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Was formerly known as the Subsequent Injuries Fund (SIF). These are complex cases involving catastrophic injuries. A SIF case is present when pre-existing disability combines with subsequent industrial injury to produce a current disability of seventy percent (70%) or more. The idea behind SIF cases is for the State to pay handicapped workers who suffer a subsequent industrial injury. The employer is insulated from liability and thus they are encouraged to hire handicapped or disabled workers. Specifically, SIF cases provide additional benefits under specified circumstances when an employee with prior disability suffers a subsequent workplace injury. The SIF provides compensation “for the remainder of the combined permanent disability existing after the last injury” (§ 4751) less the amount of all benefits received by the employee on account of the preexisting disability (§ 4753).
The payments come from the Subsequent Injuries Benefits Trust Fund (SIF), a state supervised trust funded by surcharges imposed upon employers in proportion to their payrolls (§§ 62.5, subds. (d), (e), 4751 et seq.). Thus, for the most serious injuries, the SIF allows the employee to obtain compensation commensurate with his or her overall disability without making the employer liable for more than the amount due for the most recent industrial injury. The purpose of this provision, is encourage hiring and retention of disabled workers. (State of California v. Ind. Acc. Com. (1957) 147 Cal.App.2d 818, 822, disapproved on other grounds by Subsequent Injuries Fund v. Industrial Acc. Com. (1961) 56 Cal.2d 842, 846.) SIF cases are governed by Labor Code Section 4751: If an employee who is permanently partially disabled receives a subsequent compensable injury resulting in the additional permanent partial disability so that the degree of disability caused by the combination of both disabilities is greater than that which would have resulted from the subsequent injury alone, and the combined effect of the last injury and previous disability or impairment is a permanent disability equal to 70 percent or more of total, he shall be paid in addition to the compensation due under this code for the permanent partial disability caused by the last injury compensation for the remainder of the combined permanent disability existing after the last injury as provided in this article; provided, that either (a) the previous disability or impairment affected a hand, an arm, a foot, a leg, or an eye, and the permanent disability resulting from the subsequent injury affects the opposite and corresponding member, and such latter permanent disability, when considered alone and without regard to, or adjustment for, the occupation or age of the employee, is equal to 5 percent or more of total, or (b) the permanent disability resulting from the subsequent injury, when considered alone and without regard to or adjustment for the occupation or the age of the employee, is equal to 35 percent or more of total.

For the 5% opposite and corresponding member criteria, the subsequent injury must only affect the opposite and corresponding member; it need not injure that member directly. This was detailed in the case of Hard v. WCAB (1974) 2 CWCR 48. In the Hardcase the applicant had lost his left leg prior to the industrial injury. The industrial injury involved a back injury that caused problems into the applicant’s right leg. The WCAB panel held “applicant qualifies for subsequent injuries fund benefits because the back injury affected the right leg which is the opposite and corresponding member to the previously impaired left leg.” See also: Gillispie v. Plastech (SIBTF) (2010) 38 CWCR 304 (WCAB) wherein the WCAB held that LC Section 4751 requires only that the subsequent injury “affect the opposite and corresponding member” (such as radicular sx’s in the leg as result of a back injury); it does not require that the opposite member have pathology or be injured.

The “Opposite and Corresponding” requirement is not limited to extremities. In SIF v. IAC (Hanson)(1963) 217 Cal. App. 2d 322, on May 28, 1959, the applicant, Bruce S. Hanson, was injured in an automobile accident. The major effect of this industrial injury was to accelerate existing diabetic retinitis to produce blindness of the right eye. Prior to the injury and as a result of the same disease process, applicant had already suffered practically complete loss of vision in the left eye. Here the eye injuries were Opposite and Corresponding members. A similar case was SIF v. IAC (Patterson) 1952 39 Cal.2d 83. In Patterson the subsequent industrial right eye injury rated at 26% PD. When combined with the pre-existing left eye injury, SIF liability was present. The 5% disability to the opposite and corresponding member does not have to be completely within the injured member. For example, if the subsequent industrial injury involves the neck and arm, then the arm injury need not rate 5% as long as neck combined with the arm combine to produce a 5% disability. In addition to not needing subsequent injury causing 5% disability in opposite and corresponding member, the subsequent injury need only affect the opposite and corresponding member and cause an overall disability of 5% or more. SIF v. WCAB (Post) (1976) 41 CCC 436.

The 35% threshold calculates before adjustment for occupation and age. The DFEC modifier must also be factored in when determining the rating of subsequent injury before adjustment for occupation and age. The plain and unambiguous language of LC 4751 excludes only adjustment for age and occupation. Since a WPI determination does not consider work disablement, and only considers the impact of an injury on activities of daily living, for the permanent disability determination in LC 4751 to be relevant to work disablement, the DFEC adjustment must be included. There are conflicting panel decisions from the WCAB as to whether the DFEC modifier is considered in the 35% threshold. Khandikian vs. SIBTF (2015) ADJ9150217 (Van Nuys) states that you do consider the DFEC in determining whether the 35% threshold is met,
whereas a WCAB Panel in Malen v. Kitchen Works (2011) 2011 Cal.Wrk.Comp. P.D. LEXIS 84 approved the determination that when calculating the permanent disability from a subsequent injury, the industrial disability must be considered before adjustment for DFEC

As quoted in Escobedo v. Marshalls (2005) 70 CCC 604, 19 [en banc], “…the chief requirement for SIF benefits is that the condition must have been ‘labor disabling’ prior to occurrence of the subsequent industrial injury. (Ferguson v. Industrial Acc. Com.(1958) 50 Cal.2d 469, 477 [326 P.2d 145]23 CCC 108]; Franklin v. WCAB 79 Cal.App.3d at pp. 237-238.)” The Pre-existing disability for SIF purposes must have been present at the time of the subsequent industrial injury. Under the 1957 Bachrach case (SIF v. IAC (Bachrach)) 147 Cal. App. 22 818 , the existence of a non-disabling pathological condition is not sufficient to justify entitlement to SIF benefits. And per Franklin v. WCAB (1978) 79 Cal. App.3rd 224, a retroactive prophylactic work restriction will not support SIF liability. Further, an SIF applicant cannot rely upon a retroactive assignment of disability in absence of contemporaneous evidence to meet applicant’s burden of proof (see opinion and order denying petition for reconsideration in ADJ3447817(SJO 0260464).

The pre-existing condition must have been labor disabling, but that has been defined by the Courts as any condition that would be ratable if it had been caused by an industrial injury. To be entitled to SIBTF benefits, applicant’s prior permanent disability need not have caused actual earnings loss; it must simply be a disability for which partial permanent could be made if it were industrial. In Brown v.WCAB & SIF 36 CCC 627 (1971), at page 9 of the Lexis cite, the Court stated: “Although the prior disability need not be reflected in the form of loss of earnings, if it is not, it must be of a kind upon which an award for partial permanent disabilities could be made had it been industrially caused. This is necessary to distinguish it from a “lighting up” aggravation, or acceleration of the pre-existing physical condition where the employer is to be held liable for the whole.”(36 CCC 635).

