Essential Pre-Match Communication Strategies for IMGs in Residency

Understanding Pre-Match Communication as an IMG

Pre-match communication is one of the most misunderstood parts of the residency process—especially for an international medical graduate (IMG) navigating a new system, norms, and expectations.

In this context, “pre-match communication” refers to any contact between you and a residency program from the time you apply until the rank order list deadline, that is not part of the formal ERAS/NRMP process. This includes:

• Emails to and from program coordinators or directors
• Thank-you messages after interviews
• “Letters of interest” or “letters of intent”
• Phone calls or virtual meetings outside of formal interviews
• Informal messages through networking connections

It is closely related to, but different from, pre-match offers (early contract offers that bypass the NRMP Match in certain states/specialties). This article focuses on communication behaviors and strategies that support your candidacy ethically, professionally, and effectively while fully respecting NRMP rules.

Why Pre-Match Communication Matters for IMGs

As an IMG, effective pre-match communication can:

• Reinforce your genuine interest in a program
• Clarify your fit for a specific patient population or community
• Address potential concerns (e.g., visa, gaps, changing specialties)
• Help programs remember you positively when they create rank lists
• Strengthen your professional network, even if you do not match at that program

However, it can also hurt you if it is:

• Too frequent or pushy
• Dishonest (e.g., claiming a program is your first choice when it’s not)
• Inconsistent with NRMP rules (suggesting early commitment or talking about rank lists)
• Poorly written, unprofessional, or sent at inappropriate times

The goal of this IMG residency guide is to give you clear, practical tools for communication before Match that show maturity, cultural understanding, and respect for the process.

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Rules, Ethics, and the NRMP: What You Can and Cannot Do

Before planning any strategy, you need a firm grasp of the rules and ethics around pre-match communication and early commitment.

NRMP Rules in Simple Terms

The NRMP (National Resident Matching Program) has specific rules governing program communication before match:

• Programs cannot:

  • Ask you to reveal or confirm your rank list
  • Ask you to make a promise about how you will rank them
  • Offer you incentives in exchange for ranking them higher
  • Require any form of “early commitment” if they participate in the Match

• Applicants cannot:

  • Ask programs how they will rank them
  • Try to negotiate rank positions
  • Make binding promises that conflict with NRMP rules
  • Sign contracts with NRMP-participating programs outside the Match (except in approved pathways like SOAP)

However:

• Both sides may:
  • Express interest
  • Signal enthusiasm or preference
  • Provide updates (new publications, scores, visas, etc.)
  • Communicate in a professional, non-coercive way

Pre-Match Offers vs. Pre-Match Communication

For IMGs, the term “pre-match” can be confusing because it is used in two ways:

1. General pre-match communication
   Any communication before the Match (our main topic).

2. Pre-match offers / early contracts

   • In the past, certain states (e.g., Texas) allowed programs to make pre-match offers—binding contracts signed before the Match, mainly for J-1 or H-1B visa IMGs.
   • These were a form of early commitment: if you accepted, you did not go through the Match for that specialty.
   • Over time, more programs moved into the NRMP Match, so true pre-match offers are less common, but you may still hear about them, especially in IM-heavy programs or specific states.

If you are ever offered something that sounds like a contract before the Match, you must:

• Verify whether the program participates in NRMP
• Review your NRMP agreement
• Seek advice from an advisor, ECFMG, or NRMP help line before signing anything

Do not confuse strong expressions of interest (“We really liked you”) with an official offer. Strong language does not equal a contract.

Ethical Principles for IMGs

Because you are entering a new professional culture, it helps to anchor your decisions in three principles:

1. Honesty

   • Do not tell more than one program they are your “number one” if that is not true.
   • Do not promise to rank a program first and then break that promise.

2. Transparency without pressure

   • You can say, “Your program is among my very top choices,” or “I am strongly interested in your program.”
   • Avoid phrases that sound like negotiation (“If you rank me high, I’ll rank you #1”).

3. Respect for boundaries

   • Obey NRMP rules.
   • Respect that programs are overwhelmed; communication should be brief, purposeful, and infrequent.

