International medical graduates (IMGs) enter US residency mainly through the NRMP Main Residency Match, applying through ERAS in September and submitting a ranked list of programs by early March. In the 2026 Match, US citizen IMGs matched to first-year positions at a record 70 percent, while non-US citizen IMGs matched at 56.4 percent, a five-year low. To take part, IMGs must meet all ECFMG exam requirements by the rank list deadline.
How the Match works
The Match pairs applicants with residency programs using a computer algorithm. Both sides rank each other in order of preference, and the algorithm places each applicant in the highest program on their list that also ranked them and has a position left. Applicants cannot negotiate offers outside the system once they enter it, and a match is a binding commitment under NRMP rules.
The process has two separate systems:
- ERAS, run by the AAMC, which you use to send your application, letters, transcripts and USMLE scores to programs.
- The NRMP, which runs the Match itself: registration, rank order lists and results.
Who counts as an IMG
The NRMP reports results by applicant type. The two IMG groups are:
| Group | Who it includes |
|---|---|
| US citizen IMGs | US citizens who studied at a medical school outside the US and Canada, including many Caribbean graduates |
| Non-US citizen IMGs | Graduates of international schools who are not US citizens, including permanent residents and applicants who need a visa |
Graduates of US MD and DO schools, and of Canadian schools, are counted separately.
Eligibility for IMGs
The NRMP requires IMGs to have met all examination requirements for ECFMG Certification by the Rank Order List certification deadline. That means passing USMLE Step 1 and Step 2 CK and completing an ECFMG Pathway, including the OET Medicine English test. ECFMG and the NRMP exchange data weekly to confirm each IMG's status. You will also need a valid ECFMG Certificate before you start training. Our guide to the USMLE for international medical graduates explains each requirement.
The 2027 Match timeline
These dates are from the AAMC's 2027 ERAS timeline and the NRMP's 2027 applicant calendar.
| Date | What happens |
|---|---|
| 4 June 2026 | 2027 ERAS season opens; start building your application |
| 2 September 2026 | You can submit ERAS applications to programs |
| 15 September 2026 | NRMP registration opens |
| 23 September 2026 | Programs can begin reviewing applications |
| Autumn and winter | Interviews |
| 29 January 2027 | NRMP standard registration deadline (a USD 50 late fee applies after this) |
| 31 January 2027 | ECFMG deadline for Pathway applications and OET scores for the 2027 Match |
| 1 February 2027 | Ranking opens |
| 3 March 2027 | Rank Order List certification deadline |
| 15 March 2027 | Match Week begins; you learn whether you matched; SOAP begins |
| 18 March 2027 | Four SOAP offer rounds |
| 19 March 2027 | Match Day: you learn where you matched |
SOAP
If you do not match, or only partly match, you may be eligible for the Supplemental Offer and Acceptance Program (SOAP) during Match Week. Programs with unfilled positions make offers in set rounds, and you can apply to a limited number of programs. For 2027, the four offer rounds all fall on 18 March.
IMG match statistics
The 2026 Match
The NRMP reported on 20 March 2026 that the 2026 Main Residency Match was the largest in its history, with 53,373 registered applicants and 44,344 positions offered, of which 41,482, or 93.5 percent, were filled. For IMGs:
| Group | Active applicants | PGY-1 match rate | Change |
|---|---|---|---|
| US citizen IMGs | 4,210 | 70.0% | Highest on record; 377 fewer applicants than 2025 |
| Non-US citizen IMGs | 11,944 | 56.4% | Lowest in five years; 479 more applicants than 2025 |
Within the non-US citizen group, the NRMP reported that foreign-born IMGs who needed visa sponsorship matched at 54.4 percent, a five-year low, while those who did not need sponsorship matched at 67.9 percent, a five-year high. The NRMP said these data highlight how broader policy conditions could shape future Match outcomes for non-US citizen IMGs. Source: NRMP, 2026 Main Residency Match results.
The 2025 Match for comparison
In its 2025 Results and Data report, the NRMP reported a PGY-1 match rate of 67.8 percent for the 4,587 active US citizen IMGs, and 58 percent for non-US citizen IMGs. So between 2025 and 2026, US citizen IMGs improved while non-US citizen IMGs lost ground.
What the numbers do not tell you
Match rates are averages across every specialty. They do not show your chances in a specific field, and they count only applicants who submitted a rank list. Programs vary widely in how many IMGs they take, and some do not sponsor visas at all.
Visas for non-US citizens
If you are not a US citizen or permanent resident, you will need a visa to train. The two common routes are:
- J-1 exchange visitor visa, sponsored by ECFMG for physicians in clinical training. It usually comes with a requirement to return to your home country for two years after training unless you obtain a waiver.
- H-1B temporary worker visa, sponsored by the residency program itself. Not all programs offer it.
Check each program's visa policy before you apply, since the 2026 data show a clear gap between applicants who needed sponsorship and those who did not.
How to improve your chances
- Pass every exam on the first attempt. With Step 1 pass/fail, programs rely heavily on your Step 2 CK score, and failed attempts stay on your record.
- Gain US clinical experience. Hands-on rotations in US hospitals give you US letters of recommendation, which many programs value.
- Apply where IMGs match. Look at each program's recent residents and its visa policy, and focus on specialties and programs with a history of taking IMGs.
- Apply broadly and on time. Submit early in September, when programs begin reviewing.
- Rank every program you would attend. A longer rank list generally gives you more chances to match.
If you are still choosing a school, our guide to Caribbean medical schools explains how to compare outcomes, and the programs directory lists accreditation notes for each school.
Key takeaways
- IMGs apply through ERAS and are matched through the NRMP Main Residency Match.
- All ECFMG exam requirements must be met by the Rank Order List deadline, which is 3 March 2027 for the 2027 Match; Match Day is 19 March 2027.
- In 2026, US citizen IMGs had a record 70 percent PGY-1 match rate, while non-US citizen IMGs matched at 56.4 percent, a five-year low.
- Non-US citizen IMGs needing visa sponsorship matched at 54.4 percent in 2026, against 67.9 percent for those who did not.
- SOAP offers a second chance during Match Week for applicants who do not match.
- Strong Step 2 CK scores, US clinical experience and a targeted, broad application list improve your chances.