Pre-Match Communication Guide for Non-US Citizen IMGs in EM-IM Residency

Pre-match communication is one of the most confusing—and high‑impact—parts of the residency application process, especially for a non-US citizen IMG targeting the highly specific Emergency Medicine-Internal Medicine (EM-IM combined) pathway. You need to stand out, show genuine interest, manage visa concerns, and avoid crossing any NRMP rules about early commitment or improper program communication before match.

This guide breaks down how to communicate strategically and professionally with EM-IM programs before Match Day—with a focus on foreign national medical graduates who are non-US citizen IMGs.

---

Understanding Pre-Match Communication in EM‑IM as a Non-US Citizen IMG

Pre-match communication refers to all interactions you have with residency programs before the NRMP Match results are released, including:

• Emailing program coordinators or directors
• Communications after submitting ERAS, but before interview invites
• Thank-you and follow-up emails after interviews
• Signals of interest (e.g., “You are one of my top choices”)
• Clarification emails about visas, program structure, and EM IM combined opportunities

For a non-US citizen IMG applying to Emergency Medicine-Internal Medicine programs, pre-match communication has extra layers:

• Visa sponsorship questions (J-1 vs H-1B)
• Limited number of EM IM combined programs (small, competitive niche)
• Fewer interview opportunities and higher stakes per program
• Needing to demonstrate both EM and IM interest convincingly

NRMP and Ethical Boundaries

You must understand what is and isn’t allowed in program communication before match:

Allowed:

• Expressing strong interest:
  “Your EM-IM combined residency is one of my top programs”
• Asking factual questions about:
  • Visa sponsorship policies
  • EM vs EM-IM track details
  • Schedule, curriculum, research
• Sending thank-you emails
• Clarifying whether late documents (e.g., Step 2 CK scores) have been received

Not allowed:

• Asking a program to promise to rank you first
• Offering to commit to a program in exchange for a guaranteed position
• Any formal contractual early commitment outside NRMP rules (in most ACGME-accredited EM-IM programs, this does not exist)

Even if some institutions still make pre-match offers for non-ACGME or special tracks, most EM IM combined positions are filled strictly through the NRMP Match. Always verify the program’s participation in the Match via the NRMP or program website and avoid any agreement that seems to bypass NRMP rules.

---

Step 1: Preparing Your Communication Strategy Before ERAS Submission

Your pre-match communication strategy starts before you send your first email.

1. Clarify Your EM-IM Combined Narrative

Programs will be asking—directly or indirectly—why you want emergency medicine internal medicine combined training rather than EM alone or IM alone.

Before you contact programs, write out:

• One paragraph: Why EM?
• One paragraph: Why IM?
• One paragraph: Why EM-IM combined specifically?

For example:

• EM: love acute resuscitation, rapid decision-making, procedures, critical care
• IM: value longitudinal care, complex multi-system disease, diagnostic reasoning
• EM-IM: want to bridge acute and chronic care, consider careers in:
  • ED-based observation medicine
  • Critical care
  • Hospital administration or global emergency care
  • Academic medicine spanning ED and inpatient services

Having this ready will make your emails sharper, especially when tailored to specific programs.

2. Research Programs Deeply—Especially on Visa and IMG Policy

As a foreign national medical graduate, you cannot afford scattershot communication. Research each EM-IM program:

• Check:
  • Do they explicitly sponsor J-1? H-1B? Both? Neither?
  • Recent residents: Are there IMGs? Any non-US citizen IMG graduates?
  • Dual board pass rates (ABEM + ABIM)
  • Unique features: ED-ICU rotations, global health, ultrasound, administration tracks

Use:

• Program websites
• FREIDA and NRMP program directory
• Social media (Twitter/X, Instagram) accounts for resident life and IMG presence
• LinkedIn to see current or former EM-IM residents and their backgrounds

Have a spreadsheet tracking:

• Visa sponsorship type
• Mention of IMGs
• Number of EM-IM positions
• Whether they responded to past communications

This helps you know where your effort is most likely to be rewarded.

3. Define Your Communication Goals

For each program, especially as a non-US citizen IMG, your pre-match communication should aim to:

1. Confirm eligibility (visa, graduation year, exam scores).
2. Show genuine, program-specific interest in EM IM combined training.
3. Build familiarity so your name is recognizable when they review applications.
4. Clarify any potential application gaps (e.g., old graduation date, Step 3 timing).

