On March 20th this year 34,905 (of the 41,334 total applicants) medical school graduates around the world waited anxiously to find out where they will be completing the remainder of their graduate medical education. However, after 4 or more years of medical schooling, completion of basic sciences, mandatory clinical rotations, and a grueling interview process, 2,941 withdrew their applications, 3,488 did not submit rank lists, and 8,653 post-medical graduates still failed to match into a residency position.
So who isn’t matching? US medical school curriculums are specifically designed in order to prepare students for US residency programs following the ACGME Core Competencies. So, it is no secret that the NRMP Main Residency Match favors US medical school graduates (USMGs). Typically, USMGs score higher on their USMLE exams, are better prepared for interviews, and display a thorough understanding of the ACGME Core Competencies. Therefore, program directors are much more confident that these students will be able to pass their board exams once a resident in their program.
Each year approximately 95% of USMGs match into residency programs. International and Foreign Medical Graduates (IMGs and FMGs) however, have much lower odds. This year, 62% of IMG applicants and 64% of FMG applicants remained unmatched. For the 8000+ unmatched students the next step was to tackle NRMP’s Supplemental Offer and Acceptance Program (SOAP). Previously, and appropriately, referred to as the “scramble,” SOAP offers unmatched students a last chance to match into any unfilled residency positions for that year. Although IMGs and FMGs make up the majority of SOAP applicants, USMGs are still favored in this process as well. In 2014, USMGs matched into 609 of the 998 available positions, leaving only 309 PGY-1 positions left for the 6000+ unmatched IMGs and FMGs.
The reality is there simply are not enough residency positions for the growing number of medical school graduates worldwide. So what can these 8653 unmatched students do differently to improve their chances of matching next year? For those who did not match or recent graduates from foreign and international medical schools there are a few things you can do to set yourself a part from the other applications in the stack. Since program directors typically favor USMGs for their knowledge and understanding of the ACGME Core Competencies, IMGs and FMGs need to show program directors that they too embody these competencies. This is why US Clinical Experience (USCE) is so important to program directors. Externships and research at an ACGME accredited residency program gives you the opportunity to work side-by-side program directors, department chairs, and other residents, proving you have the skills and knowledge to be a part of their residency program.
According to current Program Director, Dr. Raj Patel, “It (USCE) puts you in direct contact with the current system of the United States. Not only do you understand how the intricacies of the wards and the floors work along with the residents and faculty but you are also present in the hospital for other activities. […] You will have access to other residents of other specialties at grand rounds or at the noon lectures or at any educational session. You will also have the advantage to meet with other residents or chief residents or some of the faculty in the cafeteria where you will have a lot more networking contacts.” The key is to get your foot in the door, and USCE can provide you with this opportunity.