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Core Communication Channels and When to Use Them

As an international medical graduate, you must be especially strategic: not too silent, not too aggressive. Here are the main communication channels you will likely use.

1. Email: Your Primary Tool

Email is the safest, most professional, and most documented form of contact.

Before the Interview

You may email to:

• Clarify logistics (dates, format, travel)
• Confirm receipt of an interview invitation
• Express appreciation for an interview offer
• Politely inquire about your status if the program has not responded by a reasonable time (usually late November–January), and you have a specific connection (e.g., you did an observership there)

You should NOT email to:

• Ask directly, “Why didn’t you invite me?”
• Repeatedly request an interview without any new information
• Attach very long personal statements or multiple large files (coordinators are busy)

Example (polite interest after observership, before interview season ends):

Subject: Continued Interest in [Program Name] – Former Observership Participant

Dear Ms. [Coordinator Last Name],

I hope you are well. My name is Dr. [Your Name], an international medical graduate who completed an observership in the [Department] at [Hospital Name] in [Month, Year]. I recently applied to the [Specialty] residency program through ERAS and wanted to briefly reiterate my strong interest.

Working with your residents and faculty confirmed that your program’s emphasis on [specific value—e.g., underserved care, research, or teaching] aligns closely with my career goals. Should you still be reviewing applications, I would be deeply grateful to be considered for an interview.

Thank you for your time and for all the work your team does for applicants.

Sincerely,
[Your Full Name], MD
AAMC ID: [ID] | ECFMG ID: [ID]
[Email] | [Phone]

Use this type of message only once per program, and only if you have a genuine connection or reason.

After the Interview

This is where program communication before match becomes most important.

You can send:

• A thank-you email within 24–48 hours
• A follow-up “letter of interest” later in the season
• A final update/intent email closer to the rank list deadline (if truly appropriate)

Post-interview thank-you email basics:

• Send to program coordinator and/or program director; sometimes individual interviewers if contact information is provided.
• Keep it short (150–200 words).
• Mention 1–2 specific things you liked or learned.
• Avoid rank talk (“I’ll rank you #1”).

Example:

Subject: Thank You – [Your Name], [Interview Date]

Dear Dr. [Program Director Last Name],

Thank you for the opportunity to interview with the [Program Name] [Specialty] residency on [Date]. I especially appreciated learning about your curriculum’s focus on [specific element, e.g., global health or procedural training] and the supportive culture your residents described.

As an international medical graduate with clinical experience in [country/setting], I am excited by the possibility of contributing to the care of your diverse patient population. My conversation with you and the residents reinforced my belief that [Program Name] would be an excellent place to grow as a clinician and educator.

Thank you again for your time and consideration.

Sincerely,
[Your Full Name], MD
AAMC ID: [ID] | ECFMG ID: [ID]

2. Phone Calls and Virtual Meetings

Most routine matters should happen by email, but calls can be appropriate when:

• You have a time-sensitive visa question
• A program explicitly asks to schedule a call
• There is confusion or miscommunication about interview logistics
• You already have a relationship (e.g., you worked with the PD in your home country, or you are a research fellow there)

Always:

• Prepare a brief script
• Keep calls short and respectful
• Avoid calling repeatedly
• Follow up with a short confirmation email

3. Networking Connections

Faculty you know, former supervisors, or mentors who train or work in the US can:

• Send a supporting email or call a program on your behalf
• Provide insight into a program’s culture
• Help you understand unwritten expectations

This is especially powerful for IMGs who lack US schools’ built-in networks.

When requesting this support:

• Be specific (which programs, which specialty, your related experience)
• Provide your CV and personal statement
• Ask them to be honest; not all mentors will feel comfortable contacting programs

Do not pressure mentors to promise something they cannot deliver, such as a guaranteed pre-match offer or early commitment.