---

Step 2: Emailing Programs Before Interview Invitations

Many non-US citizen IMGs are unsure whether it’s appropriate to email before invitations are sent. In EM-IM combined programs, because they are few and competitive, carefully targeted, high-quality emails can help.

When to Email

You can consider emailing:

• Shortly after ERAS opens to programs (once you’ve applied)
• If you have:
  • A strong, specific reason for interest in that exact EM-IM program
  • A specific question about visa sponsorship or eligibility
• After a significant update, such as:
  • New US clinical experience
  • A newly accepted EM/IM publication
  • Passing Step 2 CK or Step 3 with strong scores

Avoid spamming multiple emails. One well‑crafted email + an update later (only if meaningful) is reasonable.

Who to Email

Typically:

• Program Coordinator for logistical or eligibility questions
• Program Director (PD) or Associate PD for interest/fit emails
• EM-IM Program Director specifically where there is a separate combined track leadership

You can CC the coordinator when emailing a PD to keep communication organized.

Structure of a Strong Pre-Interview Email

A concise and strategic email might include:

1. Subject Line

   • “Prospective EM-IM Applicant – Non-US Citizen IMG Inquiry (2025 Match)”
   • “EM-IM Applicant from [Country] – Visa Eligibility and Program Interest”

2. Opening & Identity

   • Name, medical school, YOG, current location
   • Non-US citizen IMG, applying to EM-IM and interested in your combined track

3. Personalized Interest (2–3 sentences)

   • Reference something specific: curriculum, EM-IM track size, research focus
   • Connect it to your stated EM IM combined goals

4. Key Question or Purpose

   • Visa question
   • Eligibility clarification
   • Inquiry about EM-IM observership or elective (if applicable and early enough)

5. Brief Strength Highlight

   • 1–2 lines: USCE, EM + IM exposure, research, Step scores (if strong)

6. Professional Close

   • Appreciation and concise sign-off
   • Include AAMC ID or ERAS ID if applications are already submitted

Example (Pre-Interview Email)

Subject: EM-IM Applicant – Non-US Citizen IMG Interested in Your Combined Program

Dear Dr. [Last Name],

My name is [Name], a non-US citizen IMG from [Medical School, Country], applying to Emergency Medicine-Internal Medicine this cycle. I am particularly interested in your EM-IM combined residency at [Institution] because of the strong integration of critical care between the ED and the medical ICU, and the opportunity to train in both community and tertiary settings.

I am writing to clarify whether your EM-IM track sponsors [J-1 / H-1B] visas for foreign national medical graduates. As a [J-1/H-1B]-eligible applicant with US clinical experience in both EM and IM at [Institutions], I hope to confirm my eligibility before ranking your program among my top combined choices.

Briefly, I have completed [X] months of US clinical experience, including [ED, inpatient medicine], and have scores of [Step 1, Step 2 CK, Step 3 (if applicable)]. My interests include [critical care/ED operations/global emergency care], and I would be honored to train in a program that bridges emergency and internal medicine as yours does.

Thank you for your time and for considering my inquiry. I appreciate any clarification you can provide.

Sincerely,
[Name], MD
AAMC/ERAS ID: [ID]
[Email] | [Phone]

Keep it short, personalized, and respectful. You’re not asking for an interview—only for clarity and signaling interest.

---

Step 3: Communication After You Receive an Interview

Once you’re invited to interview at an EM-IM combined program, every email and interaction becomes even more important.

1. Confirming and Preparing

Respond to the coordinator promptly when scheduling your interview—same day if possible. This shows professionalism and interest.

You can also send one brief email to the EM-IM PD (if not already in touch):

• Thank them for the opportunity
• Reconfirm interest in combined EM IM training
• Ask if there are EM-IM residents you might meet or speak with on interview day

2. Thank-You Emails After Interviews

Thank-you emails serve several purposes:

• Reinforce your fit
• Clarify aspects of your application or future goals
• Keep your name in the program’s awareness

Send within 24–72 hours. Write separate messages to:

• Program Director
• Any faculty/interviewer you had extended conversations with
• Optionally the EM-IM chief resident if you had a meaningful discussion

Include:

• Gratitude
• 1–2 specific details from your conversation
• Explicit reinforcement of your interest in emergency medicine internal medicine combined training at their institution
• Any information you forgot to mention (briefly)

Example (Post-Interview Email)

Dear Dr. [Last Name],

Thank you for the opportunity to interview with the EM-IM residency at [Institution] on [Date]. I especially appreciated our discussion about how your graduates have pursued careers in both ED-based critical care and academic internal medicine. The structure of your combined training—particularly the integrated EM-ICU experiences and longitudinal continuity clinic—aligns closely with my goal of bridging acute resuscitation in the ED with comprehensive management of complex medical patients.

