Essential Guide to Pre-Match Communication for US Citizen IMG in Orthopedic Surgery

Understanding Pre-Match Communication in Orthopedic Surgery

For a US citizen IMG aiming for orthopedic surgery, pre-match communication can feel like a mysterious, high-stakes part of the process. You hear about “signals,” “soft commitments,” “pre-match offers,” and “early commitment” yet no one spells out exactly what’s allowed, what’s wise, or how it differs for an American studying abroad compared with US MD seniors.

This guide breaks down how to approach program communication before Match in a way that is:

• Ethical and NRMP-compliant
• Strategic for a competitive field like orthopedic surgery
• Realistic for a US citizen IMG who may have fewer built-in connections

We’ll cover what to say, when to say it, how to read between the lines, and how to protect yourself from pressure while still advocating for your candidacy.

---

1. The Landscape: What Pre-Match Communication Really Is (and Isn’t)

Before diving into emails and calls, you need a clear mental model of what “pre-match communication” actually covers.

1.1 What counts as pre-match communication?

In orthopedic surgery, pre-match communication includes:

• Before you apply
  • Introductory emails to programs or mentors
  • Asking about whether they consider US citizen IMGs
• After you apply but before interviews
  • “Interest” emails
  • Updates on Step scores, publications, or US clinical experience
• After interviews
  • Thank-you emails
  • “Love letters” or “ranking intent” messages
  • Clarifying emails if a program reaches out with strong interest
• Any time between Rank Order List (ROL) opening and certification
  • Communication regarding rank intentions or program interest
  • Questions about how to signal interest appropriately

All of this falls under program communication before Match and is governed by:

• NRMP rules (Match Participation Agreement)
• Institutional policies
• Professional ethics and common sense

1.2 What pre-match communication is not in orthopedics

Unlike some non-NRMP specialties or eras before the current system, in ACGME-accredited US ortho programs:

• You should not receive official “pre-match offers” that require early commitment outside the NRMP (with very rare, clearly defined exceptions such as certain military or specialty tracks, which have separate rules).
• You should not be asked to sign anything binding before Match Day.
• You cannot have a legally binding “deal” about rank order with any program.

Any suggestion of a true pre-match contract for a standard orthopedic surgery residency in the NRMP Match should set off alarm bells.

---

2. NRMP Rules and Ethics: Guardrails You Must Know

Before you communicate with programs, understand what’s allowed so you don’t accidentally cross a line—or get pressured into something inappropriate.

2.1 Key NRMP principles about communication

You’re allowed to:

• Express interest, enthusiasm, and preferences
• Tell a program:
  • “You are my top choice,” or
  • “I plan to rank you highly”
• Ask questions about:
  • Case volume
  • Research expectations
  • Lifestyle
  • US citizen IMG track history

Programs are allowed to:

• Express general interest (“We enjoyed meeting you,” “You would be a strong fit.”)
• Answer your questions about training

Neither side is allowed to:

• Ask for or require a commitment to rank in a certain position
• Ask you where you are ranking other programs
• Require any pre-Match agreement

2.2 What is prohibited or risky?

Red flags:

• A program says:

  • “If you tell us we’re #1 and agree not to rank others higher, we’ll rank you to match.”
  • “We need an informal commitment before we rank you highly.”

• You say:

  • “I will not rank any other program above you, and I promise not to rank Program X at all.”

NRMP specifically warns against:

• Coercive communication
• “Shopping around” offers (trying to use one program’s strong statement to leverage another)
• Making or relying on promises of ranking positions

2.3 As a US citizen IMG, how does this apply to you?

Being a US citizen IMG / American studying abroad does not change the rules, but it often changes:

• How much clarity you have about unwritten norms
• How much pressure you feel to agree to things to “secure any ortho spot”

You may be more vulnerable to:

• Over-interpreting vague language (“We’re very interested”) as a guaranteed spot
• Agreeing to something that feels like an early commitment because of fear of not matching

Anchor yourself in this principle:
You do not need to violate NRMP rules or your own comfort to match into orthopedic surgery. Thoughtful, honest, consistent communication is more powerful than trying to game the system.

