What Step Scores Make IMGs Competitive for US Residency?

For international medical graduates (IMGs) aiming to secure a residency position in the U.S., the United States Medical Licensing Examination (USMLE) Step scores play a crucial role in determining competitiveness. The “Charting Outcomes in the Match” 2024 report by the National Resident Matching Program (NRMP) provides valuable data on the Step scores associated with successful residency matches for IMGs. This post explores the USMLE score trends for IMGs, providing insights into what scores may improve match chances across different specialties.

The NRMP defines an IMG as “a physician who received a basic medical degree or qualification from a medical school located outside the United States and Canada.”  More specifically, “individuals who are U.S. citizens when they graduate from an international medical school are U.S. IMGs” while, and Non-U.S. IMGs are those “who are not U.S. citizens at the time of medical school graduation…even if they later become U.S. citizens.” For 2024, Non-U.S. IMGs made up 22.3% of all applicants in the Match (the second largest group after U.S. MD Seniors), while U.S. IMGs accounted for 10.6 percent of all applicants.

Overall USMLE Performance Among Matched IMGs

Step 1 Scores

• U.S. IMGs who matched: Mean Step 1 score of 216.6 (Standard Deviation = 15.4).
• Non-U.S. IMGs who matched: Mean Step 1 score of 233.8 (Standard Deviation = 17.5).
• Unmatched IMGs typically had lower Step 1 scores than their matched counterparts.

The below chart shows Step 1 scores grouped by preferred specialty for matched and unmatched U.S. IMGs (top panel) and non-U.S. IMGs (bottom panel). The horizontal bars represent the median values and the vertical lines show the interquartile ranges (IQR). Some specialties with too few data points lack the vertical bar. Across the majority of specialties, the IQR of U.S. IMGs and non-U.S. IMGs who matched to their preferred specialty was higher than the IQR of those who did not match.

Step 2 Clinical Knowledge (CK) Scores

• U.S. IMGs who matched: Mean Step 2 CK score of 235.6 (SD = 14.2).
• Non-U.S. IMGs who matched: Mean Step 2 CK score of 244.8 (SD = 15.4).
• Step 2 CK scores were available for 91.1% of U.S. IMGs and 97.2% of non-U.S. IMGs.

Similarly, the below chart shows Step 2 CK scores grouped by preferred specialty for matched and unmatched U.S. IMGs (top panel) and non-U.S. IMGs (bottom panel). The horizontal bars represent the median values and the vertical lines show the interquartile ranges (IQR). Some specialties with too few data points lack the vertical bar. Just like for Step 1, across the majority of specialties, the IQR of U.S. IMGs and non-U.S. IMGs who matched to their preferred specialty was higher than the IQR of those who did not match.

Given that Step 1 is now pass/fail, Step 2 CK has become increasingly important in distinguishing applicants. For those aiming for top scores, this guide to scoring a 280 on Step 2 CK offers useful insights and strategies. As aforementioned, most specialties demonstrate that those applicants who match, on average, have a higher Step 2 CK score than those who did not match. However, there is a significant amount of overlap for some specialties – this suggests that there are other factors beyond Step score in determining your likelihood of matching.

Match Rates and Competitiveness by Specialty

The match rates for international medical graduates (IMGs) vary significantly by specialty. The NRMP’s 2024 data illustrates that some fields are much more IMG-friendly than others. The figure above highlights key differences between U.S. IMGs and non-U.S. IMGs

Specialties with the Highest IMG Residency Match Rates

Certain specialties have relatively high match rates for both U.S. and non-U.S. IMGs, making them more accessible options for international applicants:

• Pediatrics: U.S. IMGs (83.5%), non-U.S. IMGs (77.6%)
• Family Medicine: U.S. IMGs (66.5%), non-U.S. IMGs (60.8%)
• Emergency Medicine: U.S. IMGs (79.3%), non-U.S. IMGs (52.0%)
• Internal Medicine: U.S. IMGs (61.6%), non-U.S. IMGs (53.6%)

These fields traditionally have a higher demand for residents, making them more accessible for IMGs.

Moderately Competitive Specialties

Specialties with moderate match rates indicate that IMGs can match with strong credentials, such as higher Step 2 CK scores and U.S. clinical experience:

• Neurology: U.S. IMGs (53.5%), non-U.S. IMGs (48.7%)
• Anesthesiology: U.S. IMGs (49.2%), non-U.S. IMGs (43.3%)
• Diagnostic Radiology: U.S. IMGs (35.5%), non-U.S. IMGs (35.0%)
• Obstetrics & Gynecology: U.S. IMGs (41.5%), non-U.S. IMGs (34.4%)

Most Competitive Specialties for IMGs

Several specialties remain highly competitive, with low match rates for IMGs, especially for non-U.S. IMGs:

• • Plastic Surgery: U.S. IMGs (15.4%), non-U.S. IMGs (25.8%)
  • Orthopedic Surgery: U.S. IMGs (19.4%), non-U.S. IMGs (12.5%)

• General Surgery: U.S. IMGs (31.0%), non-U.S. IMGs (26.6%)

• Interventional Radiology: U.S. IMGs (26.7%), non-U.S. IMGs (38.1%)
• Vascular Surgery: U.S. IMGs (Unknown), non-U.S. IMGs (30.8%)

These specialties require exceptionally high USMLE scores, strong letters of recommendation, and significant U.S. clinical experience to be competitive.

Step 2 CK Score Impact on Residency Match Probability for IMGs

The NRMP data also illustrates how Step 1 and Step 2 CK scores correlate with match probability. We have included the figures below for all specialities only for Step 2 CK as most students applying no longer have a Step 1 Score. These figures are helpful to understand your probability of matching, based on your Step score. However, please remember that the Match process is holistic, and these data are only a few pieces of information which contribute to your overall likelihood of matching!

Anesthesiology

Child Neurology

Dermatology

Diagnostic Radiology

Emergency Medicine

Family Medicine

General Surgery

Internal Medicine

Internal Medicine/Pediatrics

Interventional Radiology

Neurological Surgery

Neurology

Obstetrics and Gynecology

Orthopedic Surgery

Pathology

Pediatrics

Physical Medicine and Rehabilitation

Plastic Surgery

Psychiatry

Radiation Oncology

Vascular Surgery

Key Takeaways for IMGs Applying to US Residency

1. Step 2 CK is now the primary differentiator since Step 1 is pass/fail.
2. Non-U.S. IMGs typically require higher scores than U.S. IMGs to be competitive.
3. Matching in competitive specialties often requires Step 2 CK scores of 250+.
4. Emergency Medicine, Pediatrics, Family Medicine, and Internal Medicine offer some of the highest match rates for IMGs.
5. The Residency Match is a holistic process and Step scores are only one piece of your application.
6. The average Step score of an IMG that matches into that speciality is extremely variable – we recommend you look at your speciality of interest to figure out your target Step scores. 

For IMGs looking to match in 2025 and beyond, focusing on a strong Step 2 CK score, applying broadly, and demonstrating clinical experience in the U.S. will be crucial in securing a residency spot. If you need assistance, please reach out to us at EMP as we have a team of expert mentors who can provide residency advising and help you achieve your goals.

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