As a non-US citizen IMG with strong interests in [e.g., ED-based observation units, global emergency care, or hospital operations], I am excited by how your program supports residents in leadership, research, and dual board preparation in emergency medicine internal medicine. Our conversation confirmed that [Institution] is a program where I would be honored to train and grow.

Thank you again for your time and consideration.

Sincerely,
[Name], MD
AAMC/ERAS ID: [ID]

Avoid sending the same generic template to every interviewer—adjust at least 1–2 sentences to reflect the actual conversation.

3. Clarifying Visa and Logistics After Interview

As a foreign national medical graduate, you may still have visa questions post-interview. It is appropriate to ask:

• Whether EM-IM residents historically were sponsored on J-1 or H-1B
• Whether Step 3 is required for H-1B
• Any institutional restrictions for non-US citizen IMG candidates

These questions can be directed to:

• Program coordinator
• GME office (if referred)
• PD (if it came up during your interview)

Frame the questions as logistical, not as demands.

---

Step 4: Late-Season Communication, Interest Signals, and “Pre-Match Offers”

As Rank List Certification approaches, you might wonder how strongly you can or should express interest—and whether “pre-match offers” or “early commitment” have any place in modern EM-IM combined training.

1. Can You Tell a Program They Are Your Top Choice?

Under NRMP rules:

• You can tell a program, truthfully, that they are your top or one of your top choices.
• The program cannot ask you how you will rank them or demand a commitment.
• You should not ask the program how they are ranking you.

Be truthful. Never tell multiple programs “you are my #1” if that is not the case. Dishonesty damages your reputation and can harm future trainees from your school or country.

Example (Late-Season Interest Email)

Dear Dr. [Last Name],

I hope you are well. I wanted to thank you again for the opportunity to interview with your EM-IM residency at [Institution]. After carefully reflecting on my interviews and the structure of different combined programs, I wanted to let you know that [Institution] is my top choice for EM-IM training.

The balance between emergency medicine and internal medicine, the exposure to [specific features: ED-ICU, global health, community rotations], and the demonstrated support for residents on J-1/H-1B visas are particularly important to me as a non-US citizen IMG. I would be honored to train at [Institution] and contribute to your program.

Thank you again for your consideration.

Sincerely,
[Name], MD

This is fully compliant with NRMP guidelines if it is true.

2. The Reality of “Pre-Match Offers” in EM-IM

Historically, some specialties and institutions made “pre-match offers” to candidates (especially IMGs), essentially giving a contract outside of NRMP. In the current era, particularly for ACGME-accredited EM-IM combined programs, this is rare and often not allowed.

Key points:

• Most EM-IM positions for US and non-US citizen IMG applicants are filled exclusively through NRMP.
• If an ACGME EM-IM program participating in NRMP offers you an early commitment or pre-match contract in exchange for withdrawing from the Match:
  • Be very cautious.
  • This may be a violation of NRMP policy.
  • It can jeopardize your standing with NRMP and future training.

If you ever receive what appears to be a pre-match offer from such a program:

• Politely request clarification:
  • “Is this position part of the NRMP Match?”
  • “How should I proceed in relation to my NRMP participation?”
• Consider seeking:
  • Advice from your dean’s office
  • Guidance from NRMP (anonymously if needed)

As a non-US citizen IMG, you might feel pressure to accept anything that offers security, but protecting your NRMP eligibility and professional integrity is more important long term.

3. Multiple Updates vs Overcommunication

Late in the season, only email programs when you have substantive updates:

• New Step 3 pass (especially if seeking H-1B)
• New EM/IM research paper or poster acceptance
• Significant new US clinical experience in EM or IM

Combine updates with a reaffirmation of interest, not as separate weekly messages.