---

3. Strategizing Communication as a US Citizen IMG in Ortho

Orthopedic surgery is one of the most competitive specialties. As a US citizen IMG, you often start with:

• Fewer home-program opportunities
• Less visibility to faculty in US ortho departments
• Less automatic trust in your clinical training

Effective program communication can partially offset these disadvantages—if you use it strategically.

3.1 Before interviews: Getting on the radar

Your goals:

• Confirm that the program does consider US citizen IMGs
• Highlight any unique strengths quickly and clearly
• Avoid spammy, generic emails

Example pre-application email (short and focused)

Subject: US Citizen IMG with Ortho Research – Question About Applicant Fit

Dear Dr. [Program Director Last Name] and the [Program Name] Residency Team,

My name is [Your Name], a US citizen currently completing my MD at [Foreign School] and applying to orthopedic surgery this cycle. I have completed [X] months of US clinical rotations, including [Y] months in orthopedic surgery at [Hospital/Institution], and am currently involved in research on [brief topic].

I’m very interested in [Program Name] because of [1–2 specific reasons: trauma volume, sports fellowship, early OR exposure, etc.], and I wanted to ask whether your program has historically considered US citizen IMGs for interview.

If helpful, I would be happy to briefly share my background, including [Step scores range, specific orthopedics experiences], to determine whether I might be a reasonable fit.

Thank you for your time and for your work training future orthopedic surgeons.

Sincerely,
[Your Name], MS4
[School] | AAMC ID: [XXXXX] | Email | Phone

Use this type of email sparingly:

• For programs you’re genuinely interested in
• Where IMG status is unclear from their website

3.2 After you apply: Appropriate “interest” messages

Once your ERAS is submitted, you can:

• Send targeted, individualized messages to a handful of programs that are top priorities
• Update programs if you gain something meaningful:
  • Step 2 CK score
  • New publication
  • Additional US ortho rotation
  • Strong letter from a US ortho attending

What not to do:

• Mass-send identical emails to 50+ programs
• Repeatedly email the same program without a clear purpose

Effective example (post-application, pre-interview)

Subject: Update and Continued Interest – Orthopedic Surgery Applicant [Your Name]

Dear Dr. [Last Name] and the [Program Name] Residency Selection Committee,

I hope this message finds you well. I wanted to briefly share an update to my application for orthopedic surgery residency.

Since submitting my ERAS application, I have:

• Completed a [4]-week orthopedic sub-internship at [US Hospital], with strong exposure to [trauma/sports/joints]
• Received a letter of recommendation from [Dr. Smith], which has been uploaded to ERAS
• [Optional: Begun a retrospective study in orthopedic trauma with [Institution]]

As a US citizen IMG, I am particularly grateful for programs that have a track record of evaluating applicants holistically. I remain very interested in [Program Name] because of your [reason specific to program].

Thank you again for your consideration.

Sincerely,
[Your Name]
AAMC ID: [XXXXX]

3.3 After interviews: Thank-you notes and “love letters”

Here is where ortho match communication becomes especially nuanced.

Your goals:

• Reinforce a positive impression
• Clarify sincere interest
• Avoid:
  • Dishonesty
  • Overpromising
  • Violating policies (some programs prohibit post-interview contact and state that clearly)

Post-interview thank-you email

Send within 24–72 hours, short and personalized.

Dear Dr. [Interviewer],

Thank you for taking the time to speak with me during my interview at [Program Name]. I especially appreciated our discussion about [specific clinical exposure, research, team culture, or mentorship], which reinforced my impression that [Program Name] provides an excellent environment for residents interested in [your goals: trauma, academic career, sports, etc.].

As a US citizen IMG, I am particularly drawn to the supportive teaching culture you described and the opportunities to develop a strong operative foundation early in training.

Thank you again for the opportunity to interview.

Sincerely,
[Your Name]

Ranking intent/“love letter” to your #1

You should send a clear, honest statement to only one true #1 program. If you are not comfortable saying “#1,” you can say “I plan to rank you very highly.”

