Top 20 reasons why IMGs don't get USMLE Residency interviews

It is no surprise that many applicants applying for USMLE residency never receive an interview and they are left questioning as to what went wrong during the application process.

 Our team has interacted with more than a thousand IMG applicants during the last 5 years. Based on our experience, we outline the top 20 reasons why some foreign medical graduates may not have received an interview during the Match Cycle, get fewer than expected interviews or get interviews quite late in the season.  

Just so you remember
  • All profiles are different and there are always outliers.
  • Many applicants can and do make up for a deficiency by exceptional performance(s) in other areas
  • There is no perfect applicant.

What are the main reasons that some IMGs do not get the residency interviews and most importantly how to how to fix those. As an IMG, what can you do to improve your chances of getting the interviews? There are some factors you no longer control, but there are others you may be able to influence (either in this season or next)- so control the controllables.

USMLE Exams

1. Low scores on the USMLE step exams
This one is obvious. Having a Low score and failing to adequately address it during your application process is a reason why many applicants may not receive an interview. Many applicants address this in their Personal Statement for residency or articulate other experiences in ERAS application/CV that demonstrate they have overcome it.
 
2. Multiple attempts on the USMLE step exams
Again, any attempt is looked at as unfavorable and it is advisable to tackle it. Like the low scores reason, some applicants address it in the personal statement.

ERAS application

3. Inaccurate ERAS applications
We all know what this is. Many applicants knowingly or unknowing take the ERAS application too lightly. They either falsify experiences in the application or will be too vague. It is not difficult to see through such applications.

4. Mistakes in ERAS application
One of the most common causes but is quite irritating to the programs. Whether it is the typos or other grammatical errors, remember that programs do look for attention to detail.
 
5. Incomplete ERAS Application
Many programs only review complete applications. If you have applied with incomplete application, you may just need to keep chasing the programs, updating them as needed. This of course delays or reduces your potential interviews as an international medical graduate.

Your profile

6. Gaps
Having large gaps in your application as a foreign medical graduate,  without adequately addressing them can have a negative impact on your application.
 
7. Prior violations or similar issues with ECFMG
 This does not apply to most IMG applicants. If you have had any violations (like trying to contact programs in SOAP) reported to ECMFG in past seasons and which have not been resolved, they become are part of your record. 

Personal Statement
 
8. Poorly prepared personal statements
Personal statements are stories and yes, the programs do read it. Many applicants fail to really touch the soul with their personal statements Remember it is called ‘personal’ for a reason. If it is generic, the program may not have a compelling reason to invite you.
 
9. Plagiarism on the Personal statement
Many IMG applicants do not realize that programs have sophisticated tools, which can easily identify phrases/statements picked from the internet. Not only that if you get your friend’s or senior’s personal statement and copy some interesting trivia, a program director can and will recall some interesting personal statement, potentially dooming your application.
 
10. Applying to multiple specialties with the same personal statement
Using the same personal statement for family medicine and internal medicine doesn’t help your cause but also reduces your chances for an interview.

Letters of Recommendation (LORs)

11. The wrong letter of recommendation
This one is fairly common. Submitting internal medicine letter of recommendations to say, Pediatrics, will likely kill your application there and then. Check the letter assignments carefully and get specialty specific letters, if possible.
 
12. Generic letters of recommendation
We strongly recommend waived LORs. The letters must be very specific. If the LORs are from a template or generic, it may not contain anything that triggers a personal touch with the applicant. Many programs really dwell deeper in the LOR especially for IMG applicants. Quality of the LOR goes a long way in determining your invites and eventual rank.
 
13. Recommendation letters only from home country
Again, Programs are unaware of Home country physicians unless it is some renown physician. In general, the recommendation letter from a home country experience will not have much significance. There are exceptions of course. For recent graduates, or for IMGs with home country residency, a home country LOR may work well.

US Clinical Experience (USCE)

14. Not enough USCE
Most programs prefer a minimum USCE (which may or may not be mentioned on the website). Some programs have strict guidelines of minimum of three months of USCE. USCE tends to be program specific so it is advisable to do your due diligence before applying, 
 
15. Wrong type of USCE for a specialty
This is true especially if an applicant is applying for a back-up program for e.g. a strong surgery applicant is applying for internal medicine. It is very unlikely for this applicant to receive an interview in Internal Medicine in such circumstances.

When to apply and where to apply

16. Applying (too) late
Applying after late November is going to be futile, in most cases, for interviews.
 
17. Applying to programs without due diligence
Research the programs well and make sure make sure meet the criteria prior to applying. Some of the criteria may be around the year of graduation (YoG) from your MBBS or medical school, months of USCE or research, USMLE step scores and so on. Some programs, for example, clearly indicate they require Spanish speaking applicants. In this case, if you can’t speak Spanish it is futile to be applying to that program.  The same goes for visa requirements. This is fairly obvious but still many applicants apply without reviewing the visa requirements of the program.
 
18. Applying to limited programs in hope of a certain match
This is true for applicants who have extremely high scores or those with any geographical limitation of a city or state. Even if you are a spouse of current resident, fellow or attending, It may prove a big blunder if you put all your eggs in that city or program basket.

The Match process

19. Not understanding the process
Incidentally, this is one of the first things you should do as you start your USMLE journey. Many applicants either start too late or do not give enough time to understand the entire process. They may rely solely on their friends’ experience or social media to guide them, conveniently ignoring that each situation and applicant is different. Avoid the habit of being spoon fed and do your own research about the process, as and when needed.
 
20. Lack of follow-up with the programs
Part of the process is to understand when and how to follow up with the programs. If your application is average or on the weaker side, it is paramount that you follow up with programs to demonstrate your interests. Emails, phone calls can all work, depending on where we are in the application season and your specific profile updates.



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