Current AMA ratings under the 2005 PDRS will satisfy the pre-existing PD requirement as the 2005 schedule for rating permanent disability is prima facie evidence of the percentage of permanent disability which must be followed unless it has been successfully rebutted. (Almarez/Guzman II 74 Cal.Comp. Cases at 1103-1104; affirmed Milpitas Unified School District v. WCAB (2010) 187 Cal.Ap. 4th 808). Thus if the applicant shows a disability under the AMA guides, SIBFT may choose to offer evidence to rebut the rating under the AMA guides. However, in all cases the applicant carries the burden to establish that prior to the subsequent injury the applicant had a pre-existing labor disabling condition upon which the award of permanent disability could have been based.

In case of multiple prior WCAB awards of permanent disability, the prior awards are simply added without dilution through the use of either the Multiple Disabilities Table (MDT) from the 1997 PDRS or the Combined Values Chart (CVC) from the 2005 PDRS. Labor Code Section 4751 refers to “combined disability, and ordinarily the MDT and CVC are used to combine disabilities. However neither applies where there are multiple disabilities. MDT and CVC are both only applicable to combine disabilities from one injury to multiple body parts of the body in order to avoid “pyramiding” and to avoid exceeding the 100% limit for one injury. This concept is discussed in the 5/18/11 Notice of Intention to Recind WCJ’s Decision and Return Matter to Trial Level for Further Development of Medical Record in ADJ3143756/ADJ317043 signed by Ronnie G. Caplane with Alfonso J. Moresi and Frank M. Brass concurring.

Under POMS Section: DI 52120.030, the SSA sets out their rules for Offsets In SIF cases. Under this section, the basic WC payment is offsettable, however, the additional payments which are made from the Subsequent Injuries Fund are not offsettable. Reverse offset applies to SIF payments.

SIF Credits are governed by California Labor Code Section 4753 which provides: California Labor Code Section 4753 Such additional compensation is not in addition to but shall be reduced to the extent of any monetary payments received by the employee, from any source whatsoever, for or on account of such preexisting disability or impairment, except as to payments being made to the employee or to which he is entitled as a pension or other compensation for disability incurred in service in the armed forces of the United States, and except as to payments being made to him or to which he is entitled as assistance under the provisions of Chapter2 (commencing with Section 11200), Chapter 3 (commencing with Section 12000), Chapter 4 (commencing with Section 12500),

Chapter 5 commencing with Section 13000), or Chapter 6 (commencing with Section 13500) of Part 3, or Part 5 (commencing with Section 17000), of Division 9 of the Welfare and Institutions Code, and excluding from such monetary payments received by the employee for or on account of such preexisting disability or impairment a sum equal to all sums reasonably and necessarily expended by the employee for or on account of attorney’s fees, costs and expenses incidental to the recovery of such monetary payments. All cases under this section and under Section 4751 shall be governed by the terms of this section and Section 4751 as in effect on the date of the particular subsequent injury.

SIF is not entitled to Credit for Veteran’s Benefits/Service Connected Disabilities. In Webineer v. WCAB (SIF) (1975) 40 CCC 774 – , the Subsequent Injuries Fund was entitled to a credit for payments made to an injured employee under a Veterans Administration pension and Social Security disability benefits only to the extent to which these payments were for a non-service connected disability which pre-existed the industrial injury. [See also Hanna, California Law of Employee Injuries & Workmen’s Compensation, Vol. 1, § 9.05[4][a].] SIF is entitled to Credit for SSDI benefits for the percentage of SSDI that is related to the pre-existing PD. The formula is (100%-Comp. PD= % x SSDI benefits = offset). The SSDI credit will end once the worker reaches retirement age and SSDI benefit converts to retirement benefits. Calculating the Social Security credit can be rather complex. To properly assess the credit four things need to be known: 1. Date of Entitlement to SSDI benefits and the beginning date of these benefits; 2. Dates and amount of changes in monthly SSDI benefits after deductions; 3. If SSDI benefits have been terminated, the date reason for the termination must be known; finally, 4. Date of Entitlement of Retirement. This information should be obtained from the Social Security Administration. We have seen the information provided on SSA form WNPSC-3070E (9/07).

There is no statute of limitations that directly applies to SIBTF cases. The SIBTF application must be filed within a reasonable time after an applicant knows or reasonably should know that there is a substantial likelihood that he or she has a claim for such benefits. If the SIBTF claim is filed within the five year period under Labor Code Section 5410, it is timely filed (although the five year limitation period described in section 5410 does not apply to claims for SIBTF benefits).The issue is more complex when the SIBTF application is filed more than 5 years after the date of injury. SIBTF cases are often very complex and the filing of an SIBTF application within a reasonable time of a WCAB finding on the issue of permanent disability will be timely if your case is complex and the applicant could not reasonably know there was a substantial likelihood that there was a viable SIF claim before the 5 year mark in LC 5410.

The California Supreme Court issued a number of dispositions in companion cases addressing this issue. It is important to read Subsequent Injuries Fund v. WCAB (Talcott) (1970) 2 Cal.3d 56 [35 CCC 80] together with Subsequent Injuries Fund v. WCAB (Baca)(1970) 2 Cal.3d 74 [35 CCC 94]. The Talcott court held: “That where, prior to the expiration of five years form the date of injury, an applicant does not know and could not reasonably be deemed to know that there will be substantial likelihood he will become entitled to subsequent injuries benefits, his application against the Fund will not be barred – even if he has applied for normal benefits against his employer – if he filed a proceeding against the Fund within a reasonable time after he learns from the Board’s findings on the issue of permanent disability that the Fund has probable liability.”. In Baca, the SIF claim was barred as there was a Petition to Reopen (and thus a WCAB finding on PD) and the applicant did not file the SIF case within a reasonable time of the WCAB finding on PD. If there is a petition to reopen filed and there is any chance of an SIF case, then the SIF case should be filed at the time of the Petition to Reopen or certainly within the 5 year period under LC 5410 or it risks being barred under Baca.

Independent Medical Examination (IME) occurs when a physician who has not previously been involved in a person’s care examines an individual. There is not doctor-patient relationship. IMEs may be conducted to determine the cause, extent and medical treatment of a work-related or other injury where liability is at issue; whether an individual has reached maximum benefit from treatment and whether any permanent impairment remains after treatment. An IME may be conducted at the request of an employer or an insurance carrier to obtain an independent opinion of the clinical status of the individual.

Insurance carriers, auto insurance carriers, and self-insured employers have a legal right tothis request. Should the doctor performing the IME conclude that a claimant’s medicalcondition is not related to a compensable event, the insurer may deny the claim and refusepayment. We respect and care for all the claimants we provide medical-legal evaluationsfor and our physicians are determined to provide the most comprehensive evaluation for you.

A qualified medical evaluator (QME) is a physician who evaluates you when there are questions about what benefits you should receive. A physician must meet educational and licensing requirements to qualify as a QME. They must also pass a test and participate in ongoing education on the workers’ compensation evaluation process. If you have an attorney, you and your claims administrator might agree on a doctor to resolve medical disputes. This doctor is called an agreed medical evaluator (AME). An AME or a panel QME will be used to resolve medical disputes in your workers’ compensation case.

