Psychiatry itself grew more slowly. It offered 2,516 first-year positions in 2026, 23% more than in 2022, and 65 of them were still empty when the matching algorithm finished, up from 8 a year earlier, the NRMP said on March 20, 2026.

Why it matters: psychiatry is opening doors for IMGs at the same moment the overall non-U.S. IMG match rate fell to 56.4%, a five-year low. The new seats are not spread evenly. Three states placed 44% of the non-U.S. IMGs who matched into psychiatry, and the rank order list deadline for the 2027 Match is March 3, 2027.

Non-U.S. IMGs now outnumber U.S. IMGs in psychiatry

Five years of NRMP data show a quiet reversal. In 2022, U.S. citizen IMGs filled 188 psychiatry positions and non-U.S. citizen IMGs filled 133. Since 2024, non-U.S. IMGs have filled more.

Taken together, IMGs filled 399 psychiatry positions in 2026, about 15.9% of the positions offered. That is almost the same share as in 2022 (15.7%). What changed is the mix: the non-U.S. IMG share rose from 6.5% to 8.8%, while the U.S. IMG share slipped from 9.2% to 7.0%.

U.S. graduates still take most seats. U.S. MD seniors filled 1,414 psychiatry positions (56.2%) and U.S. DO seniors filled 566 (22.5%), up from 387 DO seniors in 2022.

Keep the scale in view. Psychiatry accounted for only 3.3% of all non-U.S. IMG first-year matches in 2026 and 6.0% of U.S. IMG matches, so most IMGs who matched did so in other specialties. Our analysis of the 2026 NRMP Match results for IMGs covers the other specialties.

Three states placed almost half of non-U.S. IMGs

The NRMP's 2026 results by state, specialty and applicant type show where those psychiatry matches happened. New York, Texas and Florida together placed 98 of the 222 non-U.S. IMGs. Add Ohio and Virginia and the five states account for 116, or 52%.

The contrast is sharp. California offered the second-most psychiatry positions in the country, 275, and filled six with non-U.S. IMGs. Pennsylvania filled 124 positions with seven IMGs in all. Smaller states can matter more than their size suggests: Kansas placed 5 non-U.S. IMGs in 14 positions, and New Mexico placed 5 in 16.

U.S. citizen IMGs were even more concentrated. New York (38) and Florida (36) placed 74 of the 177, or 42%.

The strongest caveat: a state total tells you where IMGs matched last cycle, not which program will interview you or sponsor your visa. These are counts, not a list of IMG-friendly programs. Confirm every program's requirements on its own website.

A third of psychiatry's empty seats were in Florida

Florida had 21 of psychiatry's 65 unfilled positions after the 2026 algorithm ran. Alabama and Oklahoma had 6 each, New York 5, and Arizona, West Virginia and Wisconsin 4 each, according to the same NRMP state report.

The NRMP's release does not say why unfilled positions jumped. The rise came in the same year psychiatry added 30 programs and 128 positions. Across all specialties, 2,862 positions were unfilled after the algorithm, and 2,581 of them were offered through the Supplemental Offer and Acceptance Program (SOAP). SOAP outcomes by specialty are in the NRMP's Results and Data report, published May 26, 2026. For every specialty's unfilled count, see unfilled residency positions by specialty in the 2026 Match.

Psychiatry still leans on IMGs, but programs screen hard

The workforce case for IMGs is long-standing. In 2020 AMA data, IMGs made up 29% of active U.S. psychiatrists, compared with 23% in other specialties, and more than 40% in Florida and New Jersey, according to a 2022 study in Academic Psychiatry (doi:10.1007/s40596-022-01635-y).

Getting an interview is the hard part. In the NRMP's 2026 Program Director Survey, psychiatry was among the five specialties receiving the highest mean number of applications. Across specialties, program directors most often cited the Step 2 CK score (89%), a Step 1 pass (87%) and specialty-specific letters of recommendation (86%) when choosing whom to interview.

For IMG applicants, 92% of responding programs required Step 1 and 84% required Step 2 CK before considering an interview. Among programs requiring Step 2 CK, 32% set a target score for IMGs. Read these figures with care: only 12.7% of programs responded overall, and 50 of the 433 psychiatry program directors surveyed did.

The best specialty-specific benchmarks are in the NRMP's July 28, 2026 Charting Outcomes reports. For the first time there are separate reports for non-U.S. citizen IMGs and U.S. citizen IMGs, and the NRMP says they will now be published every year. Check the psychiatry pages for measures such as the Step 2 CK score and the number of contiguous psychiatry ranks.

The 2027 Match calendar, hour by hour

If you are applying in the current cycle, these are the NRMP's 2027 applicant dates. Times are Eastern.

What to do now: a psychiatry checklist for IMGs

1. Check your ECFMG verification status. IMGs must complete the medical science examination, clinical skills and communication skills requirements by March 3, 2027. The NRMP says IMGs who miss that deadline cannot participate in the Match, and the same verification applies to SOAP.
2. Re-register if you were in a past Match. Past participants must register again for the 2027 Match, the NRMP's September 2026 IMG newsletter says.
3. Filter by visa first. The NRMP says non-U.S. citizen applicants who need a visa are responsible for confirming that an institution will sponsor their visa type before certifying a rank order list. Check each program's website. For immigration questions, talk to an immigration attorney or the official agency.
4. Look at geography honestly. If every psychiatry program on your list is in a state that placed few IMGs in 2026, research programs in other states too, then confirm their policies one by one.
5. Rank only programs you would attend. The NRMP tells applicants to rank only programs they would be willing to attend, and to be ready to enter training wherever a match occurs. Our guide to NRMP Match rules and the binding commitment explains what that means.
6. Prepare for SOAP before Match Week. Only eligible unmatched and partially matched applicants can use SOAP, and the List of Unfilled Programs appears at the start of SOAP showing only programs you are eligible for. Applicants who are not SOAP-eligible may not contact SOAP programs. See how the SOAP List of Unfilled Programs works.
7. If you are not in this cycle, build for the next one. Use the Charting Outcomes psychiatry data to set your targets, gather new psychiatry letters, and get hands-on U.S. clinical experience where you can. MedRise arranges U.S. clinical observerships for IMGs in South Texas in internal medicine, pediatrics and family medicine.

For the 2025 cycle's version of this guide, see what to do if you didn't match into psychiatry as an IMG.

Psychiatry is growing, and non-U.S. IMGs are getting a bigger slice of it. That slice is not spread evenly, so check where IMGs actually matched before you certify your list on March 3.

FAQ

How many IMGs matched into psychiatry in 2026?

399 in all: 177 U.S. citizen IMGs and 222 non-U.S. citizen IMGs, out of 2,451 filled psychiatry positions, according to the NRMP's Advance Data Tables.

Is psychiatry a good specialty for IMGs?

IMGs filled about 16% of psychiatry positions in 2026, but the share was 33% in Florida and 6% in California. There is no specialty-wide answer; check each program's own requirements and recent residents.

Which states matched the most IMGs into psychiatry in 2026?

For non-U.S. citizen IMGs: New York (51), Texas (26) and Florida (21). For U.S. citizen IMGs: New York (38) and Florida (36).

When is the 2027 rank order list deadline?

March 3, 2027, at 9 p.m. Eastern. IMGs must also meet ECFMG verification requirements by then to take part in the Match.

Can IMGs take part in SOAP?

Yes, if they are SOAP-eligible: unmatched or partially matched applicants who meet the eligibility requirements, including ECFMG verification by the rank order list deadline.

Sources

• NRMP, Advance Data Tables: 2026 Main Residency Match (March 2026)
• NRMP news release on the 2026 Main Residency Match results (March 20, 2026)
• NRMP, Main Match Results by State, Specialty and Applicant Type 2026
• NRMP, Results and Data: 2026 Main Residency Match (May 26, 2026)
• NRMP, 2026 Program Director Survey report (August 2026)
• NRMP, Charting Outcomes for non-U.S. citizen IMGs, 2026 Main Residency Match (July 28, 2026)
• NRMP, 2027 Main Residency Match applicant calendar
• NRMP, IMG Welcome Newsletter (September 8, 2026) and eligibility requirements
• NRMP, Supplemental Offer and Acceptance Program
• Duvivier RJ, et al. International Medical Graduates in the United States Psychiatry Workforce. Academic Psychiatry, 2022 (PubMed; doi:10.1007/s40596-022-01635-y)

MedRise Articles share educational information only. They are not medical, legal or immigration advice. Confirm requirements with the official organization or program.

2026 match rates by applicant type

What the numbers mean for non-U.S. IMGs

• More applicants, barely more matches. 11,944 non-U.S. IMGs certified rank order lists, 479 more than in 2025, but only 80 more matched (6,733 in all).
• Visa status made a big difference. Non-U.S. IMGs who needed visa sponsorship matched at 54.4%, a five-year low; the high for this group was 59.1% in 2023. Foreign-born IMGs who are U.S. permanent residents matched at 67.9%, a five-year high.
• Your share of the seats. Non-U.S. IMGs filled 16.4% of PGY-1 positions, and U.S. IMGs 7.2%.

What the numbers mean for U.S. citizen IMGs

Fewer U.S. citizen IMGs applied (4,210, down 377) and 2,949 matched, but the match rate rose to 70.0%, a record. After SOAP, 77.8% had a position.

Where the positions are

• Internal medicine: 11,632 positions, 95.2% filled, down 1.6 points.
• Family medicine: 5,491 positions, 83.6% filled, leaving 899 unfilled before SOAP.
• Pediatrics: 3,185 positions, 94.4% filled.
• Emergency medicine: 3,198 positions, 95.6% filled, down 2.3 points.
• Psychiatry: 2,516 positions, 97.4% filled; unfilled positions rose from 8 to 65.

See every specialty with open positions in unfilled residency positions by specialty: 2026 Match data.

What to do now for the 2027 Match

1. Know the 2027 dates. Standard NRMP registration runs until January 29, 2027. Rank order lists open February 1 and must be certified by March 3, 2027, at 9 p.m. ET. Match Week runs March 15 to 19, and Match Day is Friday, March 19, 2027.
2. Finish ECFMG requirements by March 3, 2027. IMGs must meet ECFMG's verification requirements by the rank order list deadline to take part in the Match.
3. Use real score data. Check the NRMP's Charting Outcomes reports for non-U.S. IMGs and U.S. IMGs (July 2026) for your specialty instead of averages quoted on social media.
4. If you need a visa, filter your list first. Confirm on each program's own website that it sponsors the visa you need before you spend an application on it.
5. Rank in true order of preference. The NRMP advises ranking programs in the order you actually prefer them, not where you think you will match.
6. Prepare for SOAP before Match Week. Read the NRMP's SOAP rules and have your documents ready, so a Monday surprise does not cost you the week.

For last year’s results, see 2025 NRMP Match results: what they mean for IMGs.

How MedRise can help

MedRise offers CV advisory, interview coaching and the Residency Rescue Package for IMGs and reapplicants, and U.S. clinical observerships in South Texas. You can start with a free 10-minute call.

Frequently asked questions

Did IMGs match at a higher rate in 2026?

It depends on citizenship. U.S. citizen IMGs rose to 70.0%, a record. Non-U.S. citizen IMGs fell to 56.4%, a five-year low.

Which specialty had the most unfilled positions in 2026?