---

Step 5: Common Mistakes Non-US Citizen IMGs Make in Pre-Match Communication

Many talented foreign national medical graduates unintentionally weaken their applications through miscommunication. Avoid these pitfalls:

1. Mass, Generic Emails

• Sending identical, copy-paste messages to 30+ programs
• Using vague language: “Your esteemed program” without specifics
  Programs can tell when your email isn’t personal. It suggests lack of genuine interest.

2. Overemphasizing Visa in the First Line

Visa is important, but:

• Don’t start emails with: “I need an H-1B and will only come if…”
• Instead: Show fit and interest first, then ask about visa policy.

Programs want to see you as a future colleague, not only as a visa case.

3. Emotional or Desperate Tone

Avoid:

• Long explanations of hardship
• Statements like “This is my only chance” or “Please, I beg you for an interview”
  Maintain a tone of professionalism and confidence, even if your situation is challenging.

4. Ignoring Program Instructions

Some programs state:

• “Do not contact us about your application status”
  Respect that. You can still send thank-you emails after interviews, but avoid pushing about ranking or interview decisions if they explicitly discourage it.

5. Misrepresenting Intent or Rank

• Telling multiple programs they are your #1
• Claiming you are only applying to EM-IM when you also applied broadly to categorical EM and IM
  Programs understand you may apply broadly, but don’t lie if asked directly. You can say:

“I applied to both EM-IM combined and categorical EM and IM programs, but my strongest interest is in integrated EM-IM training.”

---

Putting It All Together: A Practical Timeline for Pre-Match Communication

Before ERAS Submission

• Clarify your EM-IM narrative
• Identify EM-IM programs that consider non-US citizen IMG applicants
• Prepare 1–2 email templates you can personalize

After ERAS Submission, Before Interviews

• Targeted emails to confirm visa eligibility and express interest
• One email per program unless you have a major update

After Interview Invitations

• Respond promptly to coordinators
• Optional brief email to PD reaffirming interest and asking about EM-IM residents you’ll meet

After Interviews

• Send personalized thank-you emails (within 24–72 hours)
• Clarify any remaining visa or logistics questions

Late Season (Before Rank List Deadline)

• If genuinely true, inform your top EM-IM program(s) of your level of interest
• Provide meaningful updates only
• Avoid any agreement that seems like an improper pre-match offer or early commitment outside NRMP rules

By approaching communication as strategic, honest, and professional, you can significantly strengthen your standing as a non-US citizen IMG in a competitive EM-IM combined applicant pool.

---

FAQs: Pre-Match Communication for Non-US Citizen IMGs in EM-IM

1. As a non-US citizen IMG, should I mention my visa needs in my first email?

Yes, but briefly and professionally. It’s appropriate to say you are a foreign national medical graduate and ask whether the EM-IM track sponsors J-1 and/or H-1B visas. Do this after you’ve expressed genuine interest in the program and its EM IM combined structure. Avoid making the entire email only about visa.

2. Can pre-match communication actually get me an interview in EM-IM?

It cannot guarantee an interview, but it can:

• Clarify if you are eligible (so you don’t waste options)
• Put your name on the program’s radar
• Demonstrate professionalism and authentic interest

For a small, relationship-based field like EM-IM, a thoughtful message can sometimes tip the scale positively, especially if your application is borderline or the program is IMG-friendly.

3. Is it okay to send a letter of intent to my top EM-IM program?

Yes, one truthful letter of intent to your top-choice program is appropriate and NRMP-compliant. State clearly that they are your top choice, briefly why, and thank them for considering you. Do not ask them to disclose how they will rank you, and do not send multiple “you are my #1” emails to different programs.

4. What if a program hints at early commitment or a pre-match offer?

If a program participating in the NRMP Match suggests an early commitment or something that looks like a pre-match offer:

• Politely ask for clarification about how this fits with the Match
• Do not sign any contract or withdraw from NRMP without clear guidance
• Consider confidentially asking your dean’s office or NRMP for advice

Protecting your ability to participate in the Match is critical, especially for your long-term career and for future non-US citizen IMG applicants from your background.

---

By mastering thoughtful, ethical, and targeted pre-match communication, you position yourself as a mature, prepared candidate—exactly the kind of physician EM-IM programs want, regardless of your passport.