Completing an application through ERAS is both easy and hard at the same time. It is easy in the sense that you only need to complete one application which can then be used for every residency program you apply to. It is hard only because there is a ton of information you must fill out. While you may have multiple personal statements for different specialties, your application is simply done once. Once you certify it, you cannot change it (with our without mistakes). Thus, start on the application early, preferably August 1st, so that you have an entire month to edit, change, add, or fix anything on your application before it is finalized.

Steps to Registering for ERAS:
  1. Obtain your ERAS token from ECFMG ($90) (July)
  2. Register with MyERAS online: MyERAS
  3. Create your profile and application
  4. Upload a photo to ECFMG
  5. Send out documents to ERAS support services at ECFMG: MSPE, Transcript, LORs, PTAL (end of July)
  6. Submit LOR Requests
  7. Add personal statements
  8. Select programs and assign documents to programs
  9. Certify application (August 31st)
  10. Apply to programs (September 1st)
How many applications

This is one of the most important things for IMGs. While US Grads can apply to 10 programs, get 7-8 interviews, and only attend 5 and still match to their top 3 (US Grads have a ridiculously high match rate into their top 3 ranked programs), IMGs have to work a little harder. While I’ve heard of some IMGs applying to over 200 programs over different specialties, it is really up to you and your budget regarding how many is right for you.

Here are some statistics for IMGs (based on my theory):

  • On average, IMGs get between 0 and 20 interviews, primarily based on your scores, clinical experience, and visa status.
  • On average, you will get 1 interview for every 10 applications. This is strictly an observation (not proven). Thus a strong applicant may get 2-3 interviews for 10 applications, while a weak applicant may get 0. You may argue saying how can a strong applicant only get 2 interviews per 10 applications? It is truly based on where you apply to. We’ll get into that next.

Most people say 10 interviews is a good number for IMGs to match. While it is never guaranteed as everyone has a different resume, interview experiences, and of course different luck, 10 is what every IMG should aim for. If you get 15+ you are doing great and hopefully you’ll match into your top 3 choices. If you only have 5 interviews, you may or may not match. It’s truly based on how competitive each program is, how strong of an applicant you are, and how you performed at your interview. Remember, once they invite you for an interview, they have already filtered through the rest of the applicants and choose you. You are already qualified for the position, now it’s just about how you fit in. Are you someone they’d want to work with for the next few years? We’ll get into interviews later.

So with a goal of 10 interviews, an average IMG should apply to at least 75 programs. While this may sound ridiculous to some, you really don’t know how many interviews you will receive. If you can afford 100 or more, go for it. You do not want to be in the position where you have very few interviews, end up not matching, and then have to reapply next year because you wanted to save a few bucks the first time through. Apply everywhere! Explore different specialty options and don’t restrict yourself to anything. It is always good to be open minded and have backups. If you don’t, there is always a small possibility match day won’t be what you expected.

Here is a general concept. There are always 3 tiers of programs:

Upper Tier – programs above your qualifications (good to great University programs)
Middle Tier – programs equal to your qualifications (average University programs, university-affiliated community programs)
Low Tier – programs below your qualifications (community programs)

How do you judge which is upper, middle, or lower tier? Look at students similar to you from your medical school. Where have they matched to previously?  Are you better qualified than them or less qualified? You really have to judge yourself where you stand in the Match. If you have such high expectations being a non-US citizen applying to Harvard and John Hopkins IM residency programs, you will most likely be disappointed. Some top tier residencies do not even look at IMG applications, so you are wasting your money applying to them. But if you are a PhD from your country, practiced for 5 years, and are the first author of some amazing publications in famous journals, you have something to offer. Remember, these programs look at everything in your application. While your medical school may be a top tier university in your country, if the PD has never heard of it, it means nothing to them. US PDs know only of US medical schools, not foreign medical schools. All applications from IMGs are in the same stack, it’s just a matter of what makes you shine from the rest to get you that interview. Sometimes if a resident from your medical school is in that program, it gives you a slight advantage that the PD is now familiar with a student from that school. Just hope they are leaving a good impression on the staff and that the resident can vouch for you. If it’s the other way around, it may hurt your chances in matching there.