Family medicine, with 899 positions unfilled after the matching algorithm ran, before SOAP.

When is Match Day 2027?

Friday, March 19, 2027. The rank order list certification deadline is March 3, 2027, at 9 p.m. ET.

Sources

• NRMP, Match by the Numbers: 2026 Main Residency Match (March 2026)
• NRMP news release on the 2026 Main Residency Match results (March 20, 2026)
• NRMP, 2026 Main Residency Match outcome reports (May 26, 2026)
• NRMP, Advance Data Tables: 2026 Main Residency Match (March 2026)
• NRMP, 2027 Main Residency Match applicant checklist

MedRise is not affiliated with the NRMP, ECFMG, Intealth, the AAMC or ERAS. Figures come from the NRMP's public reports and are for education only; check the NRMP for official data. This is not legal or immigration advice, and no outcome is promised.

The 2026 Match at a glance

Positions grew faster than matches. Total positions rose 2.6% from 2025, while the number of filled positions rose 1.8%. That gap is why a record-size Match still left more seats open than the year before.

Which specialties had the most unfilled positions

These are PGY-1 positions left open after the algorithm ran and before SOAP began.

Advanced and reserved positions were nearly full. Of 2,864 PGY-2 positions, 35 went unfilled, 17 of them in diagnostic radiology. Of 354 physician-only (R) positions, 55 went unfilled.

Specialties that filled every PGY-1 position

Anesthesiology (1,865 positions), orthopedic surgery (963), medicine-pediatrics (404), neurological surgery (280), physical medicine and rehabilitation (253), vascular surgery (110), thoracic surgery (56) and dermatology (31 PGY-1 positions) filled every PGY-1 seat. Categorical general surgery left 3 of 1,807 open and OB/GYN 2 of 1,638. Dermatology left 1 of its 546 PGY-2 positions open.

What changed from 2025

• Family medicine added 134 positions, to 5,491, but its fill rate fell from 85.0% to 83.6%. The NRMP says more applicants matched into family medicine than the year before, and it plans a Blue Ribbon Panel on the specialty in 2026.
• Internal medicine, counting all the tracks the NRMP groups together (11,632 positions), filled 95.2%, down 1.6 points.
• Emergency medicine filled 95.6%, down 2.3 points from 97.9% in 2025.
• Psychiatry added 30 programs and 128 positions. Its unfilled positions rose from 8 to 65.

Where the unfilled positions went: SOAP

Unfilled positions in participating programs move into the Supplemental Offer and Acceptance Program (SOAP) during Match Week. The NRMP's full results report, released May 26, 2026, says 2,851 positions were offered in SOAP and 2,632 were filled, bringing the combined Match and SOAP fill rate to 99.3%. (The NRMP's Match Day news release gave a lower SOAP figure, 2,581; this article uses the later full report.)

So a position that is unfilled on the Monday of Match Week is usually filled by the end of that week. If you go unmatched, SOAP is your main window, and it moves fast. Our guide to SOAP walks through the week.

Why some positions go unfilled

This part is MedRise's analysis, not an NRMP finding.

• A preliminary year is a different product. Preliminary surgery and medicine are one-year positions. Many applicants rank them only as a backup, and a preliminary year does not come with a categorical spot afterward.
• Growth can outpace interest. Family medicine and psychiatry have been adding positions quickly. When positions grow faster than applicant interest, more stay open.
• Eligibility narrows the field. Visa sponsorship, graduation-year limits and score cutoffs mean that many applicants cannot apply to a given open program, even when it has seats.

What this means for the 2027 Match

• Know the 2027 dates. Standard NRMP registration runs until January 29, 2027. Rank order lists open February 1 and must be certified by March 3, 2027, at 9 p.m. ET. Match Week runs March 15 to 19, and Match Day is Friday, March 19, 2027.
• IMGs: finish ECFMG requirements on time. To take part, international medical graduates must meet ECFMG's verification requirements by the March 3, 2027 rank order list deadline.
• Rank a backup you would really attend. Family medicine, internal medicine and pediatrics had the most open categorical positions. If a preliminary or transitional year is part of your plan, know how you would reach a PGY-2 or categorical spot afterward.
• Get ready for SOAP before Match Week. Have your application documents and letters final, and read the NRMP's SOAP rules and eligibility now rather than on Monday of Match Week.

For the applicant side of the same data, including match rates for U.S. and non-U.S. IMGs, see 2026 NRMP Match results: what they mean for IMGs.

For the same breakdown from the year before, see what specialties had unfilled positions in the 2025 Match.

Sources

• NRMP, Advance Data Tables: 2026 Main Residency Match (March 2026)
• NRMP, Match by the Numbers: 2026 Main Residency Match (March 2026)
• NRMP news release on the 2026 Main Residency Match results (March 20, 2026)
• NRMP, 2026 Main Residency Match outcome reports, including SOAP results (May 26, 2026)
• NRMP, 2027 Main Residency Match applicant checklist

MedRise is not affiliated with the NRMP, ECFMG, Intealth, the AAMC or ERAS. Figures come from the NRMP's public reports and are for education only; check the NRMP for official data. This is not legal or immigration advice, and no outcome is promised.

For medical students and residents, this is not just a tech story. It is a training story. The AI arriving on the wards in the next few years will draft notes, help plan radiation and guide surgical robots, and someone will have to check its work. That someone is you.

From gaming chips to the operating room

At its GTC conference in San Jose, NVIDIA launched what it called the first domain-specific physical AI platform for healthcare robotics, according to NVIDIA's announcement as reported by GamesBeat. Three pieces matter:

• Open-H: more than 700 hours of surgical video gathered with about three dozen collaborators. NVIDIA calls it the largest healthcare robotics dataset.
• Cosmos-H: models that generate realistic surgical video from text prompts, images or robot motion data, so a robot can rehearse on synthetic cases before it ever meets a patient.
• GR00T-H: a vision-language-action model, trained on Open-H, that converts a text command describing a clinical task into robot movement.

This is already more than a demo. CMR Surgical, which contributed most of the surgical data in Open-H, is using Cosmos-H simulation to train and validate robotic intelligence for its Versius system before clinical deployment. Johnson & Johnson MedTech is using Isaac Sim and Cosmos-based workflows to train and validate its Monarch Platform for Urology, according to NVIDIA's robotics press release.

The $1 billion bet on drug discovery

The surgery news followed a January splash. At the J.P. Morgan Healthcare Conference, NVIDIA announced a joint research lab with Eli Lilly, with $1 billion committed over five years for compute, talent and infrastructure, plus a collaboration with Thermo Fisher Scientific on autonomous laboratories, TechRepublic reported. NVIDIA also told the room that U.S. healthcare is adopting AI at nearly three times the pace of the broader economy. That is the company's own claim, not an independent measurement.

Berlin: AI that designs proteins and plans radiation

Then, on October 21, NVIDIA went further at GTC Berlin. In its announcement, the company unveiled:

• RFD4-Proteina, an open BioNeMo model built with the UW Medicine Institute for Protein Design that lets scientists and AI agents design and refine new proteins against chosen goals.
• A radiotherapy partnership with Siemens Healthineers, which is exploring NVIDIA's Nemotron models to help oncologists evaluate and refine treatment plans and plans to use NVIDIA Holoscan to adapt treatment in real time.
• AI scribes and clinical assistants in Europe, as companies including Corti, Dedalus and Sword build on Nemotron.

Kimberly Powell, NVIDIA's vice president of healthcare, framed it plainly: “Agentic and physical AI are opening new possibilities across medicine.”

Who is actually using this?

NVIDIA's own State of AI in Healthcare and Life Sciences survey, published in February, found that 70% of respondents were actively using AI, up from 63% in the previous survey. Generative AI use jumped to 69% from 54%, and 47% said they were using or assessing AI agents. The company says the report draws on more than 600 industry respondents.

Read the fine print, though. The survey comes from the company that sells the hardware, the answers are self-reported, and the respondents are industry professionals, not a random sample of hospitals. It shows direction, not proof that patients are better off.

Washington wants AI agents too

The agent idea has reached Medicare. At the HIMSS conference in Las Vegas in March, CMS Administrator Dr. Mehmet Oz said the agency had discussed giving an agentic AI tool to every Medicare beneficiary, Nextgov reported. Not everyone is sold. NPR reported that critics, including a University of Minnesota rural health researcher, warned that AI avatars for rural care could erode trust and turn rural patients into test subjects for unproven technology.

The catch: AI can be confidently wrong

Medicine has seen this movie. A widely used proprietary sepsis model, tested independently at Michigan Medicine, reached an area under the curve of just 0.63 and missed 67% of patients who developed sepsis (Wong et al., JAMA Internal Medicine, 2021). It was already in wide use. Faster chips do not fix a model that was never tested on patients like yours.

What it means if you are in training

1. AI will draft; you will verify. Catching the anchoring error, the missed red flag or the bad drug interaction in an AI draft is clinical reasoning, and it is the skill that makes the tool safe.
2. Ask who built it. NVIDIA supplies models and infrastructure. The device maker or software vendor is responsible for the clinical product, and you should know whether it is FDA-cleared for the use in front of you.
3. Learn the robot's limits. Systems trained partly on synthetic video will reach operating rooms. Know what a system was trained on and how to take over when it misbehaves.
4. New careers are opening. Clinical informatics and imaging AI need clinicians who speak both languages. Our guide to AI in medicine covers the informatics pathway.

Cheat sheet: NVIDIA's healthcare names

Definitions are based on NVIDIA's description of its Clara platform and the 2026 announcements above.

What to watch next

• Whether robots trained partly in simulation win regulatory clearance for new tasks.
• Whether CMS turns the beneficiary AI-agent idea into a formal pilot, and what safeguards come with it.
• NVIDIA's next GTC in San Jose, which the company usually holds in March. Find AI and informatics meetings on the MedRise conference list.

NVIDIA is building the machines. Medicine still needs people who can tell when the machine is wrong. You can practice that skill now with MedRise Viva.

MedRise is not affiliated with NVIDIA, CMS or any company named here, and this article is not sponsored. It is education only and is not medical or legal advice.

In short: There were 2,473 unfilled residency positions in the 2025 Match (before SOAP), with a handful of specialties contributing the bulk. Family Medicine — again — led the field. But several competitive fields saw tiny gaps too. Let’s break down what’s happening, and why this matters for next-cycle applicants.

📊 Overall Snapshot & Context

• In 2025, 43,237 positions were offered, of which 40,041 were PGY-1 slots.

• After the matching algorithm (before SOAP), 40,764 positions were filled, leaving 2,473 unfilled.

• With SOAP cleanup, the final fill rate (Match + SOAP) was 99.4 % of available positions.

• The unfilled count (2,473) decreased by 89 from 2024 (i.e., fewer unfilled slots year over year).

So while “unfilled slots” still exist, they’re becoming rarer — but their distribution is not uniform across specialties.

🏥 Which Specialties Had Notable Unfilled Positions?

Here is a specialty-by-specialty summary of fields with unfilled slots, (These are real numbers derived from the NRMP tables.)

A few additional observations:

• Orthopedic Surgery and Plastic Surgery had zero unfilled slots.

• Internal Medicine had 357 unfilled slots, though the fill rate was still high (96.8 %).

• Obstetrics‒Gynecology (OB/GYN) had 10 unfilled spots total (1 categorical + 9 preliminary).

