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What Percentage of IMGs Match Into Residency? The Surprising Truth About International Doctors

Three medical residents in white coats stand at a patient’s bedside in a hospital room, reviewing notes together while listening attentively to the patient, with monitors and IV equipment visible in the background.

You might have caught yourself wondering what percentage of international medical graduates (IMGs) match into residency in the U.S. if you’ve ever been treated by a physician who practiced in their home country before completing a residency here. What does the process look like, and does it improve the quality of care you receive? 

The latest data from the National Resident Matching Program (NRMP) shows that the Main Residency Match rate for non-U.S. citizen international medical graduates in 2024 was 58.4%, while the match rate for U.S. citizen IMGs was 61.2%. Now, compare that to the 93.5% match rate for U.S. allopathic (MD or DO) seniors. Can international students apply for medical residency in the USA? Yes, but the path they must follow is highly competitive, by design.

Understanding the IMG Match Rate: A Filter or a Flaw?

To understand what the NRMP numbers mean for patient care, let’s discuss what an IMG must overcome to practice in the U.S. They must pass rigorous U.S. Medical Licensing Exams (USMLEs), secure clinical experience, and provide recommendation levels while navigating visa sponsorships. 

However, the insider truth I’ve learned from interviewing dozens of South American physicians is that the U.S. medical system doesn’t necessarily filter for the best foreign doctors. It would be more accurate to say it filters for the most persistent and desperate applicants. 

Home-grown medical school graduates (MSGs) face numerous challenges in the U.S., including being hundreds of thousands of dollars in debt, yet having no ability to practice medicine without matching into a residency program, despite holding a U.S.-earned MD or DO degree. 

Some of these MSGs end up entering the corporate world without the ability to practice clinically, serving as physician advisors on HealthTech startups or pursuing other career paths. Other MSGs take on medical writing jobs, which makes a person question the MD or DO authorship without clinical experience and often without the rigorous academic training of a PhD. 

For those MSGs who can enter a residency, they often spend years serving as cheap labor for the hospital system rather than truly learning in what should be a well-monitored, internship-like program, usually performing the duties of senior doctors without any supervision or oversight. For example, I’ve spoken to patients whose spine surgeries were botched by unsupervised residents, resulting in permanent disability, while the attending physician (who was, in fact, not attending) billed the insurance company under his name. 

Some residency programs are basically equivalent to the CEO of a large company calling a finance intern into the boardroom, introducing the intern to the executives present at another large company buying them out, and the CEO asking the intern to handle the merger on her own without any previous training, and then leaving because the CEO has a golfing tournament to attend. 

Now compare that to a country like Colombia, which has an impressive medical education system, where medical school graduates can immediately practice as generalists after medical school. Medical school students there start gaining hands-on experience from day one. If they would like to pursue specialization after graduating as a generalist, which is a career option and not a career must, they then compete for specialization residencies with prior experience as working general medicine doctors. Many Colombian doctors are shocked when I explain how the U.S. “debt-and-no-license” model works and how U.S. specialists have no comprehensive generalist training. 

How Structural Difference Creates Two Types of IMG Candidates

From what I have observed, the two primary types of IMG candidates in the U.S. are:

  • The "US residency flex" candidate: These are the foreign physicians who seek U.S. medical credentials as their primary qualification. They often struggle with foundational medical concepts and see a U.S. residency as an escape from the competitive work culture in their home countries, and seek a credential to hide behind. Their mindset is typically “authority by association” with a notable fixation on learning U.S. medical system concepts while abandoning the South American impetus to be continuous learning of human bodily systems.
  • The demonstrably competent physician: These are the foreign physicians who lead in discussions with their deep clinical knowledge, systematic reasoning, and deep curiosity when facing the unknown. Their motivations for considering practicing in the U.S. are typically specific, like reuniting with family members or having access to more medical resources for their patients. These doctors are often fiercely critical of the impersonal, protocol-driven approach to healthcare they observe in the U.S. and proud of the foundation that their alma mater provided.  

Why the Best International Doctors Often Refuse to Play the Game

The most competent international physicians I have interviewed have no interest in practicing in the U.S. and jumping through hoops for the opportunity to do what they already do back home: practice medicine. Some of these physicians have already worked in the U.S. while here to be with family members, taking on jobs such as medical assistants in U.S. medical offices.

Their reasoning is often brutally honest about the systematic flaws in the U.S. medical education system. 

“Why would I repeat three to five years of residency to learn what I already know?” one international doctor asked. Their generalist training is typically more comprehensive than even the training U.S. specialists receive. Repeating an internal medicine residency feels regressive for these doctors. 

“Your doctors have extensive access to resources but don’t know how to use them,” another international physician explained. They are consistently stunned by the lack of foundational knowledge U.S.-trained physicians receive, for example, endocrinologists who don’t understand basic iodine metabolism for thyroid function. 

“The culture punishes competence,” one IMG said. IMGs with vast experience are often seen as “harder to teach and manage” because they don’t blindly defer to the system. U.S. medical culture usually values conformity over competency, protecting incompetence through silence. There is a lack of transparency with a us-versus-them mentality against patients, especially against disabled individuals, as reported to us by disabled Americans going through U.S. medical schools who had to hide their disabilities. 

The cultural difference is a key factor here. In many South American medical communities, physicians are encouraged to police each other’s competence to prevent patient harm, while challenging a colleague could be career suicide in the U.S. This explains why some less-competent IMGs might find practicing in the U.S. appealing. It's a system that protects you from being challenged once you’re in. 

What This Means for Your Healthcare

You don’t need a passport to have access to a more holistic approach to medicine. The solution is to bypass the broken pipeline to bring superior clinical expertise directly to you. 

We’re helping to bridge access to physicians trained in healthcare systems that prioritize:

  • Prevention and nutrition: These topics are often glossed over in U.S. curricula.
  • Systematic clinical reasoning: Providing quality care requires more from physicians than simply following a flowchart.
  • The patient-as-a-whole: The fractured, foundationless specialization focus in the U.S. vs. the generalist training in countries like Colombia. 

Countries such as Colombia, with its robust medical education system and a culture that holds physicians accountable, are now competing with their U.S. counterparts by offering digital consultations, cross-border collaborations, and patient education that your local clinic might not provide. 

Look for Demonstration, Not Validation

Some of the things to look out for when evaluating any doctor, whether they are international or not, include: 

  • Red flag: Be wary of physicians who lead with their credentials but can’t explain the “why” behind treatment recommendations. Any good physician should be able to verbalize their thought process. 
  • Green flag: Doctors who lead with curiosity, discuss lifestyle factors, look at the patient as a source of information (from what you say to a physical examination rather than just lab numbers or imaging), demonstrate logical reasoning, and aren’t afraid to say “I don’t know, but I’ll find out” are green flags. 

The best international physicians aren’t the ones scrambling for a spot in the U.S. residency system. They're often the people who only enter the U.S. system after much thought and with great hesitation, and they might be the ones building better alternatives to the U.S. system inside their own home country. 

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