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Q: Getting into Residency for Foreign Medical Graduates ( Answered 5 out of 5 stars,   2 Comments )
Subject: Getting into Residency for Foreign Medical Graduates
Category: Reference, Education and News > Job and Careers
Asked by: aditi2000-ga
List Price: $80.00
Posted: 12 Feb 2006 12:43 PST
Expires: 14 Mar 2006 12:43 PST
Question ID: 444910
I am a Foreign Medical Graduate. I have applied for the residency
program this year. I have already completed a couple interviews.  In
addition to waiting for my interview results called the "Match", which
would be declared on 14th March, I am getting ready for the
"post-match scramble," which is that 48 period after the residency
positions are announced that people can literally "scramble" to pick
up any open positions.
It's supposed to be a pretty frantic period.  I wanted information on
how best to prepare for this stage of the game.
1.  How effective/reliable are services such as those offered by  It looks like they walk you through the process,
handle the intense paperwork, follow-up with residency openings after
the scramble.  Has it actually worked for people?  Or are they just
playing off people's vulnerabilities?
2.  Are there other such services that are reputable/more effective?
3.  How should one prepare for the post-match scramble, in any case?
Thank you.
Subject: Re: Getting into Residency for Foreign Medical Graduates
Answered By: welte-ga on 13 Feb 2006 17:41 PST
Rated:5 out of 5 stars
Hi aditi2000-ga, and thanks for your question.

The post-match scramble is one of the most stressful experiences there
is.  You basically have 2 days to determine not just where you'll do
your residency, but in some cases, what field you'll end up in and if
you'll get into a program at all.  I've actually been through this
process a couple of times (as a US grad) and can say that it has very
much turned me off from the Match process itself.  I can give you some

For the reasons above, many medical school Deans recommend having
someone (such as a medical school Dean) on your side ready to make
phone calls for you as soon as the scramble list is out.  You'll know
on March 13, 2006 at noon whether or not you matched.  If you get an
e-mail that you didn't match, then you'll need to get the list of
unfilled positions on March 14, 2006 at noon (Eastern Standard Time). 
You can find list at the NRMP Match site:


Let me take your third question first... First, I highly recommend
putting together a packet of information that you will need to submit
to programs during the scramble.  I would have both a printed and
electronic (PDF) form.  Request copies of your letters of
recommendation NOW.  People tend to delay writing them and might delay
getting you a copy.  I've had this problem many times at various
points in my academic career.  This can be one of the most important
parts of your application.

The site has a good list of things to get together:

Scan a copy of the various documents into PDF format.  If you don't
have your own scanner, use one at a copy center or buy a cheap one. 
Put all of these files in one labeled directory on your desktop that
you can get at quickly.  A photo is helpful, since some programs ask
for one.  You can include a CV (Curriculum Vitae) if you have one. 
Next, I recommend making one large PDF file that contains all of these
documents.  There are various windows and Mac programs out there that
can do this.  This way you don't have to send 12 files to each program
and they can just hit "print" and get a complete printout of your

Here's a listing of PDF utilities to do merges:

Many of these have limited trials (see, for example, PDF Split-Merge 1.1):

Next, print out the merged PDF document on standard 8.5" x 11" paper
and place this in a folder where you can find it.

Lastly, put together a standard FAX cover letter that you can modify
for each program.  Don't rely on the FAX, since just about every fax
machine out there will be busy for the entire day as people madly fax
their info in.  You won't have this problem with e-mail, which is why
you want to have a PDF file to send.  Make sure that the size is not
larger than around 5MB, or the mail may bounce.  If the file is too
big, you may have to send several e-mails with the various parts of
the applications.  Put together a draft e-mail that you can modify and
send to each program after the scramble starts.  Attach your PDF file
to the draft so you don't forget to send it.  Make a backup CD of all
your files and put it in a safe place.


