Residency Intelligence
Everything International Medical Graduates need to know — match statistics, specialty data, ECFMG requirements, and program insights. Updated with 2026 NRMP Match results (released March 20, 2026).
Last updated: May 2026•NRMP 2026•ECFMG•AMA FREIDA•Charting Outcomes 2024
44,344
Total Positions
Up 2.6% — largest match in 74-year history
70.0%
US IMG Match Rate
Highest on record — 4,210 active, 2,949 matched
56.4%
Non-US IMG Rate
5-year low — 11,944 active, 6,733 matched
54.4%
Visa-Required Rate
5-year low — immigration climate impact
38,354
Positions Filled
93.5% fill rate by algorithm
6,809
Programs
183 new program tracks added
2026 Match by Specialty — IMG Fill Rates
| Specialty | Positions | IMGs Matched | IMG % | Unfilled | Level |
|---|---|---|---|---|---|
| Internal Medicine | 10,941 | 4,718 | 44.6% | 357 | Accessible |
| Family Medicine | 5,500 | 1,465 | 30.8% | 899 | Accessible |
| Pediatrics | 3,135 | 841 | 28.1% | 147 | Moderate |
| Psychiatry | 2,516 | 362 | 14.4% | 65 | Moderate |
| Neurology | 932 | 269 | 29.1% | 7 | Moderate |
| Pathology | 622 | 225 | 36.3% | 3 | Moderate |
| Physical Medicine & Rehabilitation | 595 | 120 | 20.2% | 5 | Moderate |
| Preventive Medicine | 120 | 35 | 29.2% | 10 | Accessible |
| Anesthesiology | 1,900 | 190 | 10% | 2 | Competitive |
| General Surgery | 1,778 | 214 | 12.1% | 4 | Competitive |
IMG Match Trends (2022-2026)
2022
57.7%
7,900 / 13,700
2023
59.2%
8,400 / 14,200
2024
60.2%
8,900 / 14,772
2025
60.8%
9,761 / 16,052
2026
60%
9,682 / 16,154
Step 2 CK Scores — Matched Applicants (2024)
250
US MD Seniors
244
US DO Seniors
236
US Citizen IMGs
245
Non-US Citizen IMGs
Aim for 5-15 points above your specialty average. Passing score raised to 218 in July 2025.
Interview Invitations — What to Expect
10-14
Matched Non-US IMGs
3-6
Unmatched Non-US IMGs
12-16
Matched US IMGs
15-20
US MD Seniors (reference)
Year of Graduation Impact
70-75%
Current year
65-70%
1-2 years
50-55%
3-5 years
35-40%
5-7 years
20-25%
7-10 years
10-15%
10+ years
Frequently Asked Questions
What is the IMG match rate for 2026?
In the 2026 NRMP Main Residency Match (released March 20, 2026), US citizen IMGs matched at a record-high 70.0% (2,949 of 4,210 active applicants). Non-US citizen IMGs matched at 56.4% (6,733 of 11,944 active), the lowest in 5 years. A total of 9,682 IMGs filled first-year positions. The 2026 Match was the largest in NRMP's 74-year history with 44,344 positions offered. Source: NRMP 2026.
What Step 2 CK score do IMGs need to match?
For the 2024 match cycle, the average Step 2 CK score for matched non-US citizen IMGs was 245, and for matched US citizen IMGs was 236. The passing score was raised to 218 in July 2025. IMGs should aim for scores 5-15 points above their target specialty's average. For Internal Medicine, target 238-248; for competitive specialties like Surgery, target 245-255. Source: NRMP Charting Outcomes 2024.
Which specialties are most IMG-friendly in 2026?
The most IMG-friendly specialties based on 2026 NRMP data are: Internal Medicine (44.6% IMG fill rate), Pathology (36.3%), Family Medicine (30.8% with 899 unfilled spots — most of any specialty), Neurology (29.1%), and Pediatrics (28.1%). Psychiatry added 30 new programs and 128 positions. Dermatology, Orthopedics, and Plastic Surgery remain virtually closed to IMGs. Source: NRMP 2026.
What is ECFMG certification and how do I get it?
ECFMG (Educational Commission for Foreign Medical Graduates) certification is required for all IMGs to enter US residency training. Requirements include: passing USMLE Step 1 (pass/fail), passing USMLE Step 2 CK (score of 218+ as of July 2025), passing OET Medicine (required for all IMGs regardless of native language), and completing one of six ECFMG Pathways. All exams must be completed within a 7-year window. Source: ECFMG.org.
How many observerships should an IMG do?
IMGs should aim for 2-3 clinical observerships or externships totaling 3-6 months of US clinical experience. This provides: US-based letters of recommendation (critical for applications), understanding of the US healthcare system, clinical exposure in your target specialty, and networking opportunities with program directors. Programs with hands-on externship experience are valued more than observation-only programs.
What is SOAP and how does it work for IMGs?
SOAP (Supplemental Offer and Acceptance Program) is the process for unmatched applicants to apply to unfilled residency positions after the main match. Approximately 2,500 positions go unfilled each year. The IMG SOAP success rate is 15-20%. SOAP runs over 2 days in March with 4 rounds, and response times are 2-6 hours per round. Family Medicine, Internal Medicine preliminary, and Transitional Year have the most SOAP positions. Source: NRMP.
Do I need OET for ECFMG certification?
Yes, OET (Occupational English Test) Medicine is now required for ALL international medical graduates seeking ECFMG certification, regardless of native language or country of medical school. Minimum passing scores are: Listening 350 (Grade B), Reading 350 (Grade B), Speaking 350 (Grade B), and Writing 300 (Grade C+). All four sub-tests must be passed in a single sitting. Source: ECFMG.org.
