Applying for Residency in the U.S. as an IMG can be a numbers game. Although applying as an older candidate can be an element that further complicates the equation, it is not a death sentence. Elder IMGs can successfully obtain residency it just requires some additional planning and data analysis on programs that see the benefits on someone with more real-world experience. To find out who is considered an older candidate and how to apply for residency if you fall into this category, continue reading below.

Advantages of Age

Medical graduates who have been out of school for five years or more and those over the age of forty are considered older candidates. Being an older candidate can be challenging. Most residency programs prefer applicants who have graduated from medical school in the last five years. Applying for residency within five years of graduation gives individuals more options and a greater chance of matching.

For some IMGs, applying within five years of graduation is not an option. While this does make things more difficult, it does not make them impossible. Older IMGs applying for U.S. residencies can bring a lot to their residency position. This is especially true for those with experience in research and a resume or CV chock-full of experiences they had in their home country. With these experiences it is likely that the individual has gained more real-world knowledge, examined, and treated a more diverse patient population, and obtained a certain level of maturity and expertise that only time can provide. Continuing to pursue education later in life can say a lot about an applicant’s character as well. It insinuates that they are eager to learn, hard-working, and have determination.

Tips on Applying


  • Don’t Underestimate the USMLE

For older residency applicants, test scores can be an important indicator of knowledge, skill, and effort. Although the weight a score bears in deciding who is accepted can vary from program to program, it is important to take the exam seriously as individuals may not retake the test once they have gotten a passing score.

A passing score for Step 1 is 194 however, in most cases this is not enough for individuals to receive a residency match. According to data from the 2018 National Residency Match Program, IMGs who matched had USMLE Step 1 scores in the 230-240 range whereas unmatched applicants had scores in the 215-230 range. This data proves that simply passing the USMLE steps is not enough. Older residency hopefuls should take this exam and its preparation seriously. The test is costly in terms of finances and the role it plays in one’s professional future.


  • Research, Research, Research

It is important to research both the medical specialty and programs an individual is interested in applying for. Certain specialties have higher match rates from IMGs and older applicants. These include family medicine, pathology, and internal medicine, among others, which are less favored by U.S. medical graduates. Some programs are more competitive and tend to turn away older applicants. Other programs do not put much weight on the age of an applicant.


  • Keep Your Application Up to Date

Since time may pass from when you create your ERAS account to when you apply for residency, it is important to update your profile. This means routinely checking your profile and application materials to ensure they are acceptable.

This relates specifically to your personal statement and letters of recommendation (LoRs). Your personal statement should reflect your interest in the medical specialty you are applying for. If you decide to change the medical specialty you are applying for, your statement must be updated. LoRs should be from recent clinical experiences, preferably within the last year. If more time than this has passed, an individual should complete another clinical experience to obtain a new LoR.


Is your LoR in need of a refresh? AMO offers 200+ clinical experiences that allow participants to request a LoR from a U.S. physician.

Create an account today to explore the possibilities!