A Journey Inside the U.S. Healthcare System as an IMG

By Andrea Iturralde, MD

I want to start with: What is an International Medical Graduate (IMG)? An IMG is someone who received their medical training outside the United States and wants to pursue a medical residency in the United States.

When I think about navigating the U.S. healthcare system as an IMG, many challenges come to mind. First, I want to focus on one of the biggest difficulties: moving to a new country. This transition can be overwhelming. You’re not just learning a new healthcare system, you’re also adapting to an entirely new life. Renting a house, handling paperwork, even opening a bank account—these are all tasks you must complete before you can even think about practicing medicine.

Once you’re established, it’s important to recognize that the healthcare system may work differently from that of your home country. For example, in the U.S., nurse practitioners and physician assistants play key roles in patient care. They diagnose, treat, and prescribe medications. In many countries, these roles either don’t exist or function quite differently. Electronic health records (EHRs) are another challenge. In my home country, most records were handwritten or managed in very basic systems. Here, everything is digital. I recommend taking the time to explore and practice with the EHR system whenever possible, as familiarity will make your clinical work more efficient and smoother. ERAS offers an EHR course for IMGs matching in the US, which is excellent training.

Another challenge for many IMGs is presenting patients. Doing this in a second language requires organizing thoughts clearly, translating medical terms while adjusting to the communication style of U.S. medical students and residents. It can feel intimidating at first, especially if you’re worried about making mistakes, but this is simply part of the acclimatization process. In the end, you’ll succeed! Something I struggled with was using medical abbreviations. Back home, I rarely used them, but in the U.S., they are part of every medical communication. I still remember the first time I heard one—I tried to figure out its meaning while the conversation kept moving forward without me. The good news is, within a few weeks, you’ll get used to them and start using them naturally.

Networking is also a crucial element for IMG success within the U.S. healthcare system, more than any other system I have been exposed to. Attending professional meetings and conferences provides excellent opportunities to connect with physicians who share your interests and can guide you through the process. Remember, not every contact will be the right fit for you. Seek mentors who align with your goals and values, and be genuine in your interactions. Even if some physicians don’t fully understand the IMG experience, many will try to help if they can and if you show interest. When they can’t, they’re often honest about it—which is just as valuable, because it helps you find the right mentor more quickly. Ultimately, mentorship is one of the most powerful resources for navigating the medical system. The right mentor can offer guidance, open doors, and help you adapt successfully to your new professional environment.

Through my own residency application journey, I’ve learned that understanding and showing interest in the U.S. medical system is essential. While it may feel intimidating, this knowledge will give you a real advantage when applying for positions. With some extra effort, you’ll be surprised at how quickly you can start using the tools that the U.S. medical system offers to make your practice easier and more efficient.

I want to end with the same question: 

What is an International Medical Graduate (IMG)?
An IMG is a brave professional who dares to step out of their comfort zone, choosing to grow within a new system, in a new language, in a new culture. They embrace change and discover strengths they never knew they had. An IMG is living proof that determination and passion can cross any border.

Andrea Iturralde, MD

I am an IMG from Ecuador, currently working as a postdoctoral research fellow in the Vascular Surgery Department and the Neurosciences Department at the University of New Mexico. I am applying for General Surgery in the 2026 match. I am passionate about addressing surgical disparities and improving access to surgery in low-income countries. Outside of medicine, I enjoy photography, painting, and exploring the outdoors.