What visa do IMG residents need in the US?
The most common visa for IMG residents is the J-1 Exchange Visitor Visa, sponsored by ECFMG. It has a 2-year home country requirement after training (waivable through Conrad 30 or other programs). The H-1B visa is an alternative but fewer programs sponsor it. In 2026, IMGs requiring visa sponsorship matched at 54.4% (5-year low), compared to 67.9% for permanent residents not requiring a visa (5-year high). Source: NRMP 2026.
What is the best state for IMG residency?
New York is the most IMG-friendly state with 40+ IMG-welcoming programs, primarily through the NYC Health + Hospitals system. Other top states include Michigan (20+ programs, Wayne State/DMC), Illinois (15+ programs, Cook County), Ohio (12+ programs, Cleveland Clinic community), Pennsylvania (12+ programs, Temple, Einstein), and New Jersey (10+ programs). Midwest and Southern states often offer lower cost of living with strong training.
How does year of graduation affect IMG match chances?
Year of graduation (YOG) significantly impacts IMG match rates. Current year graduates have a 70-75% match rate, 1-2 years out: 65-70%, 3-5 years: 50-55%, 5-7 years: 35-40%, 7-10 years: 20-25%, and 10+ years: 10-15%. To offset graduation gaps, pursue research fellowships, additional certifications, or recent clinical experience. Many programs use YOG as a screening filter.
What is FREIDA and how do IMGs use it?
FREIDA (Fellowship and Residency Electronic Interactive Database) is the AMA's comprehensive database of 13,000+ ACGME-accredited residency and fellowship programs. IMGs can filter by: visa sponsorship type (J-1, H-1B), percentage of IMG residents, program size, salary, location, and specialty. Basic search is free; premium features cost $20/year with AMA membership. FREIDA is essential for identifying IMG-friendly programs. Source: AMA.
How many residency programs are in the United States?
There are 6,809 ACGME-accredited residency program tracks in the United States (183 new in 2026), offering 44,344 total positions. The 2026 NRMP Match was the largest in its 74-year history. Internal Medicine has the most positions (~10,941), followed by Family Medicine (~5,500) and Emergency Medicine (3,198, rebounding with 130 new positions). Source: AMA FREIDA, NRMP 2026.
What are ECFMG pathways and which should I choose?
ECFMG offers 6 certification pathways to satisfy clinical skills requirements. Pathway 1 (clinical skills assessment by accrediting authority) is the most common and permanent. Pathways 2-5 involve attestation from medical schools or based on professional experience. Pathway 6 uses Mini-CEX evaluations. The 2026 Pathways deadline is January 31, 2026. Most IMGs use Pathway 1 or Pathway 6. Source: ECFMG.org.
How many IMGs matched in the 2026 residency match?
In the 2026 NRMP Main Residency Match (released March 20, 2026), 9,682 IMGs filled first-year residency positions — approximately 23.6% of all matched applicants. US IMG match rate hit a record 70.0%, while non-US IMG rate dropped to 56.4% (5-year low). Key trend: diverging outcomes between US and non-US IMGs, likely influenced by immigration policy climate. 2,862 positions went unfilled after the algorithm. Source: NRMP 2026.
How much does it cost to apply for US residency as an IMG?
The total cost for an IMG to apply for US residency ranges from $15,000-$25,000+. Major expenses include: USMLE Step 1 ($1,000+), Step 2 CK ($1,000+), OET ($587), ECFMG certification ($935+), ERAS application fees ($1,500-3,000+ for 150-200 programs), observership fees ($0-3,000), travel for interviews ($3,000-8,000), and living expenses during clinical rotations ($3,000-10,000). Use the USCEHub Cost Calculator to estimate your specific costs.
How does the residency match algorithm work?
The NRMP uses the Roth-Peranson algorithm (developed by Nobel Prize winners). You submit a rank order list of programs in your true order of preference. Programs independently rank applicants. The algorithm processes each applicant's list: it tries to place you at your #1 choice first. If that program is full with applicants it prefers more, it tries your #2, then #3, and so on. The algorithm is mathematically applicant-optimal — you cannot improve your outcome by ranking strategically. Always rank in your true order of preference.
What is ERAS signaling and how should IMGs use it?
ERAS preference signals let applicants indicate genuine interest in specific programs. Each applicant gets up to 25 signals (varies by specialty). Programs that receive your signal are 2-4x more likely to invite you for an interview. IMGs benefit more from signaling than US grads because programs often filter out IMG applications early, but a signal makes them take a second look. Use ALL your signals. Signal programs where you rotated, have geographic ties, or where your profile fits. Don't waste signals on your home program or places that already know you.
Are residency interviews still in person or virtual?
Most residency interviews are now conducted virtually via Zoom since the COVID-19 pandemic. Some programs offer optional in-person second looks, but the primary interview is almost always virtual. This has significantly reduced interview costs for IMGs — from $3,000-8,000 in travel to $200-1,500 for technology and preparation. Virtual interviews also allow IMGs to interview at more programs without geographic or financial constraints.
Data sourced from NRMP 2025 Main Residency Match Results, ECFMG.org, AMA FREIDA, and NRMP Charting Outcomes 2024. USCEHub is not affiliated with NRMP, ECFMG, AMA, ERAS, or AAMC. All trademarks belong to their respective owners. Statistics are for informational purposes only and do not constitute medical or legal advice. Individual results may vary.