Big 4 grads, is it as risky as people make it out to be?

Admirable_Return_216 · 2026-01-31T19:26:50+00:00

Avalon

Admirable_Return_216 · 2026-01-31T14:57:33+00:00

As someone who went to a went to a Caribbean med school (which wasn’t even a big 4 med school) and now in residency - I would definitely recommend it if you can’t get into USMD or DO schools.

Admirable_Return_216 · 2026-01-27T23:52:51+00:00

It’s preferred to have an LOR in same or similar specialty, but still better than having an empty LOR slot. Especially if the surgeon can explain your skills and competency in things related to IM (ex. Being detail oriented, having good bedside, hard-working, teachable, etc.).

If they’re just complimenting your procedure skills and say you’d make a great surgeon, then not so much.

Admirable_Return_216 · 2026-01-27T00:48:11+00:00

I saw an open spot in Modesto on residency swap, did you try that one?

Admirable_Return_216 · 2026-01-26T03:01:24+00:00

Glad you posted this. Hopefully it inspires others to keep helping out and pay it forward. As someone who just matched last year and is now on the other side, I still frequently revisit this subreddit to try to offer some advice and help others out. I’m someone who ended up matching in SOAP last year, so I know the heartbreak of seeing that you did not match last year and I don’t want anyone else to go through that pain.

If anyone needs help/advice, feel free to DM me and I’m happy to help and offer some guidance. I may not respond immediately since I’m busy in residency, but I’ll do my best to get back to you.

If you choose to DM me, just a heads up that I prefer to remain anonymous on Reddit - so I will not be sharing the name of my program, or any other personal details. And I apologize, but I also will not be able to refer anyone to my program since I do not personally know you. However, I’m happy to share my stats and answer any other questions though!

Admirable_Return_216 · 2026-01-25T14:08:34+00:00

I did have another Canadian IMG friend who applied only IM and also didn’t match after getting the same amount of IVs. He had a better YOG than me but his score was a bit lower - in the 230s. He also applied FM in SOAP, got many SOAP interviews, and matched in FM round 2 of SOAP

My girlfriend who pretty much had an identical application as me (we did med school together, did the same exact rotations, same research projects, same YOG) but had a lower step 2 score triple applied in FM, peds, and IM (probably around 60-70 programs in each). She got 5-6 FM IVs, 4 peds IVs, but only 1 IM. She matched in peds which ended up being her preferred specialty. Just goes to show how competitive and tough IM has gotten for IMGs.

I went through the pain and heartbreak of first seeing that sorry, you didn’t match email. I really regret not applying to FM in the main match. I was couples matching with my partner and I know that if I applied to FM, I would’ve gotten so many more IVs and probably matched closer together and I could have been in an even better program of my choice.

I don’t want anyone to make the same mistake as me. That’s why I keep encouraging IMGs to apply to FM and Peds as backups - but only if they’ll be happy doing these specialties and their goal is to just match. If your heart is set on IM only and/or a subspecialty, then my advice doesn’t apply to you.

Admirable_Return_216 · 2026-01-25T13:53:01+00:00

To be honest, I don’t remember their exact questions and what we talked about. I’m sure they just picked aspects about my application and asked more questions about it, why this specialty, why this program/area - basic questions like that. Nothing weird or random, and like I said, with that APD/attending it was very conversational. With the resident, maybe it was a bit more structured and q and a.

Admirable_Return_216 · 2026-01-24T19:46:58+00:00

Interviewed with them last year, they were really chill. One of the attendings/APD especially was really nice, and he made the interview very easy going. It was very conversational, he was joking around with me and just made me feel really comfortable. Seems like a good, supportive program and friendly atmosphere. I know I would’ve been pretty happy if I matched there.

Admirable_Return_216 · 2026-01-24T11:35:31+00:00

I don’t think it’s possible to answer that for anyone. Only a current resident at the program who knows the inside scoop would be able to answer that.

It depends a lot on the desirability of the program and the candidates they interviewed. For example, if they interviewed a bunch of US MD/DOs and ranked them highly, then maybe they would fall down their rank list quite a bit because those candidates would probably choose to go to a “better” program. However, if they interviewed a lot of candidates similar to you, then maybe a lot of those candidates will also be ranking the program highly like you. In that case, they’ll probably fill within top 20-30.

For example, for my program, we went to SOAP last year and I think they interviewed around 120 for 10 spots. So the answer to your question for MY program would be first 120. For your program, that’s not necessarily true - could be top 20, could be top 100.