Ok, now you have a PDF with all your application info, a printed copy
for faxing, and a draft e-mail.  The programs that will have unfilled
spots during scramble is fairly unpredictable, but you can search
online for lists from previous years to look for trends in your field.
 For example, maybe every year 2 or 3 programs don't fill. 
Unfortunately, this is often for good reason - they're malignant, they
are bad programs, they're in bad places, etc.  You'll have to decide
if the risk is worth it.  In any case, there's a good chance that some
of these repeat programs will be on the list again this year.  You
should learn a little about those programs.

Being an FMG is a bit of a special situation.  As you know, many
programs dismiss FMG's out of hand.  Of course, these same programs
might consider you if you have strong credentials and they have
openings.  That being said, it pays to find some programs that are FMG
friendly in your field.  There are lots of Internal Medicine programs
with significant numbers of FMG's, mostly in rural areas.  There are
exceptions, such as St. Vincent's hospital in Worcester,
Massachusetts.  These programs often have openings in the scramble as
well, primarily because they seem to be located in places shunned by
US grads.

Another factor that plays a major role in the scramble are phone
calls.  The ideal situation is something like... someone you've worked
with for years happened to have trained the chairman at a program you
want to go to and makes a call for you.  This rarely happens.  You
should, however, look carefully at the people who wrote you letters of
recommendation to see if any of them would be good candidates for
making calls - respected, known by or have some ties with programs in
the US, and reliable.  You can have more than one person obviously. 
For example, there are several Harvard Medical grads who now have
returned to their home countries and train FMG's, which helps those
FMG's get positions back in the US.  You might look through your
school's faculty now and identify some people who could potentially
help you.  Chairpersons, Department Chiefs, Deans, etc., are generally
good at this sort of thing.

Another meter of programs is where people from your own school have
ended up.  If there are a few schools that have taken lots of grads
from your school, give them a call, even if they state that they have
no openings.  Places can sometimes make a position for you,
particularly if they're large and people have left.  You also stand a
better chance at programs where you might have done externships as a
medical student.

Once you know the people who will be making phone calls for you, make
a sheet or file with all of their names, phone numbers, titles,
e-mails, and addresses.  You don't want to waste time looking for your
advisors office phone number.  Ask people where they will be early in
the afternoon on scramble day.

Make sure that anyone who is going to be making calls on your behalf
has your application file in hand the day of the scramble.  People
will misplace it.  People will forget what day the scramble is. 
People will forget who you are.  It's amazing given how important to
you it is, but it all happens.  You need to keep on them and check in
with them the day before the scramble.  Sometimes people go out of
town for last minute meetings and conferences.  Have at least one
backup ready to go.

Another thing to keep in mind is that for the NRMP match, more so than
for the early SF Match, time is important.  Most programs will make a
decision quickly since the Match is only two days after the scramble. 
Programs want to get the best scramble candidate they can get their
hands on, so it's also in their interest to make offers to people that
they like.  They also have the option of just not picking anyone and
leaving the spot unfilled.  In this case, positions can be posted at
the AAMC Find a Resident site:

This is a reliable resource for finding positions at all levels.  It's
not a free service, and I recommend checking that there are some open
programs in your field at your level prior to paying.  You can get a
summary listing here:

Here are some other sites that list open positions:


Ok... Now you have paper and electronic versions of all your documents
and your advisors are cued up and ready to call for you.  You can
check to NRMP site a little before noon for the scramble list, but
they are pretty strict about not releasing it until at least noon. 
Download the file (usually a PDF) and save it.  Print a copy.  The
list will usually list at least a phone number for each program.  If
they list an e-mail, send your application with a cover letter.  You
should also look up the e-mail of the chairman of the department, the
director of the residency program, and their assistants and send
copies to them.  Confirm with their assistants that a copy was
received (call or e-mail).  Remember that they are being barraged with
applications, so it can take a while to get a reply or get through by
phone.  When you confirm receipt, also ask who's making the final
decision, how the process will work (will they be interviewing, etc.),
and when a final decision will be made.

Programs get so many applications that they may not tell you that they
didn't pick you until after the Match.  Painful.  Some will just
assume that you'll figure it out when you haven't heard from them by
Match day.  More painful.  Finding a helpful assistant at a program
can really help you figure out what's going on.