Back to the tiers. On average, you want to apply to 1/3 upper, 1/3 middle, and 1/3 lower tiers. I say this because you really never know who will grant you an interview. While you may get a couple interviews from your top tier (which you will most likely rank highest), you may actually not even be granted some from your lower tier. It is very random as every program looks at different things in an applicant. Some also fulfill their quota very quickly (prematches, local applicants, or their own medical students). This is why it is best to apply broadly.

This is strictly an example:

Total Applications: 90
Upper Tier: 30                                  Interviews Granted: 3 (range 0-7)
Middle Tier: 30                                 Interviews Granted: 6 (range 3-15)
Lower Tier: 30                                  Interviews Granted: 10 (range 3-20)

Once again this is strictly an example. One may get 0 interviews from upper tier, or 10. It really depends on how strong of an applicant you are. You may also only get 3 interviews from lower tier programs, and that’s it. This is why I say apply to all tiers.

Which programs to apply to

This is your homework. When I started researching programs I was interested in, I started on google. If you type in: “UCSD Internal Medicine Residency Program” you will easily find the website for their IM residency program. This will most likely provide a lot of details on the program, schedule, salaries, benefits, current residents, etc. While all this information is nice, remember every hospital will try to make their residency look as attractive as possible. Once their website has left a good impression, now google “UCSD Internal Medicine Residency Program forums”. This will take you to forum posts regarding the program. There are many great sites where medical students and residents share their experience of hospitals, residencies, interviews, etc. Don’t believe everything they say, but definitely learn a little about them. Finding something like a program being flagged for something is very big and should matter in your decision. Then head over to FRIEDA. This site also provides detailed information of every residency program in an organized way. Some programs offer more details than others, so take what you can from it.

There are also many websites which provide lists with more detailed information of each residency program. One such is Match A Resident. These are paid services where you input your USMLE scores/attempts, months of clinical experience in the U.S., and citizen/visa status. It will then filter which programs you have a shot at. While a strong candidate may have over 250 IM programs to choose from, it is then your job to look up each one. These sites do a lot of the research for you, giving you the FRIEDA link, percentage of IMGs in the program, PD and PC phone numbers, how many spots available, and whether they prematch or not. They also provide feedback from medical students and residents about experiences at these programs. Some have no feedback, while others have quite a lot. Once again do not believe everything written, but just inform yourself. I personally used 2 lists as I wanted to know as much as I could about where I was applying to. Look at it this way, if you apply to programs after your first 30, they cost $25 each. Now buying a list from one of these sites may end up costing around $100, but it will help you decide where you should apply and where to save your money. In the end I found them very useful, but once again do not believe everything they say. They will show top tier programs on your list that you could apply to, but further research will show only 3% of their residents are IMGs (meaning 1 resident) who may be a exceptionally qualified applicant.

Narrow your list based on what your priorities are. Some find location the most important thing, as they have a spouse or family members who lives in that city. Others prefer a university program based on research opportunities to help in pursuing a fellowship. In-house fellowships at the hospital where you complete residency is an IMGs best bet at matching into that specialty. There are so many things to look at in a program that I made a survey which I used for each interview. When you go on 10 interviews or more, you start forgetting which was which and the details about each. If you write down something right after your interview, you can always go back and remember the good and bad things about the program. Once I finished all my interviews, I took all my surveys and gave them a percent score. Though my rank list was not exactly as percentage scores, it was very close. We’ll get more into that in the interview section.

Comparing top tier to middle tier programs, the difference is reputation, fellowship match lists, and location. Reputation is huge. Go look at a top 100 U.S. medical schools and look at research funding. If you can match into any of the top 50, you are made. Fellowship lists are quite important if you are interested in specializing after residency. A top tier university program will have an excellent fellowship list while an average university program may also have a great list. The difference is reputation, funding, and location. Completing a fellowship at UCLA in GI, which is recognized as one of the best GI centers in the entire US, is truly amazing. But completing a GI fellowship at a middle tier university in the Midwest, while still good, does not have the prestige of UCLA. For an IMG, it is definitely a challenge in finding a fellowship (especially in cardiology and GI), but it is doable with the right contacts, research, residency, and scores. As for location, do you want to spend your next 3 to 5 years near a beach in California or in a landlocked city in the Midwest with sub-zero temperatures in winter. If your home country is already known to have the worst seasons, it may not be that difficult for you to adjust, but if you are quite sensitive to different extremes of weather, pick and choose wisely. While you may apply everywhere and have certain expectations of a place where you received an interview invitation, go there and judge it for yourself. Since interview season is September till January, you will get to experience the winter in the city. See for yourself if you can handle it; you just might like it.