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Strategic Messages: Thank-You, Interest, and Intent

Pre-match communication isn’t about volume; it is about timing and message type. You’ll primarily use three categories:

1. Thank-you messages
2. Letters of interest
3. Letters of intent (used carefully)

1. Thank-You Messages

Purpose: Acknowledge the program’s time, reinforce your interest, and remind them of your fit.

Best practice:

• Send within 24–48 hours
• Personalize with 1–2 specific details
• Keep it positive, not pushy
• No discussion of rank lists

You don’t need to send a message to every individual interviewer if that feels overwhelming; emailing the program director and coordinator is usually sufficient, unless they give you other guidance.

2. Letters of Interest

A “letter of interest” is a more detailed email sent after the interview season, usually in December–January, to:

• Reiterate your enthusiasm
• Highlight specific alignment with the program
• Provide important updates (e.g., Step 3 score, publication, visa clarification)

Use this for select programs that you are genuinely excited about. Overusing it makes your interest seem less credible.

Example structure (200–300 words):

1. Opening: thank them for the interview, mention date
2. Main body: specific reasons you feel you fit the program
3. Updates: key new information since the interview
4. Closing: strong but honest expression of interest

Sample phrasing:

“Your program remains one of my top choices because…”
“I continue to feel a very strong connection to [Program Name]…”

Avoid:

“If you rank me highly, I will rank you #1.”
“Please tell me where I stand on your list.”

3. Letters of Intent (Use Sparingly)

A letter of intent is stronger than a letter of interest. It usually states:

• This program is your true first choice, and
• You intend to rank them #1.

You should send a letter of intent to only one program, and only if:

• You are absolutely certain
• You would be happy to train there even if other programs are “more prestigious”
• You can ethically stand behind your statement

Key: Never mislead. In many cultures, expressing strong interest is seen as polite or strategic even if it is not fully true. In US residency culture, dishonesty about rank intentions is taken very seriously, especially for an international medical graduate trying to build trust.

Letter of intent sample phrasing:

“After completing all my interviews, I have decided that [Program Name] is my first choice, and I plan to rank your program #1. I believe your emphasis on [specific aspects] aligns best with my goals as an aspiring [specialty] physician.”

Do not ask:

“If I rank you #1, will you rank me highly?”

That crosses into negotiation and violates the spirit of the Match.

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Special Considerations for IMGs: Visas, Gaps, and Cultural Nuances

As an international medical graduate, several issues require proactive and carefully worded pre-match communication.

1. Visa Status and Sponsorship

Programs need to know if you require:

• J-1 visa (commonly sponsored via ECFMG)
• H-1B visa (less common; requires Step 3 and additional cost)
• No visa (e.g., permanent resident or citizen)

You do not have to email programs early just about visa, because ERAS communicates much of this information. But you should:

• Confirm the program’s visa policy (website, FREIDA, or by email if unclear).
• If your status changes (e.g., you obtain permanent residency or pass Step 3 making you eligible for H-1B), send a targeted update.

Visa update example:

Subject: Application Update – Visa/Status – [Your Name]

Dear Ms. [Coordinator Last Name],

I hope you are well. I am writing to provide an important update to my ERAS application for the [Specialty] residency program at [Program Name].

As of [Date], I have obtained [U.S. permanent residency / H-1B eligibility with completed Step 3]. I understand that this may be relevant to your program’s visa sponsorship policies and wanted to ensure you have my most current information.

Thank you for your time and consideration.

Sincerely,
[Your Full Name], MD

2. Gaps in Training or Non-Clinical Experience

If you have:

• Years since graduation
• Research years
• Non-clinical jobs
• Time off for family, illness, or relocation

You may choose to:

• Address this in your personal statement primarily
• Clarify or expand briefly if a program asks or if it seems misunderstood

Pre-match communication is not usually the place to “re-open” sensitive topics unless:

• The program expressed concern or confusion during the interview
• You have new, positive developments (e.g., new US clinical experience, new letters, significant exam result)

Keep explanations concise and future-focused, not defensive.