If you are truly ranking them #1:

Subject: Strong Interest in [Program Name]

Dear Dr. [Program Director Last Name],

I wanted to sincerely thank you and your team for the opportunity to interview at [Program Name]. After reflecting on my interviews and comparing programs, I have decided that [Program Name] will be ranked as my number one choice on my rank list.

Your program offers exactly what I am seeking in orthopedic training: [examples—high operative volume, trauma experience, strong mentorship, resident camaraderie]. The way your residents spoke about both the rigor and the supportiveness of the environment resonated with the type of surgeon and colleague I hope to become.

As a US citizen IMG, I am grateful for how thoughtfully you consider applicants from diverse training backgrounds, and I believe I would thrive and contribute positively to your team.

Thank you again for your consideration.

Sincerely,
[Your Name]

Key points:

• Do this only if it is 100% true
• Do this for only one program
• Do not overcomplicate—simple and sincere is better than elaborate flattery

---

4. Decoding Program Signals and “Pre-Match” Language

Programs vary widely in how they communicate. In orthopedic surgery, you may hear or read various signals that sound like guarantees—but usually aren’t.

4.1 Common types of “interest” messages

You might receive:

• A generic email:

  • “It was a pleasure to meet you. Best of luck this interview season.”
  • → Usually neutral courtesy.

• A slightly personalized note:

  • “We were impressed by your background in [trauma research], and we think you’d be a good fit for our program.”
  • → Positive, but not a guarantee.

• A strong interest signal:

  • “You are one of our top applicants, and we will be ranking you very competitively.”
  • → Strong sign of interest, but still no guarantee of match (rank lists run both ways).

• Very strong/ambiguous language:

  • “You are very high on our list, and we hope to work with you next year.”
  • → You’re likely high on their list, but it can still change and there are no guarantees.

4.2 How to interpret these as a US citizen IMG

Because of the inherent insecurity of being a US citizen IMG in a highly competitive field:

• You may be tempted to treat any strong message as a pre-match offer
• You might feel pressured to:
  • Rank that program #1 automatically
  • Close doors with other programs

Instead:

• View these messages as data points, not binding commitments
• Consider:
  • Your own preferences (training type, location, culture)
  • How other programs compare
  • The possibility that multiple programs express interest but not guarantees

4.3 If a program asks about your rank intentions

Some programs will ask indirectly:

• “How do you see our program fitting into your rank list?”
• “Where do you think you might rank us?”

You can answer honestly without being overly specific:

• If they’re clearly top tier for you:
  • “I expect to rank your program very highly; it is among my top choices.”
• If they’re truly #1 (and you’re comfortable sharing):
  • “I’m planning to rank your program first.”

What you should not feel obligated to do:

• Give them a complete list of program names and order
• Rank them higher than feels right just because they asked

4.4 If a program hints at an “early commitment”

In standard NRMP orthopedic programs, a real early commitment is almost never appropriate.

If you hear something like:

• “If you tell us we’re your #1 now, we can essentially guarantee you a spot.”
• “We expect applicants we rank highly to show equal commitment in return, including ranking us first.”

You can respond with:

• Appreciation for their interest
• Confidence that you’ll give their program full consideration
• A commitment to follow the NRMP process

Example:

“Thank you so much for your strong vote of confidence. I am genuinely very interested in your program and will be giving it serious consideration as I finalize my rank list. I also want to be respectful of the NRMP process, which encourages both programs and applicants to create rank lists independently and without binding commitments in advance.”

If the pressure continues or feels uncomfortable, document the interaction and consider discussing it with:

• Your dean’s office
• An advisor familiar with NRMP rules

---

5. Practical Do’s and Don’ts for Ortho Pre-Match Communication

5.1 Do’s

• Do be concise and purposeful.
  Every email should have a clear reason: update, thank-you, or rank-intent.

• Do tailor messages to each program.
  Mention specific aspects of:

  • Operative volume
  • Case mix
  • Research infrastructure
  • Resident culture

• Do keep a communication log.
  Track:

  • Programs you contacted
  • Dates
  • Type of message
  • Any strong signals you received

• Do maintain internal consistency.
  If you tell one program they’re #1, do not send similar language to others.