You can also try faxing your application, but it takes a while to fax
a 25 page application and the fax lines will be continuously busy. 
There's little that's more frustrating than redialing 50 times,
finally getting through, then watching the fax machine jam or
disconnect before the entire application is through.  One program one
year had a fax that was out of paper for most of the day, so it would
answer but nothing would get through.  I highly recommend the e-mail


Put some money aside.  Some programs will decide to interview scramble
applicants, sometimes in part to filter out people, but also because
they have to work with you for some years and don't want to get
someone who's going to make everyone (more) miserable.  That means
getting a flight for the next day, which will be very expensive,
particularly from a foreign country.  I don't recommend this,
particularly since it means you'll be away from the phone if one of
your programs calls.  You may not even have enough time to get to an
interview if you are traveling from very far away.  You may even
consider being in the US on the day of the scramble, possibly at a
friend's, where you have good phone and computer access.  Some good
hotels can also provide this type of service, but they probably won't
let you sit and redial on the fax all day.  It's a very expensive
process, as you can see.  In any case, you won't be severely hampered
by working from home.  An advantage to this is that you will be closer
to the folks who are making phone calls for you.


Lastly in this regard, don't forget to let people know if you actually
match and don't need their help during the scramble.  They'll be happy
and relieved for you and themselves.


Regarding, even if they were the most reliable service
on the planet, I wouldn't soley rely on them.  Too much is at stake. 
They can't do anything about busy fax machines or busy phones.  They
can't get your advisors to make phone calls for you, which can be one
of the most important factors.  You're also putting things into their
hands, which could be disastrous, no matter how good they are.  I've
had experiences with the SF Match where they didn't send out letter of
recommendation, etc., and also didn't let me know.  I didn't find out
until interviews.  Errors and problems will happen, and if you're
relying on them entirely, you won't be in control to fix them or
overcome them as they happy.

That being said does9o

They also provide some useful resources.  See, for example, their
program listing, which are free:

I recommend having a copy of the list for your field on hand when you
look through the scramble programs to compare your credentials with
the snippets on the list for FMG's.

One advantage of fmgamerica is that they act as a server for your
application.  This means that you upload your letters, transcripts,
etc., and you just have to e-mail a link to the programs.  This
obviates the need to send big PDF files to everyone, which I think is
an advantage.  Of course, you could also just make your own website
and pay much less to have someone act as a server (e.g., 
Here is are some example pages from applicants:

I do find it a little suspicious that they don't clearly state their
fees for various services on their website.  They do ask you for a
credit card number before they tell you how much they might charge. 
They offer $100 off if you send them a bank check.  They claim that
this discount is due to fees that they pay for credit card processing
(typically 2-3%).  This only makes sense if their service costs in the
range of $2,000-$3,000.  This doesn't sound like a high volume,
well-oiled machine for FMG's, particularly since very few applicants
are likely to pay such high fees.  You could contact them for exact

There are very mixed opinions about FMG America out there.  People
have also raised the concern that FMG has been flooding the various
medical student forums with "testimonials," making it more difficult
to find reliable information and making their claims all the more
dubious.  Here are some examples, some of which are likely planted
(which ones no one can say with certainty of course):

Here's an interesting story that sounds believable:

"zoe - 01/05/05 12:33
Currently working in the hospital as a Lab (Tech Aid), and work in
some attorney office as accounting controller, I have very strong
personal statement, and resume too however I have list it the
non-experience in USA on my PS, I think the non-experience generate
the problem for me!!!  Any way I do believe in the LUCK Now, my major
problems (I can?t find any externship or observer ship) I have contact
some web- site like FMG America they needs $3,000.00 and I have to go
to another state + Expense like hotel or apartment and etc,  Thanks
for you nice feeling"

It doesn't sound like the individual above has actually joined FMG
America, but does state their fee.

I haven't been able to find any substantial number of reliable stories
detailing success with FMG America.  Any such stories are particularly
suspect given the accusations that FMG America has been seeding forums
with positive stories.

Multiple Lexis-Nexis and InfoTrack searches turned up nothing on them.