🔍 Why Do Some Specialties Leave Spots Unfilled?

1.

Expansion of positions / overshoot vs interest

Some fields, particularly primary care (family medicine, internal medicine, pediatrics), keep expanding their positions to address workforce shortages. If applicant interest doesn’t scale proportionally, gaps appear.

• Family Medicine added 144 slots this year but filled only 85 % — leading to 805 vacancies.

• Internal Medicine (categorical and primary-care tracks together): 11,352 positions offered, 10,984 filled, fill rate 96.8%.

2.

Perceived prestige, compensation, lifestyle tradeoffs

Many applicants avoid fields seen as less “glamorous” or financially rewarding, even when those fields deeply need providers (e.g. family medicine).

3.

Mismatch between applicant pool and specialty demands

Certain specialties require very high academic metrics, research experience, or strong clinical exposure. If the applicant pool doesn’t match, programs may leave positions unfilled.

4.

Geographic / program location deterrents

Positions in less desirable locations are more likely to be unfilled, especially in rural or underserved areas.

5.

SOAP and last-minute bidding dynamics

Some unfilled positions are “rescued” by SOAP, but not all. Most specialties with unfilled slots rely heavily on SOAP to close gaps.

🎯 Strategic Takeaways for Applicants (Especially IMGs & Late Deciders)

• If you’re flexible, target specialties with gaps (family medicine, internal medicine) — you may find more opportunity and less barrier.

• Don’t auto-skip primary care: the “competition advantage” can sometimes favor those willing to commit.

• Quality still matters: Just because a specialty has unfilled slots doesn’t mean credentials don’t matter. Programs will still pick the best candidates.

• Leverage SOAP wisely: Many of these unfilled positions move into SOAP—be strategic in eligibility and application timing.

• Geography is a factor: Be willing to go off the beaten path (rural, underserved) to gain access to slots that urban programs reject.

Why is the patient here?

1. Postmenopausal bleeding (PMB) → go to A

2. Premenopausal AUB (esp. ≥45, or <45 with risk factors) → go to B

3. Incidental thickened endometrium on imaging → go to C

A) POSTMENOPAUSAL BLEEDING (always cancer until proven otherwise)

A1. Stabilize if needed → then evaluate.

A2. First test (stable):

• TVUS to measure endometrial stripe or office endometrial biopsy (EMB).

  • Exams accept either as initial; know the 4‑mm rule.

A3. TVUS result → action

• ≤4 mm: low risk → no immediate biopsy; treat likely atrophy. Recurrent/persistent bleeding → EMB.

• >4 mm or poor visualization → EMB.

• On tamoxifen with bleeding → EMB regardless of stripe.

A4. EMB result

• EIN / atypical hyperplasia → Definitive: hysterectomy (if done with childbearing) or high‑dose progestin/LNG‑IUD if fertility desired or poor surgical candidate.

• Carcinoma → go to E (Stage & Treat).

• Insufficient/negative but bleeding persists → hysteroscopy ± D&C (target focal lesions).

B) PREMENOPAUSAL AUB (who needs biopsy?)

**B1. Who gets an EMB first?

• Age ≥45 with AUB.

• <45 with risk: obesity, PCOS/chronic anovulation, unopposed estrogen (ET‑only HRT), tamoxifen use, Lynch syndrome, early menarche/late menopause, nulliparity.

• Red flags: intermenstrual bleeding, postcoital bleeding, refractory bleeding.

B2. If not high‑risk and stable:

• Start with medical AUB mgmt (e.g., OCPs/LNG‑IUD). Persistent AUB → EMB.

B3. EMB positive → go to E.
EMB negative but persistent AUB → hysteroscopy ± D&C.

C) INCIDENTAL THICKENED ENDOMETRIUM

C1. Asymptomatic postmenopausal, stripe >4 mm: no automatic biopsy; observe unless bleeding/risk.
C2. Tamoxifen, no bleeding: no routine screening; biopsy only if bleeding.

D) PATH BASICS (know the types)

• Type I (endometrioid): estrogen‑driven, often from EIN; better prognosis; PTEN/MMR defects common.

• Type II (serous/clear cell/carcinosarcoma): p53‑abnormal, aggressive, atrophic background; treat more like high‑risk.

E) CONFIRMED CANCER → STAGE & TREAT

E1. Staging is surgical

• TAH‑BSO + sentinel lymph node mapping (or pelvic/para‑aortic LND per risk) ± omentectomy for serous/clear cell; peritoneal washings.

E2. FIGO stage (core ideas)

• I: confined to uterus (IA <50% myometrial; IB ≥50%).

• II: cervical stroma.

• III: serosa/adnexa/vagina/nodes.

• IV: bladder/bowel mucosa or distant.

E3. Adjuvant therapy (pattern you must know)

• Stage IA, grade 1–2, no LVSI (endometrioid) → observe or vaginal brachy (institutional).

• Stage IA grade 3 or LVSI; Stage IB–II (endometrioid) → vaginal brachy ± pelvic RT; select chemo (carbo/paclitaxel) if higher risk.

• Node‑positive / Stage III–IV or Type II histology → chemo (carbo/paclitaxel) ± pelvic/para‑aortic RT.

• Type II (serous/clear cell) even at earlier stage often gets chemo ± RT.

E4. Fertility‑sparing (high‑yield nuance)

• Only if: Grade 1 endometrioid, confined to endometrium (no myometrial invasion on MRI/hysteroscopic mapping), no metastasis, patient strongly desires fertility.

  • High‑dose progestin (megestrol) or LNG‑IUD, close surveillance q3–6 mo with repeat sampling. Definitive hysterectomy after childbearing.

E5. Lynch syndrome (MMR/MSI)

• Universal tumor testing recommended.

• Proven carriers: counsel for risk‑reducing hysterectomy/BSO after childbearing; earlier colon screening.

“FIRST vs BEST NEXT STEP” CALL‑OUTS

• PMB (stable): TVUS (≤4 mm = observe) or EMB; >4 mm or recurrent bleeding → EMB.

• AUB age ≥45 or <45 with risk → EMB first (don’t “just give OCPs”).

• Visible focal lesion or inadequate sampling with ongoing bleeding → Hysteroscopy ± D&C.

• Confirmed carcinoma → Surgical staging (TAH‑BSO + nodes), not “chemo first,” unless unresectable/advanced.

• Young G1 endometrioid, no invasion → Progestin therapy if fertility desired.

NBME TRAPS & REVERSALS

• Pap smear doesn’t diagnose endometrial cancer. EMB is the test.

• 4‑mm rule (postmenopause): ≤4 mm → observe; >4 mm → biopsy.

• Tamoxifen + bleeding → biopsy regardless of stripe.

• Asymptomatic thick stripe on tamoxifen → no automatic biopsy.

• PCOS/obesity/anovulation = unopposed estrogen → biopsy threshold is lower.

• CA‑125 is not a diagnostic test for endometrial cancer (can be prognostic/advanced disease monitoring).

• Staging is surgical, not clinical (contrast with cervical).

• EIN/atypical hyperplasia: definitive hysterectomy once fertility complete; progestin/LNG‑IUD if preserving fertility.

Patient context?

1. Screening/incidentally abnormal test → go to A

2. Symptoms or visible cervical lesion (postcoital bleeding, malodorous discharge, pelvic pain; friable/exophytic cervix on speculum) → go to B

A) SCREENING & ABNORMAL RESULTS (Risk‑based logic)

A1. Age & routine screening (asymptomatic)

• 21–29: cytology (Pap) q3y. U.S. Preventive Services Task Force

• 30–65: choose primary hrHPV q5y, cotest q5y, or cytology q3y. U.S. Preventive Services Task Force

• >65 with adequate prior negative screens & not high‑risk → stop screening. U.S. Preventive Services Task Force

• Post‑hysterectomy for benign disease & no CIN2+ history → no screening. (USPSTF text). U.S. Preventive Services Task Force

• Immunocompromised (e.g., HIV) → screen more frequently per specialty guidance (risk‑based; test writers expect closer surveillance). (ASCCP risk framework). Lippincott Journals

A2. Abnormal screening result → manage by immediate CIN3+ RISK (ASCCP 2019):

• ≥60% → Expedited treatment preferred (excisional, e.g., LEEP) if ≥25yo & not pregnant. Classic: HPV‑16+ HSIL, or underscreened with HPV+ HSIL. (First step vs best next step: if classic scenario → go straight to excisional treatment; do NOT wait for colpo biopsy.) PMCACOG

• 25–<60% → Expedited treatment OR colposcopy acceptable (shared decision‑making). ACOG

• 4–<25% → Colposcopy. PMC

• 0.55–<4% (5‑yr risk) → Repeat test in 1 yr. PMC

• 0.15–<0.55% (5‑yr risk) → Repeat in 3 yrs. PMC

• <0.15% (5‑yr risk) → Return to routine screening. PMC

Pearls

• Pregnant: No endocervical curettage; defer treatment of CIN to postpartum unless cancer suspected. (ASCCP principles). Lippincott Journals

• Vaccination: Routine at 11–12 (start as early as 9). Catch‑up through 26; 27–45 via shared clinical decision‑making. (Vaccine status does not change current screening intervals for adults on exams.) CDC+1

B) SYMPTOMS / VISIBLE LESION (Diagnosis → Staging → Treatment)

B1. First step

• Speculum exam. If a visible suspicious cervical lesion → immediate biopsy (don’t “Pap first”). (NBME trap: do not order Pap when a cancerous‑appearing lesion is present—biopsy it.)

B2. Confirmed invasive carcinoma → FIGO staging (clinical + imaging allowed since 2018)

• Key 2018 changes: imaging/pathology can assign stage; IB subdivided by size; nodal disease = IIIC. Obstetrics & GynecologyPMC

B3. Initial work‑up after biopsy shows cancer

• Pelvic exam (parametria/vaginal involvement), MRI pelvis (local extent), CT chest/abdomen/pelvis or PET/CT(nodes, mets), CBC/CMP; pregnancy test if relevant. (NCCN work‑up). PubMed

B4. Definitive management by stage (NCCN/FIGO‑aligned)

• Stage IA1 (stromal invasion ≤3 mm deep; FIGO 2018 no longer uses lateral width)

  • No LVSI & fertility desired: conization with negative margins.

  • No LVSI & no fertility: simple hysterectomy.

  • LVSI+: consider modified radical hysterectomy + nodal assessment (SLN mapping/pelvic LND). NCCNPubMed

• Stage IA2 (3–5 mm depth)

  • Radical hysterectomy + pelvic nodes or radical trachelectomy + nodes if tumor ≤2 cm and fertility desired. NCCN

• Stage IB1 (<2 cm) / IB2 (2–3.9 cm)

  • Radical hysterectomy + nodes or radical trachelectomy (≤2 cm, node‑neg) vs primary chemoradiationdepending on size/comorbids. PubMed

• Stage IB3 (≥4 cm) or IIA2

  • Primary concurrent chemoradiation (weekly cisplatin + EBRT + brachytherapy). (NBME: ≥4 cm or parametria involved → choose chemoradiation, not primary surgery.) PubMed

• Stage IIA1 (≤4 cm, upper 2/3 vagina, no parametria)

  • Either radical hysterectomy + nodes or chemoradiation (institutional practice). PubMed

• Stage IIB (parametrial), III (pelvic wall, lower vagina, hydronephrosis), IIIC (node+), IVA (adjacent organs)

  • Concurrent chemoradiation. PubMed

• Stage IVB / recurrent/metastatic

  • Systemic therapy (e.g., platinum/taxane ± bevacizumab, and PD‑1 inhibitors for PD‑L1+; tisotumab vedotin options). Palliative radiation for bleeding/pain. (Know that immunotherapy/bevacizumab exist; you won’t be quizzed on lines/doses.) JNCCN

B5. Adjuvant therapy after surgery (high‑risk pathology)

• Positive margins, nodes, parametria → adjuvant chemoradiation.

