the recent past.

This may have a small effect this year but has some truth for tomorrows applicants. Over 85 percent of existing medical schools have either already expanded their first-year enrollment or plan to expand within the next five years

The following figure shows what will likely happen. By 2019, the number of AMGs will equal or be somewhat higher than the residency slots that are available in the US. It is interesting that the amount of the proposed increase of AMGs is similar to the numbers of IMG PGY1 residents. The following projections are from the AAMC.


Medical school enrollment has already increased by 13.2 percent as of the 2010-11 academic year. The AAMC estimates that almost 800 first-year students will attend these new schools in the academic year 2012-13, based on future enrollment figures. Enrollment is projected to increase by 27.6 percent by 2015. Existing medical schools have increased the numbers of students and new US schools are opening. The trends seen already are not in IMGs favor. Between the 2005 and 2009 matches, the percentage of IMGs who submitted rank lists and matched dropped from 54.7% to 47.8% for US-IMGs and from 55.6% to 41.6% for non-US IMGs. Once these new US students graduate it will get progressively more difficult to attain a residency slot as an IMG. I see it as unlikely that the US government will expand funding of US residency programs to increase the size of residency programs.
All this adds up to the slow elimination of the IMGs as residents by 2019.

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.

What are my chances?

Let me get out my crystal ball.

The “what are my chances” question is not one that can be answered as I do not have enough data.  One can predict the probability of matching based on Step 1 scores or a combination algorithm.

Remember one can not underestimate the importance of data.  According to the NRMP 2009 data the probability of matching in Internal Medicine (IM) is 35% if you have 3 interviews, 50% if you have 5 interviews, 75% if you have 10 interviews.  That makes sense you have to interview to match.  Many people are lucky to get 1 interview which corresponds to a 25% chance of matching in IM.

Regarding Step 1 scores, for those who do interview in IM, the probability of matching in IM with Step 1 200 is 27%, Step 1 of 220 is 45%, 240 is 63%.  Information on step 2 scores is not present as many AMGs don’t take step 2 prior to applying.

What can I do to improve my chances?  Just over half (1092/2113) of those who match do not have any Abstracts, Presentations, or Publications which suggests that if you are strong enough as a candidate, publications/research don’t matter.

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.

Couple Matching for IMGs

I get asked about the chances for couples in the match.

The NRMP gushes about couples chances for the match but I’m not convinced that this is the golden ticket for IMGs.

“Couples enjoy great success, with match rates above 90 percent every year since 1984. In 2011, the match rate for couples was 94.6 percent, up from 93.4 percent in 2010. About 79 percent of couples are U.S. seniors, and their match rates are quite similar to those of their classmates, varying within 1 or 2 percentage points each year. Couples have the option of one partner indicating a willingness to go unmatched at a certain rank on the rank order list if the partner matches to the program linked to that rank.”

The problem is that this data might not speak to IMG couples.  “About 79 percent of couples are U.S. seniors.”  I can’t take this to mean that 21% of couples who match are IMGs. The data does not include US grads (3% of matched not in med school at the time of match) or DOs (6% of matched). Extrapolating the data, 290 of the 4600 IMGs (US AND non-US) who match are in the couple match.  I strongly suspect that most of these are US IMGs.

Remember that only 40%-50% of IMGs who interview match. I don’t give special consideration to IMG couples.  I don’t advice couples to couple match.  You are only as good as the weakest link (either yours or your partner’s).  If your partner has multiple attempts on the CS exam and low scores, neither you nor your partner will match.  If you must couple match do opt for the following option: “indicate a willingness to go unmatched at a certain rank on the rank order list if the partner matches to the program linked to that rank.”

So the couple match is not the golden ticket to residency.

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.

2 digit USMLE scores are going away

August 4, 2011 1 comment

So the two digit score is going away, sort of.

From ECFMG Reporter issue 169 May 2011: “Starting July 1, 2011, USMLE transcripts reported through the ERAS reporting system will no longer include score results on the two-digit score scale. USMLE results will continue to be reported on the three-digit scale. This affects the Step 1, 2 CK, and 3 examinations only; Step 2 CS will continue to be reported as pass or fail. These changes do not alter the score required to pass or the difficulty of any of the USMLE Step examinations.”

This doesn’t have any effect on the applicant as most programs use the 3 digit scores in their filters anyway.  What it does mean for the IMG community is a frame shift in the thinking of what the scores mean.    What this means is that “99/99” will become a thing of the past.  No more “he is a 99/99 so he must be good.”  A 99 two digit score represented about the top 20% of scores, not the 99th percentile.  True 99th percentile is a three digit score of 260 according to a nice analysis by My Dominant Hemisphere. This was a big point of confusion for a lot of people for a long time.  The only people I ever heard mention the two digit score were IMGs.  And the mention bordered on obsession.  The two-digit scores were designed for the state medical boards and will still be reported to the states and to the test taker but not the residency programs.

On the two-digit scale, the minimum passing score is always a 75 but with the 3 digit score it depends on the distribution.  Minimum Passing three digit Scores for last year were Step 1 188, Step 2 CK 189, Step 3 187. My advice is to think of your scores in the three digit form and compare them to the NRMP data to see in which specialties that you might fit.

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.

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