While there are other programs for FMG's trying to get residency
positions in the US, I don't think that any of them are any more
reliable than FMG America in my opinion.  I think that for $3,000 you
can do what they do for yourself and more.  You can dial a busy fax
machine just as well as FMG America can.  They don't have any magic
that can get through the obstacles any better than you can.  I also
doubt that they will be sending personalized letters to programs. 
Phone calls from people who know you probably go the furthest in
helping you both before the Match and during the Scramble, which are
not part of the FMG America schema.

Have some sort of a backup plan.  For example, if you're applying in
Internal Medicine, think about Family Practice.  Right now, a large
percentage of positions go unfilled, even in good programs.   Other
more competitive fields are very tough.  I've come across dozens of
(US) fellowship trained FMG's practicing in other countries who are
starting over as interns in the US so they can practice here.  One of
them was a skull base fellowship trained neurosurgeon with 15 years of
practice under his belt, applying for beginner positions in the US.


I hope this information is helpful.  I wish you the best at this
difficult time.  Hang in there... you will find a position.  You may
even surprise yourself and match!  Please feel free to request any
clarification prior to rating.



Request for Answer Clarification by aditi2000-ga on 14 Feb 2006 09:19 PST
Dear welte-ga,

               Thanks so much for your detailed answer.
However I do have a couple questions.
1. You wrote - another factor that plays a major role in the scramble are phone
calls. You
should, however, look carefully at the people who wrote you letters of
recommendation to see if any of them would be good candidates for
making calls - respected, known by or have some ties with programs in
the US, and reliable.  You can have more than one person obviously. 
For example, there are several Harvard Medical grads who now have
returned to their home countries and train FMG's, which helps those
FMG's get positions back in the US.  You might look through your
school's faculty now and identify some people who could potentially
help you.  Chairpersons, Department Chiefs, Deans, etc., are generally
good at this sort of thing.

My Question to you is, I unfortunately do not know many people here in
U.S who could help me make phone calls etc on Match Day.  For me its a
'single man show'. I am going to  put up at a friends house with
ofcourse an access to a computer and fax, but thats it. So what I am
scared of is, would I be able to do it all by myself? In my situation
where my "contact system" is poor, what would you suggest?

2. You wrote -  The programs that will have unfilled
spots during scramble is fairly unpredictable, but you can search
online for lists from previous years to look for trends in your field.
 For example, maybe every year 2 or 3 programs don't fill. 
Unfortunately, this is often for good reason - they're malignant, they
are bad programs, they're in bad places, etc.  You'll have to decide
if the risk is worth it.  In any case, there's a good chance that some
of these repeat programs will be on the list again this year.  You
should learn a little about those programs.

My Question - Which is  the site/place where I could learn the trend
of hospitals with regards to their unfilled positions in the last
couple years.

3. You spoke about the entire e-mail/fax and document management very
well, but the problem that I am currently facing is, that I am not
that computer savvy, so what should I do in that case, with regards to
my document management. Is there any place which could help me with my
documentations at an affordable rate.

Hoping to hear from you soon,


Clarification of Answer by welte-ga on 15 Feb 2006 19:09 PST
Hi again Aditi, 

Phone calls...

You can get a position without them - I did, and I'm very happy. 
Someone did finally make a phone call for me - after I had been
offered a position.  I would still consider the Dean or other faculty
at your home medical school.  It's obviously an international call,
but there's a lot at stake.  I would at least ask some people if they
could call one or two departments for you.  If they say that they
would rather not, then there's nothing lost.  Did you do any
externships in the US?  Someone that you worked with here might be
able to help you.

In any case, don't despair if you can't find someone to make calls. 
The Dean at my medical school was supposed to make calls - nothing. 
My advisor - out of town, "busy."  I managed to have a colleague that
I worked with before medical school make some calls for me, which
helped, but I didn't end up going to the place he called.


Unfilled spots...