• Intermediate‑risk (Sedlis factors) → adjuvant radiation ± chemo per risk. (NCCN). PubMed

B6. Special situations

• Pregnancy: biopsy of visible lesion is safe; defer definitive treatment (for preinvasive/CIN) until postpartum; manage invasive cancer with multidisciplinary team (gestational age–dependent). (ASCCP/NCCN principles). Lippincott JournalsNCCN

• Post‑treatment surveillance: periodic pelvic exam; imaging if symptomatic/suspicious. (NCCN). NCCN

High‑Yield “First vs Best Next Step” Callouts

• Visible friable cervical mass → First step: punch biopsy (not Pap).

• ASC‑US in age 21–24 (classic exam framing) → Repeat cytology in 1 year, not immediate colpo (risk‑based systems concur with conservative management here). Lippincott Journals

• HSIL + HPV‑16 (nonpregnant, ≥25) → Best next step: expedited excisional treatment. PMC

• Tumor ≥4 cm or parametrial involvement → Best next step: concurrent chemoradiation (not radical hysterectomy). PubMed

NBME Traps & Reversal Drills

• Don’t Pap a cancer: visible lesion → biopsy now.

• No ECC in pregnancy; treat CIN postpartum unless cancer suspected. Lippincott Journals

• Post‑hysterectomy (benign, no CIN2+ history) → stop screening. U.S. Preventive Services Task Force

• HPV vaccine: great prevention, but doesn’t change adult screening intervals on exams; 27–45 is shared decision‑making, not routine. CDC

• Staging is clinical‑imaging (FIGO 2018); node+ = IIIC even if small primary. (Choose chemoradiation.)Obstetrics & Gynecology

The Step 2 CK passing standard rose to 218

The USMLE Management Committee announced on June 16, 2025, that examinees testing on or after July 1, 2025, need a 218 to pass, up from 214 (USMLE announcement). The committee reviews each exam's passing standard about once every four years. The current minimums are pass/fail for Step 1 (since January 26, 2022), 218 for Step 2 CK and 200 for Step 3 (USMLE scoring).

Because Step 1 is reported only as pass or fail, Step 2 CK is the main numeric score programs see. The minimum is a floor, not a target: competitive specialties expect scores well above it, so set your goal from your target specialty's match data, not the passing line.

Canadian graduates are now IMGs

The Liaison Committee on Medical Education (LCME) stopped accrediting Canadian schools on July 1, 2025, leaving the Committee on Accreditation of Canadian Medical Schools (CACMS) as the sole accreditor. People who graduate from a Canadian school on or after that date are IMGs for U.S. graduate medical education. To enter an ACGME-accredited residency they need ECFMG Certification (or a full, unrestricted license), and they need ECFMG Certification to be eligible for Step 3 (USMLE; ECFMG).

For the Match, the NRMP says these graduates must be verified as eligible by ECFMG. Canadian graduates from before July 1, 2025, are not IMGs and are verified by their school (NRMP).

Core prep resources

These are the resources most students build around. Only the NBME self-assessments come from the exam's co-sponsor.

• A main question bank such as UWorld or AMBOSS, done in timed, random blocks.
• NBME self-assessments, the official practice forms, to track your trend.
• A review book such as First Aid to fill content gaps.
• Spaced repetition with Anki, ideally tied to questions you missed.

A workable routine: question blocks every day, a review of every explanation, a log of missed concepts, and an NBME form at regular intervals. Let that trend tell you when you are ready, rather than fixing a number of weeks in advance.

Using AI tutors safely

AI chat tools can generate practice cases and explain answers, but they can also be confidently wrong. Use them to quiz yourself and to rephrase explanations, and check any fact you plan to rely on against your question bank or a standard reference.

For IMGs planning a residency application

• Start ECFMG Certification early; you must hold it, or be on track for it, to enter residency.
• Build U.S. clinical experience and collect U.S. letters of recommendation.
• Research each program's recent IMG and visa sponsorship history before you apply.

Related: 2026 Match results and what they mean for IMGs.

Educational information only. Check current rules with USMLE, ECFMG and the NRMP before you act.

For scale, the median first-year cost of attendance at private medical schools was about $103,000 in 2023–24, and the median four-year cost for the class of 2025 was about $391,000 at private schools and $286,000 at public schools (AAMC). Many students will face a gap the federal cap won't cover. A 529 education savings plan is one tool for part of it.

What a 529 plan covers

• School costs: tuition, required fees, books, supplies, required equipment and computers, and room and board for students enrolled at least half time. Earnings grow tax-free, and withdrawals for these costs are free of federal tax.
• Credentialing costs (new in 2025): the same law added "qualified postsecondary credentialing expenses," including fees for tests needed to earn a recognized license or certification, for withdrawals after July 4, 2025 (Saving for College). Whether a particular exam, such as a USMLE Step, qualifies depends on how it fits that definition. Confirm with your plan administrator or a tax professional before paying exam fees from a 529, and keep receipts.
• Student loans: up to $10,000 per beneficiary over a lifetime, plus up to $10,000 for each of the beneficiary's siblings (Saving for College).

State tax rules don't always follow federal changes, so check how your state treats newer expense types before you withdraw.

The Roth IRA rollover has strict limits

Since 2024, leftover 529 money can be moved into a Roth IRA, but only when every condition is met (Vanguard; Journal of Accountancy):

• The 529 account must have been open for at least 15 years.
• Contributions made in the last five years, and their earnings, can't be rolled over.
• The Roth IRA must belong to the 529 beneficiary, who needs earned income at least equal to the amount rolled over.
• Each year's rollover counts toward the annual IRA contribution limit, and the lifetime maximum is $35,000 per beneficiary.

So a 529 you open during medical school can't be rolled into a Roth for about 15 years. An account a parent opened for you as a child may already qualify.

If money is left over

You can change the beneficiary to another family member without tax or penalty, use up to $10,000 on student loans, or roll some into a Roth if the account qualifies. Withdrawals not used for qualified expenses are taxed on their earnings and usually face an extra 10% tax.

Getting started

• See whether your state gives a tax deduction or credit for contributing to its own plan before you choose an out-of-state plan.
• Compare fees; low-cost index options matter more the longer the money is invested.
• If you will need the money within a few years, choose a conservative investment option.
• Relatives can contribute directly. Large gifts can involve gift-tax rules, so ask a tax professional.

Related: Opinion: why the federal loan cap protects first-generation students.

Educational information only; not tax, legal or financial advice. MedRise is not a financial adviser. Talk to a qualified professional before acting.

At MedRise, we work at the intersection of medical education and healthcare workforce innovation. We believe this student loan reform is a necessary correction, not a form of exclusion.

The Real Crisis: Unlimited Loans, Unlimited Tuition, Unsustainable Debt

Under the Grad PLUS loan system, medical schools were free to charge any amount, knowing the government would fund it. The result?

• Median first-year tuition and fees at private medical schools reached about $72,700 in 2023–24, and the median four-year cost of attendance for the class of 2025 was about $391,000 at private schools (AAMC).

• Among 2024 graduates who borrowed, median education debt was $200,000, and the average at private schools was about $228,000 (AAMC).

• First-generation and low-income students bore the heaviest emotional and financial burdens.

This was never sustainable. The federal loan cap is not about restricting access—it’s about protecting access to funds and limiting student debt.

The Loan Cap Is a Step Toward Equity and Financial Health

Here’s how this cap benefits future doctors—especially those from underserved backgrounds:

• Encourages schools to lower tuition instead of shifting costs to vulnerable students.

• Reduces long-term interest payments and loan forgiveness reliance.

• Restores dignity and choice to primary care and public service careers.

First-generation students won’t have to mortgage their future to become physicians.

Busting the Myth: This Will Hurt Low-Income and First-Gen Students

Quite the opposite.

Capping federal loans means institutions must compete on value, not just amenities or prestige. Students still have access to:

• HRSA scholarship and loan repayment programs, such as the National Health Service Corps (Pell Grants are for undergraduates only; see Federal Student Aid)

• VA scholarships and loan repayment created or expanded by the 2018 VA MISSION Act

• Loan repayment programs for underserved service

• Private & nonprofit scholarships

• Tuition-for-service hospital partnerships

With smaller funding gaps and less bloat, these students can finish training with smaller balances and more financial security.

Where MedRise Fits

MedRise publishes practical guides on paying for medical school, including what a 529 plan can and can't do under the new cap.

Final Word: A Smarter Path to Medical Education Equity

This isn’t austerity—it’s sustainability.

This isn’t exclusion—it’s evolution.

The federal student loan cap for medical school is a smart, long-overdue reform that prioritizes the financial well-being of first-generation and low-income students.

The techniques below take seconds, need no materials and stay within those rules. Practice them during timed question blocks so they're automatic on test day.

1. Shift your focus near to far

Look away from the screen to the farthest point you can see for a few seconds, then back. Repeat three to five times. It gives your eyes a break from close focus. It won't raise your score by itself, but it is a quick cue to reset when you catch yourself rereading the same line.

2. Slow your breathing

Breathe in through your nose for about four seconds, pause briefly, then breathe out slowly for six to eight seconds. Do two or three cycles. A systematic review of slow-breathing studies found it increases heart rate variability and is linked to more relaxation and alertness and less anxiety (Zaccaro et al., 2018). Keep it slow and gentle; fast, deep breathing can lower carbon dioxide and leave you lightheaded.

3. Use a quiet tactile anchor

Touch your thumb to each fingertip in turn while counting silently, then reverse. It is a grounding technique that pulls attention back to the present. There is little research on it during exams, but it is quick and invisible to anyone else.

4. Answer an easier question next

If you're stuck and spiraling, mark the question, move on, answer one you can handle quickly, then come back. A fast win breaks the loop of rereading a hard stem. Watch the block clock so you return to every marked question.

5. Use a one-word cue

Pick a word such as "focus" or "next" and say it silently the moment you notice your mind wandering. A meta-analysis of 32 sports studies found self-talk interventions improved task performance with a moderate effect, and worked best when people practiced them beforehand (Hatzigeorgiadis et al., 2011). Those studies were in sport, not exams, so treat this as a reasonable tool rather than a sure thing.

6. The one-minute reset

When focus is badly slipping: sit up, rest your hands in your lap, look past the screen for ten seconds, take three slow breaths, then go on to the next question.

Pace in small chunks

Split each block into checkpoints, for example every 10 questions, and compare your time with the block clock. Use each checkpoint for a quick reset.

On scheduled breaks

• Drink water and eat a small snack with some protein.
• If you use caffeine, stick to the amount you're used to; test day isn't the time to try more.
• Stand up, move and look at something far away.

Related: Step 2 CK's passing score and core prep resources.

