The results of the National Resident Matching Program (NRMP) 2016 were the largest in history and the trends show that numbers will continue to grow. A record-breaking 30,750 positions were placed in the 2016 Match, and on March 14th, 29,572 positions were filled using the Matching Algorithm. During the Supplemental Offer and Acceptance Program (SOAP), 1,022 positions out of 1,097 positions offered were filled. By the end of SOAP, 99.5% of positions were filled overall! This is a slight increase from a 99.4% position fill rate in the 2015 Main Residency Match.
Out of the 42,370 total registered applicants, 30,594 applicants found positions. The number of overall positions increased slightly from 2015 by 538 positions, but the total number of applicants increased as well, rising by 1,036. The trends for international medical school graduates are increasing—both in number of applicants and in number of successful matches. Since 2012, the number of US citizen international medical school graduates (IMGs) has risen by almost 25%. The number of non-US citizen international medical school graduate (FMGs) applicants rose slightly as well, and the match rates for both IMGs and FMGs rose by approximately 1%. At 53.9% and 50.5% respectively, the match rates for IMGs and FMGs were the highest they have been since 2005. However, this still means that nearly half of the foreign trained graduates are not matching, and this total number is increasing as the number of applicants is increasing.
The graph below shows the matching percentage trends among IMGs, FMGs, and US Seniors. The percentage of matched IMGs and FMGs seems to fluctuate more overall from year to year, however, in recent years the variation seems to be evening out at an approximate 50% match rate. US Seniors, in comparison, have had a high and steady percent matched rate over the years.
Other Trends for IMGs and FMGs:
- Internal Medicine (Categorical) (1,016)
- Family Medicine (727)
- Pediatrics (201)
- Psychiatry (162)
- Anesthesiology (126)
- Internal Medicine (Categorical) (894)
- Family Medicine (680)
- Psychiatry (178)
- Pediatrics (174)
- General Surgery (Preliminary)
- Internal Medicine (Categorical) (2,013)
- Family Medicine (382)
- Pediatrics (250)
- Neurology (188)
- General Sugery (Preliminary) (177)
- Internal Medicine (Categorical) (1,869)
- Family Medicine (366)
- Pediatrics (254)
- General Surgery (Preliminary) (254)
- Neurology (170)
As denoted above, Internal Medicine is the top specialty for both IMGs and FMGs, with numbers of matched applicants increasing from 2015. Overall, 69.1% of all IMGs/FMGs matched into categorical primary care positions (Internal Medicine, Family Medicine, and Pediatrics). This is an increase from 67.3% in 2015.
What about the trends of IMGs/FMGs in the Supplemental Offer and Acceptance Program (SOAP)? As shown in the graph below, US medical school graduates continue to dominate the number of SOAP acceptances over the years. Of the 1,022 positions accepted in the SOAP, over 70% were by seniors and previous graduates of US medical schools. This number has remained fairly constant over the past 5 years, showing no change in favor towards foreign trained medical school graduates.
What do these trends mean for International and Foreign medical school graduates?
- Despite the increase in their acceptances into Residency, this increase was almost negligible (1%) and the increasing number of IMG/FMG applicants means that a higher total number of IMGs/FMGs are not matching.
- Primary care specialties like Internal Medicine, Family Medicine, and Pediatrics seem to be more favorable for and less competitive for IMGs/FMGs.
- The chances of matching in the SOAP are not getting any greater for IMGs/FMGs.
What can IMGs/FMGs do to be more competitive applicants in the NRMP Match?
- First and foremost, it is important to get a competitive USMLE Step 1 and Step 2 score (on your first attempt). A viable score would be 230 for Step 1, and 243 for Step 2 CK, since these are the averages for all combined specialties. In the 2014 NRMP Program Director Survey, 94% and 80% of programs cited Step 1 and Step 2 scores, respectively, as important for selecting applicants to interview. Even if you have a strong CV with impressive experiences or high marks in medical school, a lot of programs will filter out your application if you do not meet a minimum score requirement or do not pass on your first attempt. If you do have low scores and attempts, you should pass Step 3, because that will be one less requirement that Program Directors will be worried about if they accept you into their program.
- Second, make sure you have some sort of US clinical experience. In order to qualify as USCE, the work must be HANDS-ON. Simply doing an observership will not count towards your USCE. You need to be physically working with and touching patients.
- Third, do not have gaps in your CV. For example, a lot of international and foreign medical school students and graduates make the mistake of taking long gaps in their medical education when studying for their Step exams. 70% of programs cited gaps in medical education as an important factor when selecting applicants to interview, as noted in the 2014 NRMP Program Director Survey. Make sure you are still active in medicine during your studies. If you do make the mistake of taking time off, find ways to fill the gaps through participating in research, externships, or volunteer work in medicine.
- Fourth, if you do have an older graduation date, low USMLE scores and multiple attempts, and no recent USCE, consider enrolling in an unaccredited PGY-1 program. Some institutions will allow candidates to participate in their PGY-1 accredited program without giving them credit for it or providing a salary. The candidate will have to repeat a PGY-1 in an accredited position the following year. While in the unaccredited PGY-1, you can also take the In-Training Exam (ITE). All residents take this during their first year and receive a percentage score. Receiving a high percentage will reassure Program Directors that you are capable of passing the boards and that you will be an asset to their program when you apply the following year. Completing a PGY-1 in an unaccredited position and scoring well in the ITE will give Program Directors confidence that you are capable of successfully completing an accredited PGY-1 in their program.