An Agreed Medical Evaluator (AME) is when both parties ‘agree’ on a physician to perform an Independent Medical Evaluation. If you have an attorney, your attorney and the claims administrator may agree on a doctor without going through the California state system used to pick a Qualified Medical Evaluator (QME). The doctor your attorney and the claims administrator agree on is called an agreed medical evaluator (AME)

The Difference between an AME and QME An Agreed Medical Evaluator (AME) is when both parties ‘agree’ on a physician to perform an Independent Medical Evaluation. If you have an attorney, your attorney and the claims administrator may agree on a doctor without going through the California state system used to pick a Qualified Medical Evaluator (QME). The doctor your attorney and the claims administrator agree on is called an agreed medical evaluator (AME)

Qualified Medical Evaluation

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A qualified medical evaluator (QME) is a licensed physician who performs medical evaluations to resolve disputes in workers’ compensation cases. To serve as a QME, doctors must meet strict educational and licensing standards, pass a certification exam, and engage in ongoing education. If both parties agree on … Read more
medical evaluation

Agreed Medical Evaluation

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medical evaluation of patient
An Agreed Medical Evaluator (AME) is a physician selected by mutual agreement between your attorney and the claims administrator to conduct an Independent Medical Evaluation. This process bypasses the state system typically used to select a Qualified Medical Evaluator (QME). When both parties agree, an AME provides … Read more

Independent Medical Evaluation

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An Independent Medical Examination (IME) is a comprehensive medical evaluation conducted by a physician who is not previously involved in a patient’s care. This medical evaluation helps determine the cause, severity, and appropriate treatment for work-related injuries or … Read more
medical reporting

The Subsequent Injuries Benefits Trust Fund (SIBTF)

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agreed medical evaluation
The Guardian Group’s SIBTF Division comprises a team of board-certified medical evaluators and certified physicians who specialize in conducting detailed and comprehensive medical reviews and SIB (Subsequent Injury Benefits) examinations for each applicant. … Read more
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10 · Passing the Torch

What they want the next IMG coming behind them to hear.

I encourage anyone pursuing this journey to work with a company like The Guardian Group or another organization that provides similar mentorship, clinical experience, and networking opportunities.

Working alongside experienced physicians allowed me to gain valuable U.S. clinical experience while building meaningful professional relationships. Just as importantly, I was surrounded by coworkers who were on the same journey. During my application season, around seven or eight of my coworkers matched into residency. We shared information, supported one another, practiced together, and learned from each other’s experiences.

Being part of that kind of environment makes the journey much easier. If you have the opportunity to work with a similar organization, you’ll have access to resources, mentorship, and a support system that can make a tremendous difference throughout your residency journey.

I followed a very unorthodox path to get where I am today. When I first joined The Guardian Group, it wasn’t something people normally associate with medical training. Most people think the path is medical school, residency, then practice. My journey looked very different, and not everything I did was directly related to medicine.

My advice is to begin with the end in mind. Know where you ultimately want to be, then build the path using the opportunities and resources available to you. That path will look different for everyone. For me, working at The Guardian Group became part of my journey. For someone else, it may be a completely different opportunity. The important thing is to keep your goal in mind and continue building toward it using whatever opportunities come your way.

From the outside, the preparation may seem overwhelming, but once you’re in the process, you’ll realize it is achievable. It requires consistency, persistence, resilience, and patience.

Having a study partner or a group going through the same journey is incredibly valuable because you can support each other and share experiences.

My biggest advice is to stay persistent, be resilient, remain patient, and focus only on the things you can control. If you do that consistently throughout the process, I’m confident you’ll be successful by the end of your application journey.

Don’t stress too much during the period between submitting your application and receiving interview invitations. Some applicants don’t receive interview invitations until December because residency programs genuinely take the time to review every application carefully to determine whether a candidate is a good fit.

Remember that it’s a two-way process. You’re looking for a program that aligns with your goals, and the program is looking for residents who fit their culture and mission. Understanding both your own goals and the program’s goals will help you find the right match in the long run.

First, I want to congratulate everyone who’s decided to pursue this journey. It’s a huge step in your career, and although it can feel long, trust that your inner strength will guide you through it.

There will be a lot of studying, networking, and communicating with mentors, physicians, and peers. Build those connections as early as you can because they’ll continue to help you throughout your journey and become lifelong relationships.

There will be emotional days. Some days you’ll feel exhausted, while others you’ll feel proud of how far you’ve come. Looking back on my own journey, I’m most grateful for the people who supported me and made me feel loved throughout the process. Hold on to those people because they’ll continue to be your strength, both during and after your journey.

Believe that your goals are achievable, even when the journey feels difficult. Being an international medical graduate comes with many challenges, but it also gives you unique strengths. We become adaptable, resilient, and bring cultural diversity to every program we join. The life experiences we’ve gained in our home countries add value to the healthcare system and to the patients we’ll eventually care for.

Stay consistent, seek support whenever you need it, and don’t let temporary setbacks define your journey. Most importantly, remember that this process isn’t just about matching into a residency program. It’s about becoming the physician you’ve always dreamed of becoming.

Wherever you are in your journey right now, make sure this is truly what you want because it’s a difficult process. It requires a significant financial investment, but beyond that, it also requires time. Spend as much time as you can with your family because, at the end of this journey, you may leave your home country to train in the United States. I’m grateful I was able to prepare myself for that by spending meaningful time with the people I love before leaving.

My final advice is to rest if you must, but never quit. There will be moments when the process feels overwhelming, but keep your eyes on your goal and do your best every day. You don’t have to accomplish everything in one day. Just continue moving forward one step at a time.

My biggest advice is not to overcomplicate the process. Focus on completing your Step exams first, stay consistent, don’t delay the important things, and start planning as early as possible.

Most importantly, don’t compare yourself to others. Everyone’s journey is different, and everyone has different goals. Stay persistent, ask for help whenever you need it, and trust the process. I was able to match, and many other international medical graduates have matched as well. If you stay consistent, start early, and keep moving forward, you can achieve your goal too.

09 · What Nobody Told Me

The surprises no guide had warned them about.

One thing I didn’t fully appreciate at the beginning was how important it is to present yourself professionally. It’s not just about your clinical knowledge or your grades. Every doctor applying to residency is intelligent. What helps set you apart is your ability to communicate, present yourself professionally, and show people who you are.

Knowing yourself is just as important as knowing your scores. Being able to present yourself honestly while highlighting your strengths is a skill that I wish I had taken more seriously from the beginning.

If I could go through the process again, I would focus more on enjoying the journey instead of stressing over every small detail. As IMGs, we often put a tremendous amount of pressure on ourselves to make everything perfect.

I’ve learned that consistency, resilience, and adaptability are much more important than perfection. I also believe it’s important to start preparing for interviews early so you can improve your communication skills, and to begin the entire journey as early as possible.

I wish I had known that there would be days when I would question whether I had made the right decision to pursue a medical career outside my home country. Some days felt lonely, but I learned to lean on the support of my loved ones and the peers I met throughout the journey.

This is a road that not many graduates from my school or my country choose to take. Trusting the accomplishments you’ve already achieved and drawing strength from the people who believe in you are essential. It’s a big decision, and you’ll need courage and resilience throughout the process.

