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The Most Frequently Asked Question by IMG’s: “Can I Match with these Red Flags?”

Question: “Dr B, I’m an IMG + OLD GRAD with low/ok scores {nsert professional history here, including USMLE Scores, YOG, Visa Status, Research, Attempts, & USCE}.  Do you think I have a chance to Match or should I give up?

It’s the question I get ALL. THE. TIME. It’s not a bad question, I just don’t think most love the answer to it.  Ready?

Answer: I have nooooo idea.

That’s right, after 11+ years of helping docs Match, when someone gives me Stats & CV info, there is no honest way to answer that question other than ‘I don’t know.’  So why do doctors I’ve never met before take the time to ask me?  Simple: they have family & friends with all kinds of red flags recommend asking for my advice because, well, they were students of ours that successfully Matched.

Is your CV an old car with a lot of miles or a brand new Lamborghini?

Asking the above question is like calling up a racing professional & asking if you can win upcoming races with the car you built.  There’s no way to know for sure.  Why?  You can have $10,000 worth of upgrades under the hood of a car, but if you don’t know how to drive it, you could easily lose to someone with minimal upgrades, but has the experience/knowledge to drive it to its full potential.

In the world of the Match – what you and I worry about every day?  I cannot tell you how many times I’ve had doctors with 210 and below on the Steps beat out candidates with 250 and above.  Or how cool it is to see an IMG that graduated medical school almost 20 years ago beat out a recent graduate for residency spot. 

So to go back to the main question, the only way to answer it with an answer that actually HELPS is to make sure ALL IMG’s understand that there are TWO sets of factors that determine the Match every March.  That’s right. There are TWO PARTS to the Match.

Part 1: PRE-September (aka BEFORE applying): The factors that matter the most here DETERMINE HOW MANY INTERVIEWS YOU GET.

Part 2: POST-September (aka AFTER applying): The factors after September that matter the most DETERMINE HOW HIGH (or LOW) PROGRAMS PUT YOU ON RANK LISTING.  THIS ultimately decides the Match.

How can your “old, high-mileage CV”  BEAT a “Lamborghini CV”? 

Ask Program Directors . . . All of Them.

Realistic Scenario:

~ I’ve met docs with 10-20+ interviews fail to Match

~ And I’ve had time and time again docs with 1 interview successfully Match

To understand why, all you’d need to do is asked the Program Directors’s. All of them.  Not possible, right?  Thankfully, NRMP asks PD’s FOR YOU! Yay!  It’s called the NRMP Program Directors Survey and it’s usually conducted every other year. (2020 at the time of this writing hasn’t been released yet, assuming the Covid-19 Pandemic made it lower on the PD’s Priority List).   Below are the results taken directly from the 2018 PD Survey:

“In March 2018, the National Resident Matching Program (NRMP) conducted its biennial survey of the directors of all programs participating in the Main Residency Match®. The primary purpose of the survey was to shed light on the factors that program directors use to (1) select applicants to interview and (2) rank applicants for the Match.” ~ NRMP Program Director Survey, Introduction

{The Following Determine the Number/Quantity of Interview Offers:}

All Specialties Percentage of Programs Citing Each Factor And Mean Importance Rating¹ for Each Factor in Selecting Applicants to Interview

1)USMLE Step 1 (94% Use it, 4.1 out of 5 Importance)

2) Letters of Recommendation (86% Use it, 4.2 out of 5 Importance)

3) MSPE (81% Use it, 4.0 out of 5 Importance)

4) USMLE Step 2CK (80% Use it, 4.0 out of 5 Importance)

5) Personal Statement (78% Use it, 3.7 out of 5 Importance)

(The Following Determine How High (or Low) you get Ranked:)

All Specialties Percentage of Programs Citing Each Factor And Mean Importance Rating¹ for Each Factor in Ranking Applicants

1) Interactions w/ faculty during interview and visit (96% Use it, 4.8 out of 5 Importance)

2) Interpersonal skills (95% Use it, 4.9 out of 5 Importance)

3) Interactions w/ housestaff during interview /visit (91% Use it, 4.8 out of 5 Importance)

4) Feedback from current residents (86% Use it, 4.7 out of 5 Importance)

5) USMLE/COMLEX Step 1 score (78% Use it, 4.1 out of 5 Importance)

Click HERE to Access the Full NRMP Program Director Survey

Two completely different criteria – well, Step 1 is the same, but it went from being the MOST important in the Top 5 to the Least important in the Top 5.  There are FOUR other factors that MORE programs use and ALL have higher importance. All 4 interview visit-related factors  were above a 4.7, with interpersonal skills at a 4.9!!!  In comparison, no factor ON YOUR CV is above a 4.2.  Weak Step Scores?  It may sound simple enough, but just kick a*s on the first four factors & you just overcame the score deficiency.

So to answer the original question using facts drawn directly from Program Directors? Can you Match?  Yes, if you can make the MOST out of your interview opportunities.  If you are average or below average on any of those Ranking factors, then you better have a really amazing Step score.  That’s not me saying that, that’s Program Directors saying that.

Am I biased?  Yes, my main focus for over a decade has been helping our doctors develop Top Notch interview & communication skills.  I’m biased towards that . . . because it’s what the Match Algorithm & Program Directors are biased towards when determining your Match chances.

Your CV, LOR’s & PS put you in the Race.  Interviewing WINS the Race.

And regarding the first factors for GETTING Interviews – I am in no way discounting their value.  USMLE is important – take a Kaplan Live Course, do USMLE World, get your MTB on.  Invest in teaching hospital-based USCE for LORs that matter.  Sh*t, get your arranged marriage EARLY and make sure they have a US Citizenship/Greencard.  Rocking those factors means higher quality & quantity of interviews.  The point I make to my own students & all IMGs out there – if you’re doing everything you can to get the interview . . . are you doing everything you can to make that interview COUNT.

While Mission:Residency may not have space to train more students – we believe in quality over quantity – as an advocate for IMG’s (I am one myself…and so are my closest friends), it’s sooo important for EVERY SINGLE IMG to get EXPERIENCED help in improving your rank list position.  You’ll do anything to save a patient’s life . . . are you willing to do the same to save your dream of residency that allows you to do that?