Monday, February 25, 2013

Non-US citizen at a Caribbean med school wonders what his chances are for getting a surgical residency

"Leighton" (not his real name) writes,

I'm a 4th yr medical student hoping to match into general surgery in 2014. The only hurdle is that I'm an international medical graduate (IMG). I'm a non-US citizen at a Caribbean med school.

I have done all my core rotations which include IM, Psych, Gen Surg, Peds and OB/GYN. So far I have all As in my rotations. I did my surgery rotation at Elsewhere General Hospital in the Midwest. It's a community hospital without a surgery residency program.

I have a pretty good USMLE step 1 score (247) and will be writing step 2 in the coming months. Since you have been a residency director, what can I do to improve my chances? What do residency programs look at? What programs might be more IMG-friendly? Surgery is quite competitive, do I have a chance as an IMG or should I focus my electives more for IM or Family med?

Data for the 2012 match (page 5) shows that general surgery filled 1143 (99.7%) of 1146 available categorical positions via the match. Of the 1143 who matched, 57 (4.9%) were non-US citizen IMGs.

While your USMLE score is very good, I don't know if it puts you in the top 5% of all non-US IMGs. 

I'm afraid it is difficult to judge what your grades mean, but that is also a problem with US med school grades. (See a previous blog of mine.) Certainly, all 'A's are better than all 'B's in any school. But how many students in your school get all 'A's?

The only way to find out if a program is IMG friendly is to go to each program's website and see where their current residents are from. Here's a link from ERAS, that gives the web addresses for all of the general surgery programs in the US.

See if your school has any information on how many of its students matched in general surgery over the last two or three years, what their records were like and where they matched. You might also try to contact a couple of those students for advice too.

I'm not sure how to improve your chances. Doing research never impressed me unless it was clinical research that resulted in a published paper in a journal that I had heard of. You might explore elective rotations at some programs that you know have taken non-US IMGs.

The way the match works favors the applicant. You have nothing to lose by trying to match in surgery. If you fail to get a categorical spot, you have two options. You can take a preliminary position and hope to work your way into a categorical one. There were 737 484* surgical prelim positions open after the match last year. However, that can be risky if no categorical spots open up.

Or you could go into internal medicine, which had only 51 unmatched positions or family medicine which had 149. The link to the NRMP match statistics shows all the specialties and how they fared in the 2012 match.

If you decide to pursue surgery, you will need to tailor your electives accordingly. I have written about fourth-year electives.

I hope this helps. Good luck and let us know how it went after next year's match.

[*Number of unfilled prelim positions corrected on 2/27.]


  1. Good post, Skeptical Scalpel.

    Lot's of interest on this topic at OnSurg.


    Here's an inspirational story and some basic immigration info meant for non-resident medical students who want to become surgeons in the US. Good luck!


  2. Chris, thanks for posting those excellent links. I'm sure "Leighton" will appreciate them.

  3. For a non-US IMG:
    What score is good enough for a categorical position? If I have 5 weeks till my exam and my recent NBME score is 246
    I think I can get into the 255+ zone in a month should I go for it or postpone for 3 months to try and get +260 but I'm afraid of burn out.
    Is the difference worth it?

  4. Gad, in my opinion, the difference between a 255 and a 260 is not worth the effort. Good luck.