When I first started studying, I thought the exams would be the hardest part of the journey. After going through everything, I realized the process only becomes more challenging. After the exams comes the application season, where you have a short period of time to research programs, understand their culture, and learn about their curriculum. Then comes interview season, where you constantly have to present the best version of yourself.

The entire journey brings a lot of stress and anxiety, and it can take a toll on your mental health. It’s really a marathon rather than a sprint. Every stage has its own challenges, and I don’t think one part is necessarily harder than another. Even after matching, there are still visa requirements and many other steps before you can finally begin residency in the United States.

One thing I didn’t realize at the beginning was how expensive the residency application process would be, especially for international medical graduates. Many of my friends were surprised by the cost as well.

When I applied to around 150 programs, every application required a fee. The first thirty applications for each specialty cost around ten to eleven dollars each, while the remaining applications cost around thirty dollars per program. Understanding those expenses early allows you to budget properly, and budgeting ahead will help you throughout the application process.

One thing that completely caught me off guard was learning that some residency programs require very recent letters of recommendation. Some programs wanted letters that were written within six months of the application period.

That’s another reason why researching programs early is so important. If you already know those requirements ahead of time, you won’t have to go back to your letter writers and ask them to update or rewrite their letters during application season.

One thing I wish I had known earlier is that the application process is truly holistic. It’s not just about exam scores. Your interview skills, letters of recommendation, work ethic, professionalism, communication skills, and the way you present your experiences all play an important role.

I also didn’t realize how long many parts of the process take. My pathway approval, document collection, and letters of recommendation all took much longer than I expected. Even a single letter of recommendation can sometimes take a month to be uploaded. That’s why it’s always better to start earlier than you think you need to.

When I first started, I assumed that I couldn’t apply without ECFMG certification. Later, I learned that if you have completed Step 1 and Step 2, you can still apply. ECFMG certification is required by the ranking period rather than when you initially submit your application.

If I had known that earlier, I could have applied during the previous cycle. I think it’s important for applicants to know that they can apply before becoming ECFMG certified, as long as they complete the certification before the ranking process.

08 · If I Could Do It Again

What they would change, with hindsight.

The most difficult part for me was the anticipation during interview season. You have to learn how to stay calm and trust the process.

The journey itself is demanding, so it’s important to take care of yourself. Exercise regularly, eat well, spend time with family and friends, and continue doing hobbies you enjoy. Balancing full-time work while preparing for residency requires a lot of energy, so maintaining a healthy lifestyle is essential.

I also believe interview preparation should begin much earlier than most people think. If English isn’t your first language, practicing your communication skills early will make a significant difference in your confidence and performance during residency interviews.

Looking back, I would have started my ERAS application much earlier. I would have begun writing my personal statement and completing the online application sooner so I could receive more feedback from my peers and mentors.

I also would have reached out earlier to other people going through the same process. At the time, I didn’t know many graduates from my school or my country who were pursuing U.S. residency. Connecting with others who share the same goal not only provides guidance but also gives you reassurance that you’re not going through the journey alone.

The biggest thing I would do differently is try even harder on my exams. Higher scores open more opportunities because some residency programs have score cutoffs before they even review your application. I’d rather have the opportunity to apply anywhere I want than have certain programs automatically closed off because my score wasn’t high enough. I encourage everyone to do their absolute best on the exams because they create more possibilities later in the process.

Overall, I would still do my best to fulfill all the requirements. The one thing I would change is how I prepared for Step 2. I studied system by system, which took much longer and prevented me from completing every system before taking the exam.

I would definitely start researching residency programs much earlier and begin writing my personal statement sooner. Writing the personal statement was surprisingly difficult because I had to find the right words to describe my strengths without sounding like I was simply complimenting myself.

I talked with colleagues, friends, and former coworkers to better understand the qualities they saw in me that made me a good student, employee, and friend. Their feedback helped me write a much stronger personal statement.

I also wish I had started researching programs earlier so I could better identify hospitals that aligned with my long-term goals. For example, if you’re interested in obstetrics but a program doesn’t offer that kind of training, it probably isn’t the right fit. Starting earlier helps you avoid wasting both your time and the program’s time.

If I had the opportunity to do everything again, I would complete all of my Step exams as quickly as possible – ideally within one year – and then focus on research, work experience, and letters of recommendation.

I would also spend much more time preparing my ERAS application, especially my personal statement and experience sections. Those parts take much longer than most people expect, and when you’re focused on studying for exams, it’s easy to neglect them. Looking back, balancing both preparation and the application earlier would have made the process much smoother.

I honestly can’t think of one single difficult part because the entire process is difficult. If I could give one piece of advice, it would be to always ask for help whenever you need it. We all started this journey without knowing exactly what to do. Many of us didn’t have connections or physicians in the United States to guide us, but that shouldn’t stop you because there are many people willing to help.

Now that I’ve gone through the process, I’ve started helping people I know who are applying in the next Match cycle. Having someone who can guide you through the application, review your personal statement, and answer your questions makes the journey much easier. It’s also one way we can give back to the IMG community.

07 · The Toughest Hurdle

The part that nearly stopped them, and what got them through.

For me, the most challenging part was the interview process. Coming from a different country meant I had to understand a different social and cultural context. Even within the United States, different states have different ways of communicating and interacting. I put a lot of effort into understanding those differences so I could relate better to the people interviewing me and, eventually, to the patients I would be caring for.

I realized early on that practicing medicine in the Philippines is very different from practicing medicine in the United States. I wanted to show interviewers that I was learning, adapting, and committed to understanding both systems. Learning those differences and then presenting that growth during interviews was the most difficult part of my journey, but I believe it ultimately helped me succeed.

The journey is long, demanding, and challenging. The hardest part for me was the uncertainty. You work so hard throughout the process, but you don’t know the outcome until Match Day.

To overcome that, I focused only on the things I could control. I concentrated on becoming the best applicant I could be and making sure I fulfilled every requirement for the application.

I would encourage everyone not to focus on the uncertainty. Instead, keep moving forward, complete everything you can, and believe in yourself. The process requires both time and money, but it is achievable if you stay focused and keep pushing forward.

The hardest part of the process was dealing with the uncertainty. The journey takes two or three years to complete when you include exams, clinical experience, applications, and everything else. If you’re also balancing a family or a full-time job, it naturally takes even longer.

What helped me was staying focused on my ultimate goal. I remained motivated throughout the process and kept reminding myself that my dream was to become a physician in the United States.

I’m still someone who gets nervous during interviews because I’m naturally an introvert. What helped me the most was practicing interview questions with another person and asking for feedback on how I structured my answers.

One technique that really helped me was the STAR method – Situation, Task, Action, and Result – especially when answering behavioral questions. I also learned that getting out of my own head and simply being present during the interview made a huge difference.

I tried to move through the process too quickly because I wanted to stay within the five-year graduation benchmark required by many residency programs. Looking back, I wouldn’t rush.

Instead, I’d encourage anyone starting this journey to begin with small, consistent steps. Even studying for thirty minutes a day or completing ten practice questions each day makes progress.