Educational information only; not medical advice. If anxiety or fatigue is affecting your exams, talk to your school's student support office or a clinician.

2025 NRMP Match Results: What They Mean for IMGs and Residency Applicants

The 2025 NRMP Main Residency Match concluded with historic participation — and new insights for future applicants, especially International Medical Graduates (IMGs).

At MedRise, we analyzed the latest NRMP data to give you the most accurate, practical advice for your 2026 and beyond applications.

2025 Match Key Statistics at a Glance

(Source: NRMP, Match by the Numbers: 2025 Main Residency Match)

• Registered applicants: 52,498

• Total positions offered: 43,237 (a record at the time)

• Positions filled: 40,764 (94.3% fill rate)

Match Rates:

• U.S. MD Seniors: 93.5% matched

• U.S. DO Seniors: 92.6% matched

• U.S. Citizen IMGs: 67.8% matched (up 0.8 points from 2024)

• Non-U.S. Citizen IMGs: 58.0% matched (down 0.5 points from 2024)

Match Trends IMGs Must Know

1. IMG Match Rates Improved — Slightly

• U.S. Citizen IMGs saw a 0.8% increase in match rates from 2024.

• Non-U.S. Citizen IMGs slipped 0.5 points while their applicant numbers rose 14.4%, so competition grew.

Interpretation:

There’s a slight upward trend for IMGs, but the match remains competitive. Strong application strategy is still essential.

2. Internal Medicine Remains IMG-Friendly — But More Competitive

• 11,352 Internal Medicine positions offered in 2025 (categorical and primary-care tracks together).

• 96.8% of IM positions filled overall.

Takeaway:

Internal Medicine continues to offer the largest number of opportunities for IMGs, but rising Step 2 CK expectations mean you must show clinical and interview strength.

3. Family Medicine and Pediatrics Are Key Opportunities

• Family Medicine had 5,357 positions offered — but only 85.0% filled.

• Pediatrics offered 3,193 positions — about 95% filled.

Important:

Both Family Medicine and Pediatrics showed lower fill rates, making them more accessible to IMGs and applicants with average or below-average scores.

4. Specialties Increasingly Rely on Step 2 CK

• Since Step 1 became Pass/Fail, Step 2 CK is the new primary metric.

For Step 2 CK score ranges of matched applicants by specialty, check the NRMP’s Charting Outcomes reports rather than averages quoted online.

Takeaway:

If your Step 2 CK is on the low side for your specialty, compensate with strong clinical experience (USCE), LORs, and interview skills.

How MedRise Helps You Succeed Despite the Competition

At MedRise, we deliver comprehensive, personalized support to maximize your chances of matching — no matter your background. Here’s what sets us apart:

1-on-1 Strategy Planning:

You’ll receive personalized match strategy sessions tailored specifically to your academic profile, career goals, visa status, and specialty interests. We don’t believe in one-size-fits-all advice — your path is uniquely designed around your strengths and opportunities.

U.S. Clinical Experience Coaching:

We guide you step-by-step in securing the right observerships, externships, and rotations that strengthen your application and demonstrate your readiness for U.S. medical practice. We focus on aligning your clinical experience with your target specialties.

CV and Personal Statement Optimization:

Your personal story matters. Our expert editors work with you to craft a CV and personal statement that meet the latest expectations of residency directors — highlighting your unique skills, resilience, and clinical readiness.

Mock Interview Preparation:

Our team conducts realistic mock interviews designed to simulate the real residency interview experience. You’ll receive honest, actionable feedback to help you answer difficult questions with confidence and professionalism.

Residency List Building:

We create a customized list of programs specifically matched to your academic metrics, visa needs, and specialty goals. Our recommendations are based on data — not guesswork — maximizing your chances of securing interviews and matching.

Visa Planning Support:

Navigating visa issues as an IMG can be complex. MedRise provides expert guidance on the differences between J-1 and H-1B visas, waiver options, and strategic planning to avoid common pitfalls that derail otherwise strong applications.

Important Disclaimer:

MedRise and its affiliates are independent educational consulting providers.

We are not affiliated with the National Resident Matching Program (NRMP), AAMC, or ERAS.

Data presented here is for educational purposes only and based on publicly available 2025 Match results.

Individual outcomes depend on applicant-specific factors, including scores, clinical experience, and overall application strength.

FAQs About the 2025 NRMP Match for IMGs

Q1: Is Internal Medicine still the best specialty for IMGs in 2025?

A:

Yes. Internal Medicine offers the highest number of positions of any specialty. However, Step 2 CK expectations have risen, so applicants must still present a strong overall package.

Q2: Can I match with a Step 2 CK score under 230?

A:

Yes — but it’s harder. Strong USCE, letters and interview performance matter more when scores are lower, and less competitive specialties and programs are more realistic targets.

Q3: How important is U.S. clinical experience (USCE) now?

A:

Critical. Programs want proof that you understand the U.S. healthcare system. Strong U.S. LORs and hands-on externships greatly boost your application, especially with lower scores.

Q4: Does MedRise help with securing U.S. clinical experience?

A:

Yes! MedRise offers guidance on securing the best observerships, externships, and rotations to strengthen your application, even helping with placement services depending on your specialty target.

Q5: When should I start preparing for the 2026 Match?

A:

Now. Most successful applicants start preparing 12-18 months before Match Day — focusing on Step 2 CK, USCE, networking, and personal statement development. MedRise offers complete Match prep packages customized to your timeline.

Looking for a U.S. observership? MedRise arranges U.S. clinical observerships for IMGs with physicians at teaching hospitals in South Texas, in internal medicine, family medicine and subspecialties. Applying is free.

Psychiatry draws more applicants than it once did, and many international medical graduates (IMGs) who apply don't match on their first try. Plenty reapply and succeed, and the path starts during Match Week itself.

During Match Week: SOAP

If you're eligible for the Supplemental Offer and Acceptance Program (SOAP), you'll see the NRMP's List of Unfilled Programs in the R3 system on Monday of Match Week, when match status is released. You can send up to 45 applications during SOAP, and programs make offers in rounds through R3; an offer you accept is a binding commitment (AAMC; NRMP).

One rule trips people up: neither you nor anyone acting for you may contact a SOAP program until the program contacts you after receiving your application (NRMP).

Psychiatry often has few unfilled positions, so consider preliminary or transitional-year positions and other specialties you would genuinely be willing to train in.

After SOAP ends

SOAP ends on Thursday of Match Week. The NRMP then posts a final List of Unfilled Programs in R3 for unmatched applicants, adding programs that didn't take part in SOAP, and you may contact those programs directly (NRMP calendar). The list is not public; copying or posting it violates the Match Participation Agreement (NRMP).

If you take a preliminary year

A preliminary internal medicine or transitional year keeps you in clinical training and gives you U.S. letters and experience. Openings to join psychiatry at the PGY-2 level come up only occasionally, so plan to reapply to categorical programs.

Strengthening your application for the next cycle

• Scores: Step 2 CK carries more weight now that Step 1 is pass/fail. Some applicants take Step 3 before reapplying to add another score, but a weak result can hurt, so take it only when you are ready.
• U.S. clinical experience in psychiatry: hands-on rotations or externships where possible, observerships otherwise, plus volunteer work in mental health or addiction settings.
• Letters: new letters from U.S. psychiatrists who supervised you.
• Personal statement: explain what you did during the gap and why psychiatry.
• Research and involvement: case reports or posters, and membership in groups such as the American Psychiatric Association.
• Program research: check each program's recent IMG and visa sponsorship history before you apply.

Related work while you reapply

Research assistant or coordinator roles in psychiatry departments, telehealth support roles and a master's in public health or clinical research can keep you close to the field and strengthen your application.

How MedRise can help

MedRise offers one-on-one reapplication support, including application and personal statement review, interview practice and a plan for the next cycle. Email admin@med-rise.com to schedule a free consultation.

Related: How the SOAP List of Unfilled Programs works.

Educational information only. Check current dates and rules with the NRMP and AAMC.

Looking for a U.S. observership? MedRise arranges U.S. clinical observerships for IMGs with physicians at teaching hospitals in South Texas, in internal medicine, family medicine and subspecialties. Applying is free.

The Ophthalmology residency match is one of the most competitive specialties, making it especially challenging for International Medical Graduates (IMGs). If you didn’t match in 2025, you are not alone! This guide will walk you through your next steps, alternative options, and strategies to improve your application for the next cycle.

Why Is Ophthalmology Difficult for IMGs to Match Into?

Ophthalmology is an extremely competitive specialty because:

✅ Limited Residency Positions: Only a few hundred ophthalmology positions are offered each year.

✅ High USMLE Scores Expected: Step 1 is now pass/fail, so programs lean on Step 2 CK, and matched applicants usually have high scores.

✅ Research Expectations: Programs prioritize applicants with ophthalmology-specific research.

✅ Few IMG-Friendly Programs: Most programs prefer U.S. medical graduates (USMGs).

If you didn’t match, don’t be discouraged! Let’s explore your options.

Next Steps After Not Matching in Ophthalmology

Step 1 – Check for Unfilled Ophthalmology Programs (SF Match & SOAP)

Unlike most residency programs, ophthalmology does not participate in NRMP. Instead, it uses SF Match.

🔎 Check the SF Match List of Unfilled Programs

• Go to SF Match and check for any open positions.

• Some programs may still accept applications after the official Match.

🚨 NRMP SOAP for Prelim/Transitional Year

• If you didn’t secure a PGY-1 year, you may be eligible for SOAP to apply for a preliminary or transitional position.

• Consider matching into Internal Medicine or Surgery prelim years, which may help with reapplying.

Step 2 – Consider an Alternative Specialty

If you’re open to other fields, here are some IMG-friendly specialties related to ophthalmology:

🔹 Neurology → Neuro-Ophthalmology

🔹 Pathology → Ocular Pathology

🔹 Radiology → Ocular Imaging

Applying to an alternative specialty now could allow you to pursue an ophthalmology fellowship later.

Step 3 – Strengthen Your Application for the Next Match Cycle

If you decide to reapply next year, here’s how to make your application stronger:

📚 Boost Your USMLE Scores

• A USMLE Step you have passed can't be retaken to raise the score. If your Step 2 CK is low for ophthalmology, put your effort into research, letters and U.S. clinical experience; passing Step 3 can also help some IMG applications.

📝 Gain More Ophthalmology Research Experience

• Work on case reports, publications, or clinical trials related to ophthalmology.

• Connect with ophthalmology researchers through ARVO, AAO, or PubMed.

👨‍⚕️ Do an Observership or Clinical Experience

• Look for U.S.-based ophthalmology observerships or externships.

• Some IMG-friendly programs allow hands-on research assistant positions.

📄 Improve Your Personal Statement & Letters of Recommendation

• Obtain strong letters from U.S. ophthalmologists.

• Highlight passion for ophthalmology, clinical skills, and research experience.

📍 Network with Ophthalmology Programs

• Attend AAO (American Academy of Ophthalmology) conferences.

• Reach out to program directors and ophthalmologists for mentorship.

Alternative Career Paths in Ophthalmology

If reapplying isn’t an option, consider alternative career paths in ophthalmology:

👁 Fellowships Without Residency

• Some countries offer direct entry ophthalmology fellowships.

