Factors IMGs Must Consider Before Selecting Specialties

Factors IMGs Must Consider Before Selecting Specialties

Nov 18, 2020 Published by Kathrin O'Neill

Table of Contents

The US is an attractive option for medical graduates worldwide. To become a licensed physician in the US, it is necessary to obtain a medical residency. Every year, around one-fourth of the Accreditation Council for Graduate Medical Education's accredited GME program residents are international medical graduates (IMGs). Around one in four physicians in the US is an IMG and reportedly, 12,000 IMGs apply for residency positions in the US annually.

However, the road to practicing in the US for IMGs is quite a complicated one. There are several challenges that they have to face on their own. Such as navigating requirements without any structural support from a US-based medical school, mentorship of peers and faculty, and the language/culture differences they have to prepare themselves for. Then there are USMLE exam pressures, gaining clinical experience in the US, ECFMG certification, and dealing with visa issues.

Matching into a residency program is another challenge since programs have stringent requirements for IMGs. Therefore, for an IMG to successfully match into a program, it is essential to pick the right specialty. If you are an IMG, check out the factors to consider when selecting a specialty for your medical residency program.

Why Practice in the US?

The US presents an opportunity-filled healthcare industry for domestic and international medical graduates. The country is known for its high-quality standards adopted to maintain the quality of training in the practice environment. Furthermore, candidates can expect a predictable career path and job options soon after completing training with a flexible career structure. Another great benefit is that board certification opportunities offered in the US are recognized across the globe. Since completing a US residency, mandatorily requires grads to practice medicine in the US, it is possible to get immigration soon.

Eligibility for a Residency Spot

IMGs need to go through a rigorous process to ensure they are competent enough to practice in a US clinical environment under a training program's supervision. The ECFMG certification process is the evaluation standard for gauging the eligibility of IMGs to allow them to enter the country's healthcare system. Through this process, they are assessed for their readiness to participate in the residency or fellowship program.

Selecting a Specialty

Before you apply for a residency, whether you are an IMG or a native graduate, choosing a specialty is necessary. The primary care specialties, including family medicine, internal medicine, psychiatry, and pediatrics, have traditionally remained popular among IMGs because these programs offer the most spots and are generally less competitive. Some applicants may opt to apply for several specialties; however, this practice is often criticized because it gives the impression that you aren't fully committed to any specialty. If you want to apply for a more competitive specialty, many of which fall into the surgical specialty category, you must consider applying for a preliminary general surgery residency program. It is a one-year program to examine how an IMG performs prior to training them for the entire residency duration.

Factors to Consider when Selecting Specialty

Apart from statistics, IMGs must necessarily consider several other factors when selecting medical specialties. Here's an overview of those factors.

USMLE Exam Requirements

IMGs must consider the minimum score requirements, limitations on the number of attempts, and flexible preferences that are part of the USMLE exam requisites. Moreover, some programs require IMGS to complete the CS exam before interviews. Therefore, some specialties are highly competitive and have more expectations and rather stringent criteria for residency candidates. For instance, General Surgery programs require higher USME scores in comparison to Psychiatry.

Clinical Experience in the US

Many medical residency programs require the applicant, including IMGs, to provide evidence of exposure to the US healthcare system. Clinical experience is one form of gaining that exposure. All specialties want to see some proof of the candidate's commitment and interest in the specialty. Certain specialties, for instance, Family Medicine, prefer to see some history of the applicant's experience in this specialty as evidence of their dedication.

ECFMG Certification

As mentioned above, ECFMG certification is a must to begin the residency process. A majority of medical residency programs in the US demand ECFMG certification before considering an IMG for interviewing.

Time Since Graduation

The only discriminating factor in the US medical system is the applicant's time since graduation. If you graduated several years back, you would face many more challenges in matching.

Visa Sponsorship

You must check if the program sponsors HI-B visas, or they accept ECFMG sponsored JI's? Both are crucial considerations for the IMGs.


You cannot achieve anything by applying to programs that do not accept or consider IMGs. Hence, your entire focus should be on programs that are IMG-friendly.

Specialty-Specific Supporting Documents

In order to prove your dedication and interest in a specialty, you should consider providing specialty-specific supporting documents. You must get letters of recommendation and prepare for a personal statement for each specialty you want to apply to.


There's no doubt that applying for a residency is an expensive process. The minimum application limit for an IMG is 100 programs per specialty for each candidate, and you need to pay in dollars to apply for every specialty program. This means you must have sufficient finances to pay fees, which may amount to up to thousands of dollars. You must assess your specialty decision wisely to use your resources appropriately.

Residency Program choices and opportunities

The selection should depend on how extensive your chosen specialty is and the number of available, IMG-friendly programs you are eligible to apply to as per your professional credentials and every program's application criteria. Picking a specialty that offers limited choices and opportunities isn't going to help you in the long run, and you will need to prepare a backup specialty.

Bottom Line

Selecting a specialty for your medical residency application will take its fair share of time and consideration. Some specialties are less competitive, while some are highly competitive. Yet, none of them will guarantee 100% matching. Hence, no matter which specialty you select, you will need to work much harder for your ERAS Application materials and program research.