3. Cultural Communication Norms

Some IMGs come from systems where:

• Being very persistent is expected
• Refusing to answer questions about rank or commitment would be seen as rude
• Flattering language is common

In the US residency context:

• Professionalism requires clarity, brevity, and boundaries
• Overly emotional or very long emails can be seen as red flags
• Repeated uninvited calls or messages can damage your candidacy

Helpful guidelines:

• Keep emails to 1–4 short paragraphs
• Focus on facts, specific interests, and concrete examples
• Avoid excessive flattery (“Your program is the best in the world…”)—instead, state genuine, program-specific reasons you are interested.

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Practical Timeline and Action Plan for IMGs

Here is a structured way to plan your IMG residency guide for pre-match communication across the season.

1. Application Submission to First Interview (September–October)

• Focus:
  • Submitting polished ERAS application
  • Following each program’s instructions carefully
• Communication:
  • Confirm receipt of important documents only if requested
  • Rare, targeted emails if you have a strong, real connection and no interview by mid/late October

2. Active Interview Season (October–January)

For each program where you interview:

1. Immediately after interview (24–48 hours):
   • Send a brief thank-you email to PD and coordinator
2. During the season:
   • If you receive new honors (e.g., Step 3 pass, major publication), send a single update to all programs where you interviewed, using BCC to avoid mistakes.
3. If you haven’t heard from a program you are very interested in:
   • Send at most one polite inquiry (especially if you did an observership or research there).

3. Post-Interview Period (Late December–February)

• Identify your top 3–5 programs.
• For 2–4 of them, send letters of interest (if you genuinely see yourself thriving there).
• For your true #1 choice, consider sending one letter of intent (only if honest).

Spacing:

• Wait at least 2–3 weeks after your interview before sending a deeper letter of interest.
• Aim for letters of interest/intent between early January and 1–2 weeks before the rank list certification deadline.

4. Final Weeks Before Rank List Deadline

• Double-check that you have:
  • Thanked all programs where you interviewed
  • Sent updates about any major changes (visa, Step 3, major academic achievement)
• Avoid last-minute daily emails—nothing appears more desperate and is unlikely to change decisions.

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Frequently Asked Questions (FAQ)

1. As an IMG, should I email programs that did not offer me an interview?

You can, but only sparingly and strategically:

• It is reasonable to email one time if:

  • You have a genuine, strong connection (observership, research, former employee, or close mentor at that program), and
  • It is still relatively early to mid interview season (October–November).

• Avoid mass-emailing every program that did not invite you. That does not increase your chances and may harm your reputation.

Focus instead on strengthening your application for the following year if needed.

2. Can pre-match communication really change my rank or help me get ranked?

Yes—but in subtle and limited ways:

• Thoughtful, professional communication can:

  • Help a PD remember you positively
  • Clarify misunderstandings (e.g., explaining a visa option)
  • Highlight your unique fit with their patient population or mission

• However, communication cannot compensate for:

  • Very low exam scores or serious professionalism issues
  • Major gaps without explanation
  • Lack of US clinical experience in competitive specialties

Think of pre-match communication as a booster, not a replacement for a strong core application.

3. Is it okay to tell more than one program they are my “top choice”?

No. That is considered dishonest and unprofessional.

• You can tell multiple programs they are among your “top choices” or that you are “very strongly interested.”
• Reserve direct statements like “I will rank you #1” or “You are my first choice” for one program only, and only if it is the truth.

Programs talk to each other more than applicants realize; as an international medical graduate building credibility in a new system, integrity is especially important.

4. I am worried about asking about visa sponsorship. Will that hurt my chances?

Asking for clarification about visa policies is normal and appropriate. Programs expect this, especially from IMGs.

• Check their website and FREIDA first.
• If unclear, send a short, polite email to the coordinator.
• Asking about policy does not hurt your chances; programs already know whether they sponsor visas from your ERAS information. Clarity helps both sides.

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Thoughtful pre-match communication is an essential part of your IMG residency journey. By understanding the rules, focusing on honesty, and using clear, targeted messages, you can signal interest effectively, avoid common pitfalls around pre-match offers and early commitment, and present yourself as a mature, professional colleague in the making.