📊 Ophthalmic Industry Roles

• Work in ophthalmic research, medical writing, or clinical trials.

📡 Telemedicine & AI in Ophthalmology

• Remote teleophthalmology jobs are expanding globally.

Key Takeaways – Moving Forward After Not Matching in Ophthalmology

✅ Check SF Match for unfilled spots

✅ Consider applying to SOAP for a PGY-1 position

✅ Gain more U.S. clinical experience & research

✅ Improve USMLE scores & application materials

✅ Explore alternative pathways in ophthalmology

💡 Pro Tip: Some applicants match on a later attempt after strengthening their application. Persistence and targeted improvements are key.

FAQ – Common Questions from IMGs Who Didn’t Match in Ophthalmology

Can I apply for SOAP if I didn’t match into ophthalmology?

Yes! If you need a PGY-1 year, you can apply for prelim or transitional year positions in SOAP.

What are the most IMG-friendly ophthalmology programs?

There is no official list. Check each program's website and SF Match listing for IMG eligibility and visa sponsorship, and look at whether its current residents trained abroad.

Should I do a research year before reapplying?

If your USMLE scores are low or you lack research experience, a research year in ophthalmology can improve your chances.

Final Thoughts – Keep Moving Forward!

Not matching into ophthalmology is not the end of your journey. Whether you reapply next year, consider an alternative specialty, or pursue a related career path, there are many ways to stay in ophthalmology.

📌 Need personalized guidance? Contact MedRise for residency consultation.

🔗 Related Resources:

👉 SF Match Unfilled Positions

👉 AAO Career Center

👉 ERAS Application Guide

Looking for a U.S. observership? MedRise arranges U.S. clinical observerships for IMGs with physicians at teaching hospitals in South Texas, in internal medicine, family medicine and subspecialties. Applying is free.

Who can see the list

Only applicants the NRMP deems SOAP-eligible can see it, and each sees only the programs they are eligible for based on their match status (NRMP). To be eligible you must be registered for the Main Residency Match, be unmatched or partially matched, and be eligible to start training on July 1; for IMGs that depends on ECFMG status by the NRMP's deadlines. If you didn't register for the Match, you can't see the list.

When it appears

The list opens in the NRMP's R3 system on Monday of Match Week, when applicants learn whether they matched. Applications open the same day; in 2026 the window ran from Monday, March 16, at 11 a.m. ET to Thursday, March 19, at 9 p.m. ET (AAMC).

How to apply

• Review the list in R3 and note the programs that fit.
• Apply through the application service the program uses, usually ERAS. You get 45 applications for all of SOAP, including programs you reapply to.
• Programs review applications, contact the applicants they want to interview and submit preference lists in R3. You don't rank programs.
• Offers arrive in rounds through R3. You can receive more than one offer in a round, and an offer you accept is a binding commitment (NRMP).

The contact rule

Neither you nor anyone acting for you, including advisers and consultants, may contact a SOAP program until the program contacts you after receiving your application (NRMP). The NRMP investigates reported violations.

After SOAP ends

SOAP ends on Thursday of Match Week. The NRMP then posts a final List of Unfilled Programs in R3 that adds programs that didn't participate in SOAP, and unmatched applicants may contact those programs directly (NRMP). In the 2024 cycle, the list stayed available until May 1 (NRMP 2024 schedule).

The list is never published on the NRMP's public website. Copying, sharing or posting it is a violation of the Match Participation Agreement (NRMP), so be wary of anyone offering "the full SOAP list."

If you don't get a position

Keep checking the post-SOAP list, contact programs directly, and start planning the next cycle with research, clinical experience or a preliminary year.

Related: Didn't match into psychiatry? Next steps.

Educational information only. Dates change every year; check the NRMP Match Week schedule and AAMC SOAP guidance for the current cycle.

1. Tailored Application Review

• MedRise experts thoroughly review your ERAS application to ensure it's optimized and tailored specifically for SOAP programs.

• Get personalized feedback and quick edits to your CV, personal statement, and other crucial application materials within hours.

2. SOAP Strategy Sessions

• Schedule one-on-one strategy sessions to identify your strengths and target the best-fit residency programs.

• Gain clarity on your SOAP strategy, including specialty choices and geographic flexibility.

3. Interview Preparation and Coaching

• Receive focused training to master the unique SOAP interview environment, which demands quick thinking and concise responses.

• Access practice sessions that simulate real SOAP scenarios, boosting your confidence and effectiveness.

4. Responding to Programs

• Under NRMP rules, neither applicants nor anyone acting for them may contact a SOAP program until the program reaches out after receiving the application (NRMP). We help you prepare for and reply to program contacts; we never contact programs for you.

• Assistance available in real-time to help you promptly respond to program inquiries, maximizing your chances of securing an offer.

5. SOAP Tracking Tools

• Utilize MedRise's custom-built SOAP tracking tools to stay organized, manage communications, and keep track of deadlines and program interactions seamlessly.

6. Continuous Guidance and Support

• Our team provides ongoing support and encouragement throughout the SOAP process.

• Benefit from our supportive community and mentors who've successfully navigated SOAP themselves.

Ready to talk? Email admin@med-rise.com

Don't leave your SOAP outcomes to chance. Contact MedRise today, and let us help you pursue a residency position.

Stay proactive, stay prepared—MedRise is here to ensure your success.

Step 1: Understand the SOAP Timeline Clearly

• Monday (Match Week): Receive notification about your Match status. SOAP positions become visible in ERAS. Begin applying immediately.

• Tuesday to Thursday: Programs review applications and extend offers.

• Friday: Final offers conclude. Remaining unmatched positions open to all.

Step 2: Optimize Your ERAS Application Immediately

• Update your CV: Highlight recent clinical experience, research, or volunteer work.

• Revise your Personal Statement: Tailor it specifically toward the programs and specialties you’re targeting in SOAP.

• Letters of Recommendation: Confirm that your letters are uploaded and reflect your strengths.

Medrise has packages available to help you navigate through SOAP. Email us today at admin@med-rise.com to create your custom package.

Step 3: Strategically Select Programs

• Prioritize applying to programs where you realistically meet or exceed their typical applicant profile.

• Be flexible: consider applying broadly across different geographical areas and related specialties to increase your odds.

Step 4: Perfect Your Communication Strategy

• Prepare concise, professional messages or emails to programs expressing genuine interest.

• Respond quickly and professionally if contacted—availability and responsiveness matter significantly during SOAP.

Step 5: Master Virtual Interviews

• Set up a distraction-free virtual environment.

• Prepare brief, impactful responses to common interview questions, such as your interest in the specialty, your qualifications, and your enthusiasm for their specific program.

Step 6: Stay Organized and Proactive

• Create a spreadsheet to track your applications, interviews, and program contacts.

• Regularly monitor ERAS and NRMP communications.

• Check your email frequently and respond promptly to any communication.

Step 7: Utilize Your Support Network

• Contact mentors, advisors, or peers who can offer guidance or advocate on your behalf.

• Engage with online communities and forums (such as Reddit or SDN) for real-time support and tips from others navigating SOAP.

SEO Keywords:

Match Day, SOAP, Supplemental Offer and Acceptance Program, ERAS application, unmatched residency applicants, residency match tips, navigating SOAP, medical residency positions, match week tips.

Final Thoughts

Navigating SOAP successfully requires quick action, strategic planning, and resilience. Remember, many residents find their perfect programs through SOAP each year. Stay positive, act decisively, and use every resource at your disposal—you've got this!

Good luck from the MedRise team!

Why Do Academic Dismissals Happen?

Academic dismissals in medical school typically occur due to a combination of academic, personal, or health-related issues that impact performance. Common reasons for dismissal can include:

• Failing grades or an inability to meet GPA requirements

• Inadequate performance on key exams, such as the USMLE Step 1 or 2

• Attendance or professionalism concerns

• Health challenges, including physical or mental health issues, that impact academic performance

Caribbean medical schools, while offering tremendous opportunities, also have distinct challenges that can impact student performance, including resource limitations, fast-paced schedules, and high expectations.

Step 1: Understand Your School’s Policies on Academic Dismissal

Each Caribbean medical school has its own set of policies and procedures for academic dismissals and appeals. The first step is to review the student handbook or academic policies to fully understand:

• The reasons for your dismissal

• The timelines and guidelines for filing an appeal

• Any specific requirements or documentation needed to submit an appeal

Often, schools provide a limited window to initiate an appeal, so it’s essential to act quickly. Familiarizing yourself with these guidelines helps you make informed decisions and navigate the process more effectively.

Step 2: Assess the Grounds for Your Appeal

When appealing a dismissal, it’s critical to present a strong case by addressing why the dismissal should be reconsidered. Some grounds for an appeal may include:

• Health or Personal Circumstances: Documented medical conditions or life events (e.g., illness, family issues) that impacted academic performance. Schools may be open to reconsidering dismissals if a health issue, especially one that has since been resolved, significantly affected your ability to succeed.

• Violation of Student Rights: If you believe you experienced unfair treatment or discrimination, especially regarding race, religion, or disability, this can form a legitimate basis for appeal. Collecting evidence and documenting incidents are crucial in this case.

• Lack of Adequate Support or Accommodations: If your school failed to provide necessary accommodations for a documented disability, this may strengthen your appeal. Check your student handbook for the school’s written accommodation policy and whether it was followed. Many Caribbean schools are accredited by international agencies such as ACCM or CAAM-HP rather than U.S. bodies, and whether U.S. disability law applies to a school outside the United States is a question for a lawyer.

• Academic Irregularities: If there were irregularities in the assessment or grading processes, or if your educational experience did not meet the expected standards, these may also be grounds for an appeal.

Step 3: Prepare a Comprehensive Appeal Letter

Your appeal letter is your chance to present your case clearly and persuasively. It should be professional, concise, and to the point. Here’s a breakdown of what to include:

1. Introduction: Briefly introduce yourself and state the purpose of the letter (i.e., to appeal the dismissal decision).

2. Statement of Circumstances: Provide an honest and specific explanation of the circumstances that led to your academic challenges. Be transparent about any obstacles you faced and how they impacted your performance.

3. Supporting Documentation: Include documentation to support your claims, such as medical records, emails, or other records that validate your situation. This evidence helps build a credible case.

4. Plan for Improvement: Outline a clear, actionable plan to address the challenges you faced and explain how you intend to improve your academic performance. This may include seeking additional tutoring, adopting new study methods, addressing health issues, or working with an academic advisor.

5. Request for Reconsideration: Politely request reconsideration of your dismissal based on the circumstances and evidence presented.

Step 4: Explore Alternative Solutions if the Appeal is Denied

If your appeal is denied, there are still options available:

• Transfer to Another Medical School: Most medical schools ask transfer applicants for a letter of good standing from their current school, which makes transferring after a dismissal difficult. Ask each school’s admissions office directly before you apply.

• Ask About Readmission: Some schools let dismissed students apply for readmission after a set period. A leave of absence is usually requested while you are still enrolled, so if you are struggling but not yet dismissed, ask about one early.

• Switch to a Related Health Field: For students open to alternative career paths, there are numerous health-related fields where medical training can be valuable, such as public health, clinical research, healthcare administration, and education.

Step 5: Seek Guidance and Support

Navigating an academic dismissal can be overwhelming, but you don’t have to go through it alone. Consulting with mentors, advisors, or professionals who specialize in medical education can provide valuable insights and help strengthen your case.