I would also recommend connecting early with graduates from your medical school or physicians already in U.S. residency programs. You can even reach out through LinkedIn. Having mentors who have already gone through the process provides valuable guidance, helps you avoid mistakes, and may even shorten your path to residency. Networking early is one of the best investments you can make.

To be honest, the hardest part wasn’t the USMLE exams. It was the entire application process. Many people think the exams are the hardest part, but I actually found the ERAS application, writing my personal statement, obtaining pathway approval, organizing documents, getting the ERAS token, writing my experiences, and making sure everything was completed on time to be much more difficult.

The application has so many moving pieces that I strongly recommend beginning your planning around June if you’re applying that cycle. I got through the process by asking people who had already completed it and by using online resources. Talking to senior applicants helped me avoid mistakes and better understand what to expect.

The most demanding part for me was researching programs that aligned with both my qualifications and my career interests. I probably spent the majority of my application season doing that research.

There are great resources available, such as FREIDA, that you can start using early. Once the ERAS token becomes available, you can also use Residency Explorer through the AAMC to compare programs and determine which ones best fit your goals.

I would complete all three Step exams before applying. During my application cycle, I wasn’t able to take Step 3. Although it’s not required to apply for residency, I think completing all three exams makes your application stronger.

You’ll eventually need to take Step 3 during residency, and finding time to study while working long hospital hours is much more difficult. Looking back, I would have prepared for and completed Step 3 before starting residency.

06 · In the Hot Seat

What interviews were actually like on the day.

My biggest advice is to really think about your experiences and reflect on who you are and what you’ve done over the years. It sounds simple, but it’s actually difficult. During my first interview, I thought I knew exactly what I wanted to say, so I didn’t practice. Once I started answering questions, I realized that knowing what to say is very different from knowing how to say it. It isn’t just about telling the truth – it’s about presenting your experiences in a way that highlights your strengths and shows how you’ve overcome challenges.

I spent time practicing with my wife. She would ask me common interview questions so I could think about my answers, organize my thoughts, and practice communicating them clearly. Even small things like transitioning between topics or enunciating certain words became important.

My first interview was difficult because I was underprepared, but every interview after that became easier. I realized the interviewers already knew my academic background from my application. What they really wanted was to know me as a person – how I work with others, how I communicate, and how I handle stressful situations. I tried to highlight experiences that showed I was a good teammate, someone who communicates well under pressure, and someone people enjoy working with.

One final piece of advice is to be yourself. Programs don’t want to see someone who only talks about medicine. They want to know your hobbies, interests, and the things that make you who you are. I shared what I enjoy doing outside of medicine, and I think that helped them see me as a real person rather than just another applicant.

After submitting your application, I believe the interview becomes the single most important factor in determining whether you’ll match into a residency program.

One thing that helped me tremendously was practicing interviews with other doctors who were going through the residency application process at the same time. We met almost every day for thirty minutes to an hour to conduct mock interviews. We shared questions we had been asked by different residency programs and practiced answering them together.

Those sessions greatly improved my communication skills and helped me clearly explain my journey and qualifications to residency faculty and admissions committees. If possible, practice with people who are applying during the same cycle. If not, practice with family members, friends, or coworkers. The important thing is to practice because interviewing is a skill that improves with repetition.

I honestly think interviews are the most important part of the process because, by that stage, most applicants already have solid applications. Programs want to understand who you are as a person. One thing I didn’t realize at first was how many scenario-based questions programs ask during interviews.

You can find many practice questions online, and I also recommend using AI tools to practice. After submitting your application, practice every day with friends, family, seniors, or anyone who’s willing to help.

During the interview itself, just be honest. Authenticity matters a lot. Interestingly, the program where I ultimately matched was the interview where I was completely honest. That experience taught me that you don’t always need the perfect answer—you just need to be genuine.

I recommend starting your interview preparation very early because it takes time to become comfortable. Practice the most common interview questions, which you can easily find on Reddit, YouTube, and many other resources online.

The most important thing is practice. Practice your communication skills and learn how to express yourself genuinely to the Program Director or Associate Program Director. The more you practice, the more naturally you’ll be able to present yourself during the interview.

One thing that really helped me was having a study partner from my home country. We prepared together for Step 1, Step 2, and Step 3. Having someone going through the same journey kept me motivated and accountable.

I also had an interview practice group made up of applicants from my country. Every day from 5:00 to 7:00 p.m., we practiced common interview questions. One person acted as the interviewer, another as the applicant, and the rest served as the interview panel. Practicing every day helped me build confidence and develop structured answers.

I also worked with a professional interview coach who gave me valuable feedback. Within our group, we constantly shared new interview questions and discussed how we would answer them.

I would encourage everyone to find a study or interview group if possible. During the interview, it’s your opportunity to show who you are, how motivated you are, and what you can contribute to the program.

One challenge I faced during interviews was that I’m naturally shy, and English isn’t my first language. During virtual interviews, I sometimes found it difficult to express myself because it’s harder to show emotions through a screen.

What helped me most was practicing with my friends through Zoom and Google Meet so we could simulate real interviews. Even if you don’t have someone to practice with, you can rehearse in front of a mirror and observe how you speak and present yourself. There are also many online resources that list common interview questions, so you won’t be surprised by unexpected questions during the interview.

Programs often ask behavioral questions because they genuinely want to know who you are. My biggest advice is to be yourself. Don’t try to become someone you’re not because experienced interviewers will recognize that immediately. Stay calm, be genuine, and simply do your best in every interview.

During most of my interviews, the questions focused much more on my personality than on my medical background. I think the interviewers already knew my academic achievements, grades, extracurricular activities, and experiences from reading my application. What they really wanted to know was who I was as a person and whether I would fit well within their program.

My advice is to be genuine during the interview. Let your personality show so that both you and the program can determine whether you’re a good cultural fit for each other. There’s no benefit in pretending to be someone you’re not because you’ll eventually spend years training with those people.

One of the most challenging parts of the process was writing my personal statement because I wanted it to genuinely reflect who I am. I revised it many times and asked other people to read it and provide feedback. There were moments when I felt it wasn’t good enough, but hearing from others that my authenticity came through gave me confidence to keep going.

Another challenge was overcoming my nerves during interviews. I truly believe that a good personality can outweigh perfect exam scores and even a polished application. Once you’ve earned the interview, you’ve already gotten your foot in the door. At that point, it’s important to trust your accomplishments and believe in everything you’ve achieved.

05 · Beyond the Books

Research, observerships, and what the score doesn't show.

For me, letters of recommendation made the biggest difference. During my time at The Guardian Group, I worked with many physicians and built strong relationships with them. They trusted my work enough to confidently recommend me and say that I would be a good fit for residency.

Many residency programs view international medical graduates as a risk. Having respected physicians who know your work personally and can endorse you helps reduce that uncertainty. I earned those recommendations by building genuine relationships, networking, and consistently doing my job well every day.

One of the greatest advantages of working at The Guardian Group was gaining high-quality U.S. clinical experience while interacting with physicians from both the specialties I applied to and many other specialties. Those experiences strengthened my application tremendously.

The letters of recommendation I received from those physicians also had a significant impact. If I had to prioritize these factors, I would put U.S. clinical experience first. I recommend completing at least three months of clinical experience, preferably in a hands-on role whenever possible.