What specialty to apply to

Of course apply to what you want to do the rest of your life. If you truly enjoy Anesthesiology, don’t settle for anything less. It may be a hard road to achieve, but remember you have worked so hard getting here. The past 5-10 years of your life you studied to achieve this residency spot. Settling for something that you will not enjoy the rest of your life is not what you’ve worked so hard for. Now you may say, what if I have no chance in matching into the specialty I desire? This is when you sit down and think what else am I good at or enjoy. Medicine is such a vast field and there are so many options after medical school it’s hard not to like something. If you are applying to Internal Medicine, take a look at family practice as a backup. While you may be limited in your fellowship opportunities after residency with family practice, they still do what internists do, along with OBGYN and pediatrics. That makes them more well-rounded in my opinion. If private practice is your dream, FM is as good as IM. Psychiatry is also a great field if you have an interest in it. It does not hurt for you to apply to a few backup specialties, especially if you do not receive a good number of interviews in your first specialty of choice. You have to decide whether you are OK with pursuing a certain field or you want to stick to your first specialty and are willing to spend an extra year or two to build up your resume in order to achieve it. In the end, it comes down to whether you can settle for something and be happy with it, or work hard and achieve what you want. Think long and hard before ranking backup specialties because if you match there and are not happy, you cannot get out of a contract with NRMP without a lot of consequences.

I will share my opinion as to difficulty for IMGs into matching to certain specialties: (% based on difficulty)

Internal Medicine – Categorical      Somewhat difficult
Internal Medicine – Preliminary     Very difficult
Emergency Medicine                        Very difficult
Pediatrics                                           Somewhat difficult
Pathology                                           Somewhat difficult
Physical Medicine and Rehab         Somewhat difficult
Family Medicine                                Not difficult
Psychiatry                                           Not difficult
General Surgery – Preliminary        Not difficult
General Surgery – Categorical         Very difficult
ENT                                                      Very difficult
OBGYN                                                Very difficult
Urology                                                Very difficult
Orthopaedic Surgery                         Very difficult

Advanced Specialties (after completion of one prelim year – IM or surgery depending on specialty)

Radiology                                           Very difficult
Ophthalmology                                 Very difficult
Dermatology                                      Very difficult
Anesthesiology                                  Somewhat difficult
Neurology                                          Somewhat difficult

Fellowships (after completion of 3 year categorical IM residency):

Cardiology                                         Very difficult
GI                                                        Very difficult
Hem-Oncology                                  Very difficult
Allergy / Immunology                       Very difficult
Pulm-Critical Care                             Somewhat difficult
Endocrinology                                   Not difficult
Nephrology                                        Not difficult
Rheumatology                                   Not difficult
Geriatrics                                            Not difficult
Infectious Disease                             Not difficult

(These change every year and everyone has their own opinion about them. This is strictly based on my research and experience)

As for my experience with the match, I had applied to 50 great university programs with high hopes of receiving interviews. By the end of September and early October, I did not even receive one interview from them. I was very surprised and disappointed, but I didn’t lose hope. I went out and researched more places I would be happy with matching to (with a hint of desperation). I researched every program I applied to, the good, the bad, as many details as I possibly could find as most of these places were just a name and city to me. I have no first-hand experience at any of them. In October I added another 50 programs bringing my total to 100. The interviews started coming. Even though they weren’t in by September, October is still not too late. Since most of these were middle and lower tier programs (university-affiliated community and community programs) I had higher chances of being interviewed and matching there, which is basically what happened. Thus, do not think of yourself as too high or strong of a candidate than you really are. Apply above you, equal to, and below you.

Fees:
ERAS Token: $90
ERAS electronic submission of USMLE transcript: $70
J-1 Visa Application: $250 + $180 (Dept. of Homeland Security)

ERAS Application costs per specialty:
First 10: $75
11 – 20: $8 each
21-30: $15 each
31 or more: $25 each

(Prices can change – I am writing this in 2011)

Links:

ERAS Support Services at ECFMG

ERAS IMG Resources

Step 6: Personal Statement