At MedRise, we understand the unique challenges Caribbean medical students face and are here to support you in exploring your options. Whether it’s understanding your appeal rights, preparing documentation, or finding alternative pathways, we’re here to guide you through every step. Don’t let a setback define your future—take the next step toward making your medical career dreams a reality.

Conclusion: Your Journey Isn’t Over

Academic dismissal is a significant hurdle, but it doesn’t mean the end of your journey in medicine. With a well-prepared appeal, support from advisors, and a clear plan for improvement, you can overcome this challenge. Remember, resilience and persistence are key traits of a successful physician. Continue to advocate for yourself, seek guidance, and keep moving forward toward your goals.

Educational information only; not legal advice. For deadlines or disputes, read your school’s written policies and consider talking to an education lawyer.

Quick answer

New York's most IMG-heavy internal medicine programs are mostly city and community teaching hospitals in the Bronx, Brooklyn and Upper Manhattan. Of the seven programs we checked, Jacobi, BronxCare, St. Barnabas and Maimonides state that they sponsor both J-1 and H-1B visas, and Brookdale says J-1 sponsorship may be available. Harlem Hospital says almost all of its residents are international graduates.

Seven New York programs we checked

Watch the program name. Jacobi's site warns that the Jacobi Medical Center/North Central Bronx Hospital program is a separate residency from the Jacobi/Einstein program. Check the NRMP code before you apply or rank.

Other New York programs to look up

These programs often appear on IMG lists. We have not yet checked their 2027 policies, so look each one up before relying on it: Lincoln Medical Center (Bronx), One Brooklyn Health/Interfaith (Brooklyn), NYC Health + Hospitals/South Brooklyn Health (Brooklyn), SUNY Downstate (Brooklyn), NYC Health + Hospitals/Metropolitan (Manhattan), Jamaica Hospital and Flushing Hospital (Queens), Nassau University Medical Center (Long Island) and SUNY Upstate (Syracuse).

Large academic programs such as NYU Langone, Columbia, Weill Cornell and Mount Sinai also appear on some lists. Check their FREIDA graduate mix before you spend a signal there.

How to check any program in about five minutes

1. FREIDA first. On the program's FREIDA page, read the visa status (J-1, H-1B, F-1), the "Types of Graduates" three-year averages and the "Data last updated" date.
2. Then the program's own page. Look for the visa policy, first-attempt rules, a graduation-year cutoff, when ECFMG certification is due (at application or before the start date) and any U.S. clinical experience requirement.
3. Match the name and NRMP code. One hospital can run more than one internal medicine program.
4. Be careful with third-party "IMG %" sites. They often disagree. On one such site, the same Brooklyn program showed 0% IMGs on its program page and 92% on the site's own IMG-friendly list.
5. Email the coordinator only with a question the website does not answer, such as whether they take H-1B transfers or need Step 3 before ranking.

J-1 or H-1B: the short version

• J-1: sponsored by ECFMG, not the hospital. Step 3 is not required. Most J-1 physicians must spend two years in their home country after training unless they get a waiver (INA 212(e)), for example through Conrad 30.
• H-1B: sponsored by the hospital. You must pass USMLE Steps 1, 2 and 3 before the petition is filed, and there is no home-country requirement. Fewer programs offer it, and some want Step 3 passed before they rank you.

This is general information, not legal or immigration advice. For your own case, ask the program's GME office or an immigration attorney.

Where internal medicine stands for 2027

In the 2026 Match, non-U.S. IMGs matched at 56.4%, and 54.4% of those who needed a visa matched. Categorical internal medicine still had 537 PGY-1 positions unfilled after the Match, before SOAP. See 2026 NRMP Match results for IMGs and unfilled positions by specialty.

For the 2027 Match, rank order lists are due March 3, 2027 at 9 p.m. ET, and Match Day is March 19, 2027.

Sources

• Jacobi Medical Center IM residency: application information
• AMA FREIDA: BronxCare Health System internal medicine
• SBH Health System internal medicine residency
• Harlem Hospital Center IM residency: how to apply
• Maimonides Medical Center: medical education FAQ
• One Brooklyn Health: Brookdale IM residency
• NYC Health + Hospitals/Woodhull IM residency
• AAFP: visa requirements for IMGs
• APA: visa and immigration basics for IMGs
• NRMP

What NRMP rules prohibit

Programs may not ask you to reveal where else you have applied or interviewed, which specialties or locations you are considering, which programs you signaled, or how you plan to rank them (NRMP program policy handout; NRMP help). You may volunteer that information, but you don't have to. Programs can still ask why you are interested in their program, specialty or region, and they can tell you they are interested in you.

Neither side may demand a commitment: a program can't ask you to promise to rank it first, and you shouldn't press a program on where it will rank you. The NRMP says questions about application, interview and ranking intentions tell a program nothing about how well you fit its culture and mission (NRMP Policy Corner).

What anti-discrimination law restricts

Laws enforced by the Equal Employment Opportunity Commission make it illegal for employers to discriminate against applicants because of race, color, religion, sex (including pregnancy, sexual orientation and gender identity), national origin, age (40 or older), disability or genetic information (EEOC). Questions on these topics invite a discrimination claim, so well-run programs avoid them. Examples:

• How old are you, or what year did you finish high school?
• Are you married, pregnant or planning to have children?
• What is your religion, or will you need religious holidays off?
• Where were you born, or what is your native language?
• Do you have a disability or a medical condition? Disability-related questions are generally off-limits before a job offer.

Some related questions are allowed. A program can ask whether you are authorized to work in the United States or will need visa sponsorship, and it can describe the call schedule and ask whether you can meet it. Many states add protections, such as for marital status, so the rules vary by location.

How to respond

• Redirect: answer the concern behind the question. To "Do you have kids?" you might say, "I'm fully prepared for the demands of residency."
• Decline politely: "I'd like to keep the focus on my training and qualifications."
• For NRMP questions: "I'm keeping my rank list private, but I'm very interested in this program because..."

How to report a problem

Report possible Match Participation Agreement violations to the NRMP at policy@nrmp.org. For possible discrimination, talk to your school's dean's office; you can also contact the EEOC or your state's civil rights agency.

Related: NRMP Match rules explained.

Educational information only; not legal advice.

NRMP vs. ERAS

ERAS, run by the Association of American Medical Colleges, is how you send applications, letters and transcripts to programs. The NRMP handles Match registration, rank order lists, the matching algorithm and SOAP.

The rules that matter most

1. A match is binding

If you match, or accept an offer during SOAP, you are committed to train at that program. Only the NRMP can grant a waiver of that commitment; programs and applicants can't release each other (NRMP help; NRMP professional behavior). Rank only programs you would actually attend.

2. Withdraw on time if you take another position

If you accept a position outside the Match, such as a military residency position, withdraw from the Match before the Rank Order List Certification Deadline; failing to withdraw by that deadline is a violation (NRMP). The deadline falls in early March; for the 2025 Match it was Wednesday, March 5, at 9 p.m. ET (NRMP). Check the NRMP calendar for the current year.

3. No pressure about rankings

Programs may not ask where else you applied or interviewed or how you will rank them, and neither side may require a ranking commitment from the other. You can volunteer information if you choose (NRMP).

4. Don't contact SOAP programs first

During SOAP, applicants and anyone acting for them may not contact a program until the program initiates contact after receiving the application (NRMP). SOAP is part of the Main Residency Match, not a separate match you have to choose between.

5. Keep the List of Unfilled Programs private

Copying, sharing or posting the List of Unfilled Programs for anyone not registered for the Match is a violation (NRMP).

6. Be truthful

Give accurate, complete information to the NRMP, to programs and to your school. Misrepresenting credentials, publications or eligibility can lead to sanctions.

What happens after a reported violation

The NRMP investigates, gathering information from the applicant, the program and anyone else with knowledge of the situation (NRMP). Confirmed violations can bring sanctions, including bars from future Matches and a notation that programs can see in your Match history.

Applying in Canada too

You can take part in both the NRMP Match and Canada's CaRMS match. Under an agreement between the two, an applicant who matches in the country whose match runs first is removed from the other (NRMP).

Related: What residency programs can't ask you.

Educational information only. Read the current Match Participation Agreement and confirm deadlines with the NRMP.

Medical schools have been a part of the public stock market. One in particular is Adtalem Global Education Inc. (ATGE) which is the holding company for Chamberlain University, Walden University, American University of the Caribbean School of Medicine, Ross University School of Medicine, and Ross University School of Veterinary Medicine. The stock was trading at $75.30 on September 22, 2024, and today on November 7 it was trading at $90.66 (Adtalem Global Education, 2024; NYSE).

While there are several stock valuation methods, I decided to utilize absolute valuation to determine how this company is doing. Their P/E Ratio is 20.75 and the EPS is $3.44 which means it is priced higher than its earnings (these values reflect trailing 12 months). The company has a price-to-sales ratio of 1.79 which means it is valued at about 1.8 times its sales. Their gross margin is 55.47% (Adtalem Global Education, 2024). To understand relative I found out that it is trading above its industry peers at 20.13x ratio vs 19.77x (Yahoo Finance, 2024).

References

Adtalem Global Education. (2024, August 8). Adtalem Global Education fiscal fourth quarter and full-year 2024 results[Press release]. https://s24.q4cdn.com/745190157/files/doc_financials/2024/q4/Press-Release-Adtalem-Global-Education-Fiscal-Fourth-Quarter-and-Full-Year-2024-Results-FINAL.pdf

New York Stock Exchange (NYSE) (2024). Adtalem Global Education Inc. (ATGE) stock information. Retrieved November 7, 2024, from https://www.nyse.com/quote/XNYS:ATGE

Yahoo Finance. (2024, September 20). Why Adtalem Global Education Inc. stock is trending. Yahoo Finance. https://finance.yahoo.com/news/why-adtalem-global-education-inc-131408334.html

Federal loans charge simple daily interest

Federal Direct Loans are "daily interest" loans: interest accrues every day on the principal, and unsubsidized loans start accruing as soon as the money is sent to your school, whether or not you are making payments (MOHELA, a federal loan servicer). Because the interest is simple, unpaid interest does not itself earn interest unless it is capitalized, meaning added to your principal.

Since July 1, 2023, the Department of Education has eliminated capitalization in every case not required by law (U.S. Department of Education). One common remaining trigger is the end of a deferment on an unsubsidized or PLUS loan (Tate Law).

A hypothetical example

For 2026–27, new graduate and professional Direct Unsubsidized Loans carry a fixed 8.07% rate (Federal Student Aid). Suppose a student owes $200,000 at 8.07%:

• Simple interest adds about $16,140 a year, or about $44 a day.
• Over four years with no payments, that is about $64,560 of unpaid interest on top of the principal.
• If that unpaid interest were capitalized, future interest would be figured on about $264,560, so each year would add about $21,350 instead of $16,140.

Paying even part of the interest during school or residency keeps the balance from growing, and knowing which events trigger capitalization helps you avoid adding interest to principal unnecessarily. Each loan is fixed at the rate set for the year it was first disbursed, so your actual rates may differ.

Put compounding on your side

If you have earned income, such as from tutoring, scribing or summer work, a Roth IRA lets investments grow and be withdrawn tax-free in retirement, and you can take out your contributions (not earnings) at any time. Small, early contributions matter: $1,000 that grows 7% a year becomes about $7,600 in 30 years. Returns are never assured, and markets can fall, but time in the market is the one advantage students have over attending physicians.