Letters of recommendation from U.S. attending physicians—especially those in the specialty you’re applying to—are extremely valuable, particularly if they’re well-known within residency education. Research is also an important part of a strong application because it helps make your overall profile more well-rounded.

One of the biggest misconceptions is that exam scores alone guarantee success. There are many other factors that are equally important.

U.S. clinical experience is extremely valuable because it teaches you how the healthcare system works, how documentation is done, and how multidisciplinary teams function. For me, documentation and working alongside departments like social work and case management were completely new experiences compared to what I was used to in Iraq.

Letters of recommendation are also very important because they give residency programs insight into your work ethic, professionalism, and how you’ll function clinically. Building strong relationships with faculty and residents during your rotations allows them to write recommendations that genuinely reflect who you are.

Even if you don’t have extensive research experience, don’t let that discourage you. There are many different factors that contribute to becoming a strong residency applicant.

Step exam scores alone are not enough. Applicants should also have U.S. clinical experience through observerships, externships, or hands-on clinical experiences. This helps you understand the U.S. healthcare system, electronic medical records, consultations, and medication reconciliation. If possible, completing more than three months of U.S. clinical experience is even better, and hands-on externships generally carry more value than observerships.

Volunteer work is also an important part of the application. Strong letters of recommendation can significantly increase your chances of receiving interview invitations.

Research publications are especially important if you’re applying to university-based programs. Even for community-based programs, it’s beneficial to have at least two or three publications. Applicants should work on all of these areas alongside preparing for their exams.

Since Step 1 is now pass/fail, I think scores matter much less unless you’re applying to a highly competitive specialty. I wouldn’t spend years trying to improve a score slightly while increasing your years since graduation. If you’re passing everything on your first attempt, it’s better to complete your exams quickly and focus on strengthening the rest of your application.

For me, letters of recommendation made a huge difference. I’m very grateful for the letters I received through my work as a Medical Assistant at The Guardian Group. Strong recommendations from physicians who truly know your work ethic carry a lot of weight.

When it comes to research, I think people sometimes overthink publications. I recommend joining LinkedIn groups, reaching out to researchers, and getting involved in projects. I don’t think author position matters as much as demonstrating genuine interest in research. From what I understand, future Match cycles will focus more on research experience rather than simply the number of publications. My advice is to prioritize your Step exams first, then strengthen your application, work on your personal statement, secure strong letters of recommendation, and finally pursue research opportunities.

Research is very program-dependent. If you’re applying to an academic center where the goal is to produce new research and scientific findings, then research becomes much more important.

What I found to be even more valuable was networking with the right people—not just physicians, but also nurses, administrators, and anyone who could help introduce you to a program. Those relationships can help open doors and even increase your visibility during the application process.

I actually learned the importance of networking after my application cycle ended. Physicians and other professionals would tell me about programs they knew well and suggest places where they thought I would be a good fit. Looking back, I wish I had understood the value of networking much earlier in the process.

I believe a strong application should be well-rounded. It’s not just about your exam scores, OET, or pathway requirements. One of the things that strengthened my application was my experience at The Guardian Group, where I had the opportunity to work with physicians from different specialties throughout Southern California. That gave me unique experiences with different patients, which became valuable talking points during my interviews and strengthened my understanding of the U.S. healthcare system.

Strong letters of recommendation also played an important role. Building good relationships with the physicians you work with allows them to speak about your work ethic and why you’d be a good fit for residency. Those recommendations can leave a strong impression on program directors. I also included experiences outside of medicine, such as volunteering in church, singing in our medical school choir, and being involved with a nonprofit organization. Those experiences made my application more well-rounded and gave me meaningful topics to discuss during interviews.

When programs review your application, they first see how strong you are on paper. One of the biggest things I focused on was my personal statement. It’s your opportunity to introduce yourself, explain why you wanted to become a doctor, share your story, and describe the kind of physician you hope to become. I spent a lot of time making sure my personal statement reflected who I truly am.

U.S. clinical experience is another valuable part of an application. Although it’s not required by every hospital, it helps you understand how the U.S. healthcare system works, how insurance functions, and how physicians communicate within the healthcare team. It also gives you a better understanding of the clinical environment before you begin residency.

04 · Picking Your Programs​

How they chose where to apply and how many.

I’m based in California, and my wife and I had many conversations about where we wanted to live before I submitted any applications. That discussion was important because moving to another state would affect both of us, not just me. If you’re going through this process with a significant other, it’s important to make those decisions together.

I applied to around 80 programs. As an international medical graduate, you need to cast a wide net because some programs don’t consider IMGs, while others have score cutoffs or specific requirements. I wanted to stay in California because that’s where we’ve built our lives, and my wife also works here.

I also preferred community-based programs over academic programs because I felt they would provide the kind of training I was looking for. I wanted strong inpatient experience along with exposure to obstetrics and gynecology, pediatrics, and other areas so I could become a well-rounded physician. Every applicant should consider the type of training they want and find programs where they realistically fit.

I applied to both Family Medicine and Internal Medicine programs, with a total of around 150 applications. I wanted to apply broadly so I would have more opportunities.

The first thing I considered was location. I wanted to train either on the East Coast, particularly New Jersey and New York because they’re generally more IMG-friendly, or in California, where my home is. I also looked at the diversity of each program because I wanted to train in an environment with residents from backgrounds similar to mine.

Another important factor was each program’s graduation-year requirement. At the time I applied, I was approaching five years since graduation, and many residency programs have a four- or five-year graduation cutoff. I also considered their Step score requirements when deciding where to apply.

As an IMG, I applied broadly to maximize my opportunities. I submitted applications to nearly 180 programs. I know that’s much higher than what most U.S. graduates apply to, but for international graduates, applying to around 150 to 250 programs is fairly common.

The first thing I looked for was whether a program was IMG-friendly. I also considered the learning environment, the geographic location, and whether it would be a good place for me and my family to live. I looked at opportunities for professional growth, including fellowship placement after residency. Another important factor was whether the program had experience training residents from diverse backgrounds because transitioning into a new healthcare system is already a major adjustment, and having a supportive environment makes a difference.

I applied to both Internal Medicine and Family Medicine programs. In total, I submitted applications to 150 programs—more than 100 in Internal Medicine and 50 in Family Medicine.

As an international medical graduate, my primary criterion was selecting IMG-friendly programs. I used Match A Resident and FREIDA to filter programs based on graduation year, Step scores, and IMG friendliness. After narrowing down my list, I visited each program’s official website to review their requirements and preferences.

I also considered how diverse the resident population was, the educational structure, faculty support, curriculum, and the balance between inpatient and outpatient training. All of these factors helped me decide where to apply.

My situation was a little different because I participated directly in the SOAP process after missing the regular Match application cycle. During SOAP, I received five interviews and thankfully matched into Internal Medicine at SOVAH Health Danville.

One thing I really want people to understand is that the ERAS application looks simple from the outside, but it’s actually a very long and time-consuming process. It’s not something you want to leave until the last minute. During your free time, look at what the ERAS application actually contains. Learn what goes into each section, including your experiences, meaningful activities, and personal statement.