• Do leverage mentors.
  Particularly as a US citizen IMG, ask:

  • US orthopedic attendings
  • Research mentors
  • US clinical rotation faculty
    to:
  • Call or email programs on your behalf
  • Clarify whether a program is really IMG-friendly
  • Help interpret vague or strongly worded messages

5.2 Don’ts

• Don’t send daily or weekly follow-ups.
  One meaningful update or thank-you is usually enough.

• Don’t lie about your rank list.
  It damages your reputation if discovered and creates moral distress.

• Don’t name-drop other programs strategically in your own emails.
  (“Program X told me I’m at the top of their list; what about you?”)
  This can be perceived as unprofessional.

• Don’t violate stated program policies.
  If their website or interview day slide clearly says:

  • “We do not consider post-interview communication in ranking,” or
  • “We discourage thank-you emails,”
    then respect that.

• Don’t panic if you receive no post-interview communication.
  Many programs deliberately do not send interest signals; lack of email ≠ no chance.

---

6. Building a Strong Ortho Application to Support Your Communication

Communication works best when it’s backed by substance. As a US citizen IMG pursuing orthopedic surgery residency, focus on making your candidacy robust so your emails and conversations have real weight.

6.1 Core pillars for US citizen IMGs in ortho

• Board scores / exams

  • Aim for strong Step 2 CK scores (especially if Step 1 is pass/fail)
  • Consider OITE performance if in a prelim or transitional year

• US clinical experience

  • Prioritize US-based orthopedic sub-internships (away rotations)
  • Show strong performance:
    • Early pre-op readiness
    • OR professionalism
    • Good team behavior

• Research

  • Ortho-focused projects: case series, retrospective reviews, biomechanics, etc.
  • Presentations or posters at:
    • AAOS
    • Specialty societies (AOFAS, ASES, OTA, etc.)

• Letters of recommendation

  • From US orthopedic surgeons who know you well
  • At least one or two letters from recognized academic orthopedists if possible

• Narrative

  • A compelling personal story that explains:
    • Why orthopedics
    • Why you studied abroad as an American
    • How your unique path strengthens your perspective and resilience

6.2 Aligning communication with your strengths

• If you’re research-heavy:
  • Emphasize fit with programs that value publications and academic careers
• If you’re clinically strong but research-light:
  • Highlight work ethic, operative readiness, and team-oriented behavior
• If you have a nontraditional path:
  • Use communication to show maturity, clarity of purpose, and persistence

Your pre-match messages should echo what’s already clear in your ERAS, not introduce a completely new persona.

---

FAQs: Pre-Match Communication for US Citizen IMGs in Ortho

1. As a US citizen IMG, should I send a “you are my #1” email to increase my chances?

You should send a “#1” message only if it is true and only to your genuine first choice. Programs do appreciate clarity, but sending that message to multiple programs or being dishonest can damage your reputation and is ethically problematic. For other programs you like, you can say, “I plan to rank your program very highly.”

2. What if I don’t receive any post-interview communication from programs?

Many orthopedic surgery programs—especially larger academic ones—either:

• Avoid individualized post-interview emails, or
• Use only generic messages

Silence does not mean you’re not being ranked. Focus on creating a thoughtful rank list based on your priorities, not on who emails you the most.

3. How often should I email a program if I haven’t heard about an interview?

Once is usually enough. Persuasive, specific communication is better than frequent reminders. If you have a significant new update (e.g., Step 2 CK score, new ortho publication, or a strong US ortho LOR), one additional email is reasonable. Avoid repeated “checking in” messages without new content.

4. Can a program really “guarantee” me a spot before Match Day?

In standard NRMP-participating orthopedic surgery programs, no one can truly guarantee you a spot before Match. Even strongly worded emails or conversations are not binding. Treat all such statements as positive signs, but still rank programs in your genuine order of preference. The NRMP algorithm is designed to favor your true preferences, not who seems most enthusiastic.

---

Used wisely, pre-match communication can help you, as a US citizen IMG and American studying abroad, bridge gaps in visibility and demonstrate readiness for orthopedic surgery. Keep your communication honest, strategic, and respectful of NRMP rules, and pair it with a strong, well-built application. That combination—substance plus clear, professional communication—is your best path toward a successful ortho match.