11 May 2023

by: Anjani H Turaga, IMG

The day starts at 5 am on an unusually cold morning in Los Angeles, where we see our protagonist, an IMG (International medical graduate) brushing her teeth furiously, trying her hardest to pay attention to the video lectures playing in the background, all while checking her clock to make sure she has enough time to reach the hospital before her preceptor. The physical exhaustion that comes with having only a few hours of sleep is overwhelming, yet she remains focused on her goal: matching into a residency program in the United States.

While at first glance, the scene above seems overwhelming, it is a reality that every medical student, irrespective of their location, experiences in the year leading up to the Match. Our protagonist’s journey is made more complicated, however, with her decision to to pursue a surgical residency program as an IMG. The uphill battle that IMGs face in securing a residency position in the United States has been well documented (1), but what hasn’t been written about in such detail is that the path to matching into residency is very mathematical. For IMGs especially, understanding this “Match Equation” is essential.

This equation isn’t our typical quadratic formula, nor is it a logarithmic one. It is a process, simplified into a formula, that involves a plethora of factors – some in the student’s control, others not so much. The higher you score on this formula and the more factors you possess, the more achievable the dream of being a surgeon becomes. Our protagonist aims to break down each of these factors, and provide some much-needed insight on what an IMG should focus on to succeed in the Match process.

Let’s start with the first factor- academic performance. The United States invites medical students from all over the world to participate in their residency programs and to practice as a doctor in their country. While each country has its own medical curriculum, the education process is unique to the region, hence it’s understandable why the common benchmark of the USMLE is considered to be an important academic gauge. Scoring well on the USMLE not only shows that an IMG has the knowledge necessary to practice medicine in the United States, but it also demonstrates their dedication to their craft. Despite this, there might be several reasons why a student might not fare well on their examinations, and that makes the process more daunting. But, all is not lost. Other factors exist to help balance out any shortcomings in academic performance.

One common misconception that a lot of IMGs face is that it is entirely possible to match into the United States for a residency without ever stepping foot in the country. However, when program directors were asked what they considered the most important factor in ranking residency applicants, clinical experience was voted the highest.(2) By way of common sense, it would only be fair that program directors would want to see that an applicant has some exposure to the healthcare system in the United States, and understands its nuances. For IMGs, this is a great way to be acquainted with the system and its intricacies, and to maximize their chances of success once residency begins. These clinical experiences often translate into letters of recommendation being given at the end, which makes the person reading them aware of how the student behaves in a clinical setting and what skills they bring to the table.

When IMGs focus on the above two factors and combine them with the extra edge that a research experience or an additional degree such as a MPH brings, it can significantly boost their chances of matching into a residency program. A research experience does not mean that an IMG must have a breakthrough or a discovery published in a prestigious journal, rather it is important to show how their experience has made them adept at critical thinking and to demonstrate that they have the ability to contribute to a larger scientific community. Most university programs value the ability of an applicant to bring a research perspective and the skills required for it are easily transferable to a clinical setting. If an IMG goes the extra mile and is able to have a few papers published by the end of his research position tenure, those stand out as extremely positive points when an application is being reviewed by the Program directors.

A doctor used to be called the greatest benefactor of mankind- and that still holds true today. Residency programs look for candidates who are in this profession for the right reasons and who are passionate about making a positive impact on the health and well-being of their patients. It is because of this reason that volunteering experiences are held in high regard on an application. Volunteering experiences show program directors that the applicant values service over personal gain and that the applicant has a larger goal of improving the lives of others.

This entire process translates to a commitment stretching over a year, which most IMGs begin during their final year of medical school. Programs look for applicants they believe have additional work experience in their resumes. These experiences translate into showing how a student’s interests and passions extend beyond their academic work, which is crucial in the medical field where patients are not just numbers to be checked off on a chart but real people with real needs.

Even when all of the above criteria have been met, additional elements that are often out of the control of IMGs can be a factor. A strong, professional personal statement, which is carefully worded to showcase the student’s strengths and skills, might look desirable to a few program directors, while an emotional, personalized, and heartfelt one might appeal to others. In addition, having an outgoing personality and excellent communication skills can be an asset during the interview process, especially during interviews which are conducted online as seen post-pandemic. It is often recommended to have mock interview sessions with family or seniors to help overcome the initial nerves associated with the process. A sad but often present factor, especially in surgery residencies is the student’s gender, which can sometimes be a limiting factor due to old-fashioned biases and stereotypes perpetuated in certain programs.

When you succeed at all the above factors and work hard to excel in each of them, the likelihood of matching into a program increases significantly. For IMGs, this can mean:

Strong Academic Performance + Clinical Experience + Research Experience + Volunteering Experience + Add. Work Experience + Well-Written Personal Statement + Exuberant Personality/Communication Skills 

Increased Chance of Matching into Residency

Even though it may seem daunting, and the road very uncertain at times, with perseverance, dedication, and a focus on the factors mentioned above, IMGs like our protagonist can have a successful, fulfilling career in medicine and make a positive impact on patient care in the United States.



Anjani Turaga is a humble medical student pursuing a career in general surgery, aiming to specialize in trauma surgery. As valedictorian of her class, she exemplifies a dedication to academic excellence. Additionally, Anjani Turaga founded The Health Herald, an independent medical magazine, showcasing her entrepreneurial spirit and commitment to sharing healthcare information. Her passion for research is evident through her published work in esteemed medical journals and presentations at national conferences. Her achievements contribute to her pursuit of knowledge and desire to improve patient outcomes as she enters her general surgery residency.

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