Letters of recommendation take time to upload, pathway approvals can be delayed, and many parts of the application move much more slowly than expected. Ideally, everything should be completed by the first week of September. Even if you’re still early in the process, start familiarizing yourself with the application so there are no surprises later.

When I was preparing, I didn’t realize how many sections the application contained or what I should include in my experiences. Looking back, researching the ERAS application much earlier would have made the entire process much easier. Preparing for the Step exams is only one part of the journey. It’s easy to overlook the application itself while studying, so learning about it early can save you a lot of stress.

I applied to more than 100 programs. Although it seems like a lot, I still researched each one carefully. One of the biggest factors I considered was whether I had a good support system nearby, including close friends or family.

Now that I’m a resident, I realize how valuable that support system really is. Residency can be very stressful, and while many people rely on you, it’s also important to have people you can rely on. Having family and close friends nearby was one of the biggest reasons I chose the programs I applied to.

I applied to around 150 Family Medicine programs. It was a significant financial investment, but I knew Family Medicine was the specialty I wanted to pursue, so I wanted to maximize my chances of matching.

The biggest factor for me was geographic location. I wanted to train and eventually build my practice in California, so most of the programs I applied to were in California, with a few in neighboring states. I also looked closely at each program’s culture and curriculum by reviewing their websites, reading resident and alumni testimonials, and looking into the research opportunities, electives, and other experiences they offered.

I spoke with many of my seniors from medical school and from the preceptorship I completed in Hawaii before deciding to apply to about 200 programs.

I really researched every hospital before applying because each application comes with a fee, and I didn’t want to waste the opportunity. I wanted to understand each program through its website and by talking to people who trained there. One thing that was very important to me was whether the program accepted physicians from different ethnic backgrounds. Coming from a different culture, I wanted to feel that international graduates were welcomed. I also considered whether my scores matched the program’s expected range and whether the overall culture of the hospital was somewhere I could see myself spending the next three years of training.

03 · Getting Test-Ready

How they prepared, and how they knew they were ready.

The exams were difficult because they required a different style of learning than what I was used to in medical school. Back then, there was a heavy emphasis on memorizing facts. For Step 1 and Step 2, what really mattered was understanding concepts and applying them to clinical situations. You still needed to know the facts, but understanding what was happening and figuring out how to help a patient was much more important.

Doing question banks every day helped me the most because they not only reinforced knowledge but also taught me how to think through clinical problems. Step 1 focused more on the basic sciences, which was challenging because it had been a while since I had studied those subjects. Step 2 focused more on clinical knowledge and the situations you actually encounter in the hospital, so the mindset shifts between the two exams. Having a strong foundation in the basic sciences made Step 2 much easier. I would also recommend taking Step 2 shortly after Step 1 so that foundation remains fresh.

The best strategy is to plan ahead. Create a schedule for completing your question banks, taking your NBME self-assessment exams, and deciding when you’ll sit for the actual exam.

One of the advantages of the USMLE is that the NBME offers self-assessment exams that allow you to evaluate your readiness and estimate your expected score, especially for Step 2. Those assessments helped me understand where I stood and whether I was ready before scheduling my exam.

Another important difference is that Step 1 is now pass or fail, while Step 2 is scored. Your Step 2 score plays a significant role in residency applications, so performing well on that exam is very important. Taking multiple self-assessments before the real exam helped me identify my strengths, recognize areas that needed improvement, and determine when I was ready to test.

My preparation was built on consistency and practice questions. I focused on reviewing each question carefully, studying the explanations from the question bank, and identifying my weak areas.

One thing I learned is that readiness isn’t about feeling 100% confident before the exam. For Step 1, I relied heavily on my NBME self-assessment scores. Once I was consistently scoring above 70%, I felt ready to schedule the exam.

For Step 2, I looked at the score range expected for the specialty I wanted to apply to. Once my self-assessment scores consistently fell within that range, I felt confident enough to move forward with the exam. That’s what worked for me, although everyone’s experience may be different.

Step 1 was very different from Step 2 because it mainly focused on the basic sciences. Since I graduated in 2017, there had been a gap between learning the basic sciences and preparing for the exam, so it required much more intensive preparation. It took me around eight to ten months.

For Step 1, I used multiple resources including UWorld, Amboss, Boards and Beyond, Sketchy Microbiology and Pharmacology, and First Aid. Since Step 1 is now pass/fail, I don’t think people should spend too much time preparing. Once your performance is consistently around 75% or higher and you feel confident, it’s time to take the exam. As an IMG, failing Step 1 is a significant red flag, so it’s important to be well prepared. Fortunately, I passed on my first attempt.

For Step 2, UWorld was my primary resource. Since the exam focuses on clinical knowledge, I found it much easier because we already have clinical experience after graduation. I recommend starting with mixed questions from day one instead of studying system by system. After completing about half of the question bank, take an assessment to identify your strengths and weaknesses, continue improving your scores, and then schedule the exam when you’re consistently performing well.

Step 3 was not as difficult, but I recommend paying close attention to the CCS clinical cases and practicing them as much as possible.

One thing that really helped me was taking Step 2 immediately after Step 1 because a lot of the knowledge was still fresh. Step 1 focuses more on the fundamental sciences and concepts, while Step 2 CK is much more clinical and management-based. You’re thinking more about patient care, diagnosis, and the next best step.

My preparation mainly involved using the UWorld Question Bank, taking self-assessments, and consistently reviewing my weak areas. I would definitely recommend not taking a long break between Step 1 and Step 2 because you’ll forget much of the knowledge you gained from Step 1, and that foundation is very important for doing well on Step 2.

I used a lot of the study resources that are already available online, including UWorld, AMBOSS, YouTube, and NBME self-assessment exams. There are many YouTube channels that explain pathology, disease management, and high-yield concepts. After completing question blocks from UWorld or AMBOSS, I used the NBME exams to validate that I was understanding the material correctly. Once I consistently demonstrated that knowledge, I felt ready to schedule my exam.

Step 1 focused on understanding the mechanics, pathology, and physiology of the human body. Step 2 built on that foundation by applying those concepts to clinical scenarios. Instead of simply knowing the science, you needed to identify the correct diagnosis and determine the appropriate management plan based on the patient’s symptoms and objective findings. I think having a strong foundation from Step 1 carries over and makes Step 2 much easier.

I used a variety of study resources that most people preparing for the USMLE are familiar with. The resource I relied on the most for both Step 1 and Step 2 was the UWorld Question Bank because it helped me develop the thought process needed to answer questions correctly. I also reviewed Anki flashcards every day to reinforce what I had learned.

For Step 1, I also used First Aid, Pathoma, and Sketchy Medical. For Step 2, I continued using UWorld and Anki but added the AMBOSS Question Bank and library. Toward the end of my preparation, I took NBME practice exams to assess my readiness. Once I was consistently getting satisfactory results, I knew I was ready to take the exams.

I don’t think you’ll ever truly feel prepared because it’s one of the most difficult exams I’ve taken throughout my medical journey. I’m the type of person who prefers focusing on a few study materials and mastering them instead of using many resources without fully understanding them.

