As an IMG you might not have much of a choice but to do a shotgun approach and apply anywhere and everywhere. That being said, I would argue you can be smart about it and make smarter decisions as to where in the US to apply.
Residency applications are expensive and they get exponentially more expensive the more programs you apply to as a deterrent for this exact strategy.
These were the factors I took into account when applying
Where I’m from
- This is an easy start. Apply to your local hospitals and programs. That’s a given. Your best chances are at programs near you because programs like training physicians that will ideally stay in the area after graduation from their program.
Where I want to be
- Like I mentioned in the last question, programs want to know where you will be after graduating from their program.
Connections to the area
- If you have any family members around the country or any connections geographically, I would draw upon those points during any communications with the programs either in your personal letter for that program or any other letters or emails and definitely during the interview if you end up getting one.
Hospitals that have accepted graduates in the past
- At least for SGU, there are a lot of graduates that end up in a few hotspots. Common things happen commonly so the chances of them hiring SGU graduates again the following year are usually high. You can see a list I put together for the last 5 years here.
- Obviously you can always be the first SGU graduate a hospital accepts however you are taking your chances at this point, unless any of the previous points I listed above would convince them otherwise.
Where my scores could realistically get me
- At the end of the day, it still comes down to scores and cutoffs. Some specialties are less strict than others but you need to be realistic about where you are in the candidate pool. If you want to get super selective about applying to some reach programs you can look program’s average or minimum Step scores online.
All of these things considered, here’s what I did.
As a 20+ year resident of New Jersey, I applied to every NJ program that had my specialty. I also applied to every NY program that accepted SGU students. Based on the data publically available, close to 50% of SGU graduates end up in these 2 states so I would be foolish not to apply to both these states. I also applied to a few programs in Philadelphia and Connecticut. I knew going in, I had my best chances in NJ with minimal chances elsewhere due to scores and lack of interest of ranking them highly anyway and vice versa. I might have sacrificed on a handful of programs and opportunities in a few of the midwest states however at the end of the day realistically my application to interview ratio would be much higher at home. I ended up applying to less than 70 programs in the tristate area which goes against recommendations by advisors at SGU but I felt this was the best use of my money. In the end, after comparing notes with colleagues that applied to 200 programs for the same specialty, I ended up with just as many interviews as between all of us, most of them were from NJ anyway.
That being said, if you’re not from NJ or NY, you should probably apply to both these states plus your home state. Results may vary as there are plenty of confounding factors however in my experience, geographical factors are quite significant with weak to average scores at least for obtaining the interview. If you have higher steps scores, you can be a little more selective and broad about where you apply but at least for SGU grads, I would still recommend all of NJ and NY as a baseline.