Bottom line

• Federal loans grow linearly unless interest is capitalized; know your capitalization triggers.
• Pay interest when you can, and track each loan's rate.
• Start compounding for yourself early, even with small amounts.

Related: What a 529 plan can and can't do under the new loan cap.

Educational information only; not financial, tax or legal advice. MedRise is not a financial adviser.

Every election including this one of 2024 with Donald Trump or with Kamala Harris, brings about significant changes across industries, and healthcare is no exception. Policies, funding, and regulations often shift with new administrations, directly influencing medical professionals, facilities, and patients. As healthcare providers and professionals prepare for the potential impacts of election outcomes, understanding the ways policies can shape healthcare can be invaluable.

In this blog post, we’ll explore the key areas of healthcare likely to be affected by elections, including healthcare funding, regulatory changes, and implications for medical education.

1. Healthcare Funding and Access

Election outcomes often impact government funding for healthcare programs, which can affect hospital budgets, insurance coverage, and access to care. Changes to Medicare, Medicaid, and funding for public health programs can have a ripple effect, influencing how healthcare providers allocate resources and treat patients. Medical students and residents can stay informed about these trends to better understand potential changes in their practice environments and the financial landscape of healthcare services.

2. Regulation and Compliance

Healthcare is one of the most heavily regulated sectors, and new administrations may bring in changes that affect how hospitals, clinics, and private practices operate. Compliance with updated health information privacy laws, insurance coverage requirements, and pharmaceutical regulations are just a few examples of areas that can change after an election. For healthcare providers, staying updated on regulatory shifts ensures they remain compliant and prepared for new operational requirements.

3. Public Health and Preventive Care Initiatives

Public health policies, including vaccination programs, preventive care initiatives, and mental health services, often take center stage in election platforms. Election outcomes may influence funding and support for these initiatives, impacting how healthcare professionals approach patient care. Medical students interested in public health should pay attention to changes in these areas, as they can shape career opportunities and practice focus.

4. Implications for Medical Education and Training

For medical students and residents, election outcomes can also impact the structure and funding of medical education. Changes in policies related to student loans, residency funding, and healthcare education grants can affect how medical professionals finance their training and access educational resources. By staying aware of these potential shifts, students can make informed decisions about their education and career path.

5. Technology and Innovation in Healthcare

Finally, new policies may promote advancements in healthcare technology and digital health. Some administrations may support funding for telemedicine, electronic health records, and AI-driven medical innovations, which can transform patient care and open up new career pathways for healthcare professionals. Staying informed about technology policy trends can help doctors, students, and healthcare organizations anticipate and adopt new tools effectively.

Staying Informed and Adapting to Change

Election cycles bring uncertainty, but staying informed on policy changes and understanding their potential impacts on healthcare can help professionals adapt and continue providing quality care. For those in the medical field, paying attention to healthcare-related election outcomes can help you plan ahead, from adapting to new regulations to seizing opportunities in emerging areas of healthcare. By doing so, medical students, healthcare providers, and patients alike can navigate the evolving landscape of healthcare with greater awareness and preparedness.

At MedRise, we’re committed to keeping healthcare professionals and students informed about the latest trends and policy changes that shape the healthcare industry. Follow our blog for more updates on topics that matter to your career and future in medicine.

For medical students, finances are often tight, and the demands of school make it challenging to focus on building wealth. But what if you could take a few small, strategic steps now to set the foundation for long-term financial success? A simple three-part framework, sometimes marketed as the "Rockefeller Method," can guide you even on a limited budget. Here’s how medical students can apply it with just $500.

The three parts

The framework has three parts: protect and diversify what you have, control your cash flow, and plan for the long term. Even with a modest starting amount, they help you build habits that pay off over time.

Step 1: Asset Protection and Diversification

The first step in wealth building is protecting what you have and setting up streams for growth. Even with $500, you can make meaningful moves here.

1. Start an Emergency Fund ($100): Put aside $100 to start an emergency fund. While this amount may seem small, it's a safety net for unexpected expenses. Adding to it gradually creates a habit of saving and keeps you from relying on debt when minor emergencies arise. Consider keeping it in an FDIC- or NCUA-insured high-yield savings account instead of a regular savings account. The FDIC’s national average savings rate was 0.38% in August 2026, and many online high-yield accounts pay several times that, so compare current rates before you open one (FDIC national rates).

2. Micro-Investing for Growth ($150): Consider putting $150 into a micro-investment account that allows fractional stock or index fund investments. Platforms like Acorns, Stash, or Robinhood let you start small, investing in the stock market or diversified funds with minimal upfront costs. This helps you begin growing wealth while developing an understanding of investments.

3. Invest in Financial Knowledge ($50): Use $50 to build your financial literacy. Buy a few finance books or sign up for a course on investing or budgeting basics. Building a foundation of financial knowledge early on is invaluable, especially for future high earners like doctors. Understanding how money grows and how to protect it will serve you well for life.

Step 2: Cash Flow and Income Control

Managing your income and expenses well, even on a limited budget, is essential for financial stability. Here’s how to keep things on track:

1. Budget Consistently: Use a budgeting app such as Rocket Money or YNAB (You Need a Budget), or a simple spreadsheet, to track every dollar. Sticking to a budget makes it easier to see where your money is going, which is especially important when you’re balancing school expenses and personal spending.

2. Automate Savings and Investing: Set up automated weekly or monthly contributions to your emergency fund and investment account. Even $5 a week adds up over time and becomes a powerful wealth-building habit. Automatic transfers keep you on track even when life gets busy, helping your money grow consistently.

3. Explore Low-Cost Side Hustles ($100): Consider using $100 to start a small side gig, like tutoring, freelancing, or content creation. Look for options that require minimal startup costs but offer flexibility around your study schedule. This extra income can go directly into your savings or investments, accelerating your wealth-building journey.

Step 3: Legacy and Generational Wealth Planning

Legacy planning may sound premature when you’re just starting out, but taking small steps now can set you up for a lifetime of smart financial management.

1. Learn About Generational Wealth: With so many free resources available, take some time to understand the basics of wealth transfer, tax-advantaged accounts, and trusts. Starting to think about the long-term impact of your financial decisions will help you build a stronger foundation.

2. Start a Simple Roth IRA ($100): If you have any earned income from a job or side gig, consider contributing $100 to a Roth IRA. This retirement account grows tax-free, and starting one early lets your money compound over decades. Roth IRAs also offer the flexibility to withdraw your contributions without penalty if you need funds for emergencies.

3. Consider Philanthropy: Purposeful money decisions include giving back. As you grow your finances, set aside a small portion of any gains or extra income for causes you care about. This helps reinforce a healthy mindset around money, reminding you to use it in ways that create a positive impact.

Final Thoughts

Even with just $500, medical students can start building wealth by following these three steps. By establishing an emergency fund, dipping a toe into investing, automating savings, and learning about long-term financial strategies, you’re not only securing your financial future but also building habits that will serve you throughout your medical career and beyond.

Building wealth takes time, but this framework can keep you on track. These initial steps may be small, but with consistency, they have the potential to grow into a foundation of financial security and independence. Start small, stay disciplined, and let these habits guide you toward a prosperous future.

Educational information only; not financial advice. MedRise is not a financial adviser, and we do not earn referral fees from the companies named in this article.

ECFMG: the gateway to the USMLE and residency

International medical graduates need ECFMG Certification to enter ACGME-accredited residency programs. Eligibility starts with the school: it must be listed in the World Directory of Medical Schools with an ECFMG Sponsor Note stating that its students and graduates can apply for ECFMG Certification and examination (ECFMG fact sheet).

In 2024, ECFMG put its Recognized Accreditation Policy into effect. A school meets the policy if its accreditor is recognized by WFME or NCFMEA, the two organizations ECFMG has approved; more than 50 agencies worldwide hold one of those recognitions (ECFMG; ECFMG accreditation resources). ECFMG said the policy would not, at first, be a requirement for ECFMG Certification, and that it will keep evolving (CAAM-HP summary of the ECFMG policy). Many school websites still describe the older plan, under which WFME recognition would have become mandatory in 2024, so check ECFMG's own pages for the current rule.

NCFMEA: about federal loans, not schools

NCFMEA does not accredit schools. It reviews the standards a foreign country uses to accredit its medical schools and decides whether they are comparable to U.S. standards (NCFMEA guidelines). A comparability determination is one of the requirements for a foreign school's students to borrow U.S. federal student loans. On its own, it doesn't make you eligible for the USMLE or the Match.

What to check about your school

• Its World Directory listing and ECFMG Sponsor Note.
• Its accreditor, and whether WFME or NCFMEA recognizes that accreditor.
• Whether it takes part in U.S. federal student aid, if you plan to borrow.
• Its recent USMLE pass rates and residency placement results, from sources you can verify.
• Any state rules on clinical rotations or licensing for graduates of international schools, if you have a target state.

Where MedRise fits

MedRise helps students make sense of these rules and plan around exam and residency requirements. We are not a law firm and can't give legal advice.

Related: Academic dismissal from a Caribbean school: your options.

Educational information only. Confirm current requirements with ECFMG, the U.S. Department of Education and your school.

People often wonder will their application be considered late if they don't submit on the day that the application opens. Understanding the overall structure is key to answer those questions. As someone who has worked in a residency program before let's start with the overview of the residency process.

Preparation Phase

• Self-Assessment and Specialty Selection: MedRise offers tools and resources to help you evaluate your interests and strengths, aiding in the selection of a specialty that aligns with your career goals.

• Understanding Program Requirements: Access comprehensive databases and guidance materials to familiarize yourself with various residency programs' criteria and expectations.

• Document Preparation

  • Curriculum Vitae (CV) Enhancement: Utilize MedRise's templates and expert advice to craft a CV that effectively showcases your academic and clinical experiences.

  • Personal Statement Development: Receive personalized feedback and examples to write a compelling personal statement tailored to your chosen specialty.

  • Letters of Recommendation (LoRs): Learn strategies for selecting appropriate recommenders and tips on how to request strong, supportive letters.

  ERAS Application Submission

  • Application Guidance: MedRise provides step-by-step instructions on completing the Electronic Residency Application Service (ERAS) application accurately and efficiently.

  • Program Selection Strategy: Access data-driven insights to help you choose programs that match your profile and preferences.

  Interview Preparation

  • Mock Interviews: Participate in simulated interviews to practice common questions and receive constructive feedback.

  • Interview Tips: Gain access to resources that offer advice on professional conduct, attire, and effective communication during interviews.

  Rank Order List (ROL) Submission

  • Strategic Ranking Advice: MedRise offers guidance on how to rank programs based on your preferences and the likelihood of matching, ensuring an informed and strategic approach.

  Post-Match Support

  • Onboarding Assistance: Access checklists and resources to help you navigate the onboarding process smoothly after matching.

  • Unmatched Applicants: For those who do not match, MedRise provides information on the Supplemental Offer and Acceptance Program (SOAP) and alternative pathways to secure a residency position.

By leveraging MedRise's comprehensive resources and expert guidance at these critical stages, you can enhance your residency application, increase your chances of matching successfully, and embark on your medical career with confidence.