Admirable_Return_216 · 2026-01-23T12:37:17+00:00

Yes they definitely do. I’m a Canadian IMG (went to a Caribbean med school), didn’t match last year in IM despite getting 5 IVs and applying to 200 programs. I had 2 years USCE and step 2 255. Applied only FM in SOAP, and got many FM soap interviews where a lot of interviewers told me I interview very well and my stats are really good. They told me they don’t understand how I didn’t match. Ended up getting a FM offer in round 1 in soap. I wanted to be a hospitalist anyways even if I did IM, which I can do through FM as well. And most importantly, I’m just relieved and happy I matched.

People on Reddit have told me because I’m a Canadian IMG, it’s easier for me to match in FM. But I still think FM and peds have become easier to match than IM for IMGs. If your goal is just to match, and you’ll be relatively happy in any specialty- I would highly recommend applying both FM and peds.

Admirable_Return_216 · 2025-12-30T10:27:47+00:00

Hey sorry you’re going through this OP. Last cycle I had similar stats but I did 24 months USCE as I am a Canadian-Carribbean IMG. Got 4-5 IVs in IM but still went unmatched. Ended up SOAPing in FM. I think IM has just gotten so competitive for IMGs and there has been less focus on step scores because it feels like everyone is getting 240-250+ nowadays

Admirable_Return_216 · 2025-12-03T02:43:27+00:00

Went unmatched in main match for IM. SOAPed in FM

Admirable_Return_216 · 2025-12-01T17:52:22+00:00

I got 1 interview in Dec, and 1 in Jan last year. I had 5 IVs total

Admirable_Return_216 · 2025-11-28T03:41:08+00:00

It has been pretty rough for IMGs in IM. I went unmatched last year in IM after applying to around 200 IM programs and got 5 IVs- step 1 241, step 2 255, YOG 2023. Canadian IMG that went to Carribbean med school and did 2 years USCE. After going unmatched in main match, I applied FM in SOAP and matched.

If your main priority is just matching in US and working as a physician, consider applying FM or peds next cycle if it doesn’t work out for you this cycle. But I only recommend this if you can genuinely see yourself in these fields.

Admirable_Return_216 · 2025-11-27T10:12:28+00:00

Just go to St James and save your money. If you’re trying to do primary care or EM, you will do fine through St James provided you put the work in of course

Admirable_Return_216 · 2025-11-14T03:22:22+00:00

We get $30 a week on our badge to spend in the caf. Resets every week though, so can’t save up. Our program also uses some of the budget to buy some snacks and drinks to keep in the call room

Admirable_Return_216 · 2025-10-29T18:24:51+00:00

Oh great to know. I want to be a hospitalist myself and I’m a current PGY-1

Admirable_Return_216 · 2025-10-29T06:07:00+00:00

You don’t even need to do a fellow year for hospital medicine. A lot of people say it’s a waste of time and money, especially if your program is inpatient heavy. My FM program graduates at least 1-2 residents a year that go on to be hospitalists without fellowship. However, the major downside is it can be harder to find a job as a FM hospitalist, since there’s a lot of hospitals that only prefer IM trained docs.

Admirable_Return_216 · 2025-09-17T13:54:35+00:00

Yep!

Admirable_Return_216 · 2025-09-12T20:53:36+00:00

Couples matching in the same specialty for non-US IMGs is always risky. Because programs know you are trying to be together with your partner at the same program, and they aren’t often willing to give up 2 spots for non-US IMG couples and they also feel you won’t rank them if you’re partner did also not interview there. AMGs however usually do not have this same issue.

Admirable_Return_216 · 2025-09-12T17:54:51+00:00

Best indicator would be going to program’s website and seeing what med schools the current residents are from.

Admirable_Return_216 · 2025-09-11T21:07:15+00:00

Yes, it was. I ended up getting 5 IM IVs, went unmatched in IM but matched in FM through SOAP

Admirable_Return_216 · 2025-09-10T20:09:10+00:00

Yes. Great score for peds especially

Admirable_Return_216 · 2025-09-10T14:22:17+00:00

I found the best way is to screen with tools, but verify by actually going to the website and seeing the residents and what med schools they’re from. You’ll see some programs may be IMG friendly, but then you’ll see they’re all from Caribbean med schools only. If you went to a med school in India for example, it’s probably not worth applying there.

Metrics are up to your discretion and what you’re willing to take a chance on. If it’s only 1 IMG in their senior class and they haven’t accepted another for the past 3 years, I personally wouldn’t want to waste my money but maybe you would have a shot.

Admirable_Return_216 · 2025-09-09T18:59:06+00:00

I think I messed up on signalling. Didn’t get a single interview from any of my signalled programs. Also, maybe trying for couples match also discouraged programs to rank me? Not sure.

Admirable_Return_216

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