For Step 1, I mainly used the UWorld Question Bank for two months. Once I started reaching my target scores, I took the NBME practice exams to monitor my progress. When I consistently achieved my target passing scores, I booked my exam.

The difference between Step 1 and Step 2 is significant. Step 1 focuses on the basic sciences, while Step 2 focuses on clinical sciences, including internal medicine, surgery, and the major medical specialties. Personally, I found Step 2 more difficult because, although Step 1 is pass or fail, Step 2 is scored, and those scores are important for residency applications. Different programs have different preferred score ranges. Even if you don’t reach your target score, passing the exam is still an accomplishment because there are many other ways to strengthen your application.

02 · Juggling It All

Fitting study, work and the application into the same week.

I was very lucky when I started working for The Guardian Group as a Medical Assistant because I had an open conversation with my boss about my goal of pursuing residency. He was very supportive throughout the process. Working full-time while studying and preparing all the paperwork was extremely difficult, but having a supportive boss and coworkers made a huge difference. My wife and my brother also supported me by giving me the space I needed to study and helping me through difficult days.

Beyond that, discipline and resilience were essential. There was no shortcut. It was about sitting down every day, reading my books, working through question banks, and consistently putting in the effort. That daily discipline helped me get through the entire process.

Time management is the most crucial part of this process. I completed all of my exams while working a full-time job, so I had to make the most of my schedule. After work, I would go home, take a shower, and study for three to four hours every weekday. I also tried to maximize my weekends for studying.

At the same time, I believe it’s very important to maintain a balance between studying and social interaction. People should stay involved in activities like fitness, going to the gym, spending time with friends and family, or doing adventures. During my preparation, I enjoyed activities like river rafting and skiing because they helped me recharge and avoid burnout.

The process can become exhausting in the middle, so maintaining that balance while staying focused on your study goals and timeline is essential. Time management and consistency are very important.

Time management became one of the most important skills I learned during this journey. I was preparing for Step 1 while working in the hospital, and my schedule was very busy. Even on long workdays, I made sure I accomplished something that moved me closer to my goal.

I didn’t try to study for extremely long hours every day. Instead, I focused on dedicating part of each day to studying so I could stay on track and take my exam within the timeline I had set for myself.

At first, I had a difficult time figuring out what schedule worked best for me. I was very fortunate that my work schedule with The Guardian Group was flexible, which allowed me to study during my days off by answering UWorld question banks, reviewing Anki flashcards, and going over my mistakes.

What worked best for me was creating a daily timetable and setting weekly goals. At the same time, I made room for days when I couldn’t accomplish everything I had planned. I learned to give myself grace, recognize my small wins each day and throughout the week, and stay flexible whenever changes came along.

For me, it was all about prioritization while I was studying for the exams and completing my application. I always prioritized tasks that were more urgent or had immediate deadlines. Then I considered how much time each task would require. If something would take several hours and had to be completed right away, I focused on that first. Smaller tasks were saved for the breaks in between the larger ones.

When I was working at The Guardian Group while completing my applications, I knew there were assignments that required more time and attention, so I tackled those first. Whenever I had free time between those larger responsibilities, I used it to complete the smaller tasks. That’s how I managed to stay on top of everything.

It was quite difficult at the beginning, but time management made a huge difference. One strategy that really helped me was breaking large tasks into smaller, manageable pieces. After finishing my full-time workday, I usually studied for about an hour and a half, sometimes two hours at most. I used my weekends and holidays to study longer whenever I could.

Later, when I transitioned to remote work, I gained extra time because I no longer had to commute. I used those additional hours for studying. If you can manage your time well, it’s possible to balance full-time work, studying for the USMLE, and preparing your residency application at the same time.

I studied for Step 2 CK while completing my U.S. clinical experience in New York, so balancing everything definitely required planning. I stayed disciplined and studied whenever I had free time. Some days were more difficult than others, but staying consistent helped me keep moving forward.

After completing Step 2, I joined The Guardian Group as a Medical Assistant. At that point, I was able to focus more on strengthening my application, gaining clinical experience, and building relationships that eventually led to strong letters of recommendation.

The whole USMLE journey is quite expensive, so I had to work while studying for my Step exams. During the two years I worked in the hospital, I saved as much money as I could to pay for Step 1 and Step 2. After I resigned, I studied full-time for three months because I’m the kind of learner who can’t multitask. I really wanted to focus on the exam before doing anything else.

After I passed Step 1, I took a break because studying for that long takes a toll on your mental health. I worked for about six months before taking another leave of absence to spend three more months preparing for Step 2.

01 · First Things First

Where to begin when the whole thing still feels enormous?

The best advice I received when I started my own journey was from a colleague who asked me a very simple question: whether I really wanted to do this. The path for an international medical graduate is difficult. It isn’t a straight path – it has a lot of twists and turns, and it can be exhausting.

That question made me stop and really reflect on what I wanted. Once I decided that this was truly what I wanted to pursue, committing fully to that path made everything much easier. For anyone starting this journey, that’s the first question you should honestly ask yourself: what do you really want out of life?

The biggest advice I can give is that it’s doable. It may seem like a long and difficult journey, but every step you take moves you closer to your goal. Stay optimistic, focus on what you can do today, and keep moving forward one step at a time. That mindset really helps throughout the entire process.

The biggest advice I can give is that it’s doable. It may seem like a long and difficult journey, but every step you take moves you closer to your goal. Stay optimistic, focus on what you can do today, and keep moving forward one step at a time. That mindset really helps throughout the entire process.

I think it’s a long process. It’s really demanding in terms of time and money. But at the same time, I wanted to emphasize that this is a doable process. If I’m doing it, anyone behind me can do it.

I would encourage them to start as soon as possible, be patient throughout the process, and focus on things that they can do to their best. I think with all these things, this process is doable and it can be achieved.

If I could give one piece of advice, it would be to finish your Step exams as early as possible and not delay them because I delayed mine quite a bit. Looking back, it really helps to complete Step 1, Step 2, and even Step 3 within about a year if possible instead of spreading everything out. A lot of people spend too much time trying to achieve an extremely high score or delaying exams, but finishing your Steps first gives you peace of mind and momentum. Once that’s done, you can focus on rotations, jobs, research, your personal statement, and the rest of your application without constantly worrying about your exams. Finish the big things first, then build the rest of your application.

One of the biggest things I learned during the process was to start early and have a clear plan of action. The AAMC website provides important deadlines that you can use as target dates. Having those deadlines in mind allows you to plan around personal commitments and schedule everything you need to complete before the actual application deadlines.

I think the most important part of this process, once you’ve decided to fully commit to pursuing a medical career in America, is to lay out your timeline from the very beginning. Plan how much time you’ll need to study for Step 1, Step 2, the OET, and whichever pathway you need to complete. Having everything organized makes a big difference because it helps you pace your studying, plan your clinical experience around your exams, and prepare for obtaining your letters of recommendation. That organization was one of the most helpful things in my journey.

First, make this your only goal so you don’t have a Plan B or Plan C in the back of your mind. Keep your eyes on matching into the U.S. residency system. Then, plot your timeline based on when you want to join the Match cycle so you can properly identify the best time to take each of the exams. I think that’s the first thing you should consider once you decide to apply for residency in the United States.