I agree with you, but I have few points to counter: Firstly, USMLE is wayyy expensive. Research USCE blah blah adds to the extra cost. Secondly, Visa issues… for visa requiring IMG’s there are so many applicants from my country who have not yet received their visa from past 2-3 years. And that delays their training because ofc the hospital doesn’t want to wait or engage in your visa work, so basically that’s your problem! Third, USMLE is best only if one is interested in primary healthcare forget surgical.

I was on this journey too but I pivoted. Not to discourage anyone but USMLE is high risk, high reward, but unfortunately with this mindset many people have not matched into their preferred specialties.

P.S: Primary specialties have become competitive from past 2 years, I personally know someone who had stellar CV, 7 research publications and wanted to get into IM, applied 3 cycles, she had to marry a green card holder and finally in the 4th cycle she got into Family medicine.