You can find lists of unfilled programs from the past scattered around
the web.  Here's one such list from 2002:

Here are the 2003 positions:

2004 positions:

2005 positions:

Search strategy:
"unfilled programs" anesthesiology psychiatry medicine "emergency
medicine" filetype:pdf

Here are some other useful resources in this regard:

Match statistics: - A great place to get more information about programs
and correspond with fellow applicants and FMG's:


Document management...

After you assemble everything, I recommend going to a copy center with
computers - someplace like Kinko's.  The staff there should be able to
sit down with you (or do for you) to make a PDF file and compress the
size to something reasonable.  The simplest way to compress a PDF file
is probably use Adobe Acrobat Pro, select "File" and then "Reduce File
Size."  Adobe Acrobat is standard software at Kinko's:

They can also run off a copy of the documents so that everything is on
an 8.5 x 11" page to make faxing easier later.  You can certainly give
them a call and see what they can do...

You can even print directly to your nearest store and pick up the
printout when you get there:

My experience with them is that their computer rental rates can be a
little pricey, but nowhere near FMG America.  The staff are generally
helpful in getting something done and helping with the computers, but
of course this varies by store.  You can obviously call ahead and
describe your task (scan multiple documents to multiple PDF files and
merge them into one PDF file, then burn all the files onto a CD to
take home) and see if they will be able to walk you through the


Good luck with all of this.  I know it's tough.  Remember, even if you
don't match, there are lots of preliminary positions out there in both
medicine and surgery and many people get great spots out of
preliminary positions.  It helps you meet people in the US who can
then help you find a permanent residency position and also lets you
prove yourself in the US clinical system.  I've met dozens of FMG's
who were fantastic doing just this.


Request for Answer Clarification by aditi2000-ga on 25 Feb 2006 03:01 PST
Dear welte-ga,

             Thanks a million for all your help, time, consideration
and above all your very detailed answers.
However there is this one thing I needed to know...As mentioned
earlier I am an FMG, I was wondering if I could do this whole process
from my home country; or do I need to be in U.S during the Match and

I was also wondering if I do not match; then what is the best way I
should look for a Research position. Again can I do the post-match
'hunting' from my  home country.

Thanks ,



Clarification of Answer by welte-ga on 25 Feb 2006 09:21 PST
Hi again aditi2000-ga,

You can do the Match and Scramble from your home country, but I feel
you would be at a disadvantage.  You'll rarely get through directly to
a program director - they will often have to call you back.  They are
less likely to dial an international number than a domestic one.  Lots
of the phones in the hospitals (even for administrators) won't even
dial long distance, much less international.  You don't want to be
dropped into the recycle bin just because the person trying to call
you couldn't figure out the phone number.

Another consideration is, depending upon where you are, how reliable
your internet, phone, and fax service are.  If you have a power outage
on Scramble day, you could be out of luck.  If you're in London, this
probably isn't an issue.  If you're in a small African country, you
might have problems.

If you don't match and nothing looks good or works out in the
Scramble, don't panic.  As you suggest, research is a great option. 
There may be some visa issues involved, but these can likely be worked
out between you and your lab.  You should pick carefully.  I would
look for a lab where there is participation by someone who can help
you get into a residency.  For example, a lab doing work you're
interested in run by a program director at a place that takes lots of
FMG's would be ideal.  Unfortunately, most places in the US that take
lots of FMG's tend to be in more rural areas and don't do lots of
research.  There might be some exceptions... St. Vincent's in
Worcester, Massachusetts comes to mind as not being in a rural area
and has lots of FMG's (a very bright FMG was actually their cheif
medical resident when I was rotating through there as a medical
student).  I don't know how much research they're into though.

While you're doing research, go to conferences, Grand Rounds, etc., so
that people get to know who you are.  Get to know the Chief Resident
in the program you're planning to apply to - they help decide who gets

Use the web to your advantage when looking for research.  You can
either search for research labs in a geographical and academic area
you're interested in working and see what you find.  Most well
established research groups now have some type of lab website where
you can see who's working there and their positions within the
hospital or university.

I would start by picking a few programs that are likely to take FMG's.
 You can usually take a look at their current residents and their
medical schools to figure this out.  Then, look up who the chairman
and program directors are and try to find their research.  You can use
PubMed for this to see if they've published anything in the last 5
years.  If it looks like stuff you think you could be interested in,
e-mail them with a CV to find out if they might have any positions. 
It pays to do this well in advance, since often grant renewals and
such take place a long time before the money is actually available. 
There is sometimes discretionary money that an institute can pull from
to hire someone at the last minute if the lab director really wants

I know that match lists were just submitted, so things are now out of
your hands in that respect.  It's just a waiting game now.  Work on
preparing for the Scramble and hope for the best.  Start looking into
research possibilities so that you have some sort of (at least mental)
backup during the Scramble.  Don't tell a lab director that you're
definitely coming if you haven't found out yet whether or not you have
a residency position - you don't want to back out of a deal,
particularly if they take the time to find funding for you, etc.  Let
them know you're exploring multiple options up front.

Good luck!


Request for Answer Clarification by aditi2000-ga on 03 Mar 2006 04:45 PST
Dear welte..Hi again...Thanks once again for every detail, for all
your tme and help.

Here's the thing
After lot of 'deep' thinking, consideration and fundamentally for some
PSYCHOLOGICAL support, I have finally become a member of FMG AMERICA.
I just spoke to them and they said they would take care of everything
on my behalf during the scramble, which means they would be contacting
the programs, forwarding my stuff.  What I need to know is (especially
because quite many people have told me not to rely on them
wholly)should I also do the whole scramble process myself which I
would be otherwise doing.
 I am asking this; because I need to know would it create unnecessary
confusion if FMG and I did the same thing. Ofcoure I have not told the
FMG site that I would also be taking care of this.

Would really appreciate if you could help me solve this problem.

Thanks once again for everything

Clarification of Answer by welte-ga on 04 Mar 2006 09:36 PST
Hi again aditi2000-ga,

As you say, I wouldn't rely on FMG American as your only ally.  I
would select 3-5 programs from the list of unfilled programs and focus
your attention on those.  Rank your top 3 choices (ones you'd like to
be at that you think you have a chance of getting into) and focus your
efforts on these.  Some programs will decide to fill their unfilled
positions outside the Match. In this case, you could offer to go out
and visit for an interview after the Scramble (if you don't find a

I don't think that sending your own materials would be confusing,
provided you clearly state in your cover letter that FMG America is
sending materials on your behalf, but that you want to be sure that
your "top" picks receive your information as quickly as possible and
that they might receive a duplicate packet.

Another potential source of psychological support might be to track
down some FMG's who are current residents in your field in the US and
talk to them about their experiences.  Many programs list their
residents online with their e-mails, and this is probably the best
place to start.  Having a backup plan that you're happy with is also a
good plan.  Knowing what you'll do if you don't get a position can be
somewhat comforting.  Many FMG's take preliminary positions and hope
for a spot in the next round.


Request for Answer Clarification by aditi2000-ga on 10 Mar 2006 06:54 PST
Dear welta,

            I completely appreciate all your help.  I am 'almost' set
to face the big ordeal!!.
I was just wondering if you could give me your contact info and I
would be really happy to talk to you in person.

Once again Thank you for everything


Clarification of Answer by welte-ga on 15 Mar 2006 09:29 PST
Hi again,  Sorry for the delay - I was out of town.  Unfortunately,
Researchers aren't allowed to give our their personal contact info. 
You can reach me via Google Answers, however.  I'd like to hear how
you do in the Match, Scramble, etc.  Feel free to post as a Comment if
you like.


aditi2000-ga rated this answer:5 out of 5 stars and gave an additional tip of: $10.00
Excellent site and excellent people (researchers)
Thanks for all the help and effort

Subject: Re: Getting into Residency for Foreign Medical Graduates
From: anatolyk-ga on 16 Feb 2006 14:24 PST
Just a comment on available research and unfilled position historical data:

another pointer to a scramble strategy:

Good luck!
Subject: Compiling Tips-N-Tricks for IMGs at
From: digitaldoc-ga on 17 Jul 2006 16:11 PDT
IMG Friendly Residency Lists at :

g/l to us all !

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