Essential Questions for US Citizen IMG in Addiction Medicine Residency

As a US citizen IMG (American studying abroad or graduate of a Caribbean or international school), the questions you ask programs in addiction medicine can powerfully shape how you are perceived—and whether you’ll be happy if you match there. Thoughtful, targeted questions signal maturity, insight into the specialty, and genuine interest in substance use care.

This guide breaks down strategic, high‑yield questions to ask residency and fellowship programs in addiction medicine, with a special focus on what matters for a US citizen IMG. You’ll also see how to tailor interview questions for them—program directors, faculty, and current fellows—to get honest information and present yourself as a strong future colleague.

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Why Your Questions Matter So Much as a US Citizen IMG

Residency and addiction medicine fellowship interviews are not just for programs to screen you; they’re a two‑way evaluation. The questions you ask can:

• Help you evaluate training quality and substance abuse training depth
• Reveal how the program treats IMGs and US citizen IMGs specifically
• Demonstrate you understand addiction medicine as a complex, multidisciplinary field
• Give you material to use in your rank list decisions
• Show that you’re ready to advocate for patients with substance use disorders

As an American studying abroad or a US citizen IMG, you also have unique concerns:

• Visa is usually not an issue, but perception of IMGs sometimes is
• You may have had less US clinical exposure and need to assess how welcoming and supportive the environment will be
• You might be working to overcome assumptions about your training background

Strong, specific questions help you shift the focus from “where you went to school” to “how you think and what you care about.”

Use this mindset as you decide what to ask program leadership, faculty, and current residents or fellows.

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Core Themes Your Questions Should Cover

Before diving into examples, it helps to organize your questions to ask residency and fellowship programs around a few key themes:

1. Clinical Training & Scope of Practice
2. Education, Mentorship & Career Development
3. Program Culture & Support for IMGs / US Citizen IMGs
4. Research, Policy & Public Health Opportunities in Addiction Medicine
5. Logistics: Schedule, Call, Salary, and Location

You don’t need to hit every category with every interviewer, but aim to cover each by the end of interview day (or interview season if multiple programs). Tailor what to ask the program director versus fellows or coordinators.

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High-Yield Questions About Clinical Training & Substance Use Care

Addiction medicine is a hands‑on specialty. You want robust exposure to:

• Opioid, alcohol, stimulant, and polysubstance use disorders
• Inpatient consult services
• Outpatient addiction clinics
• Integrated behavioral health and psychosocial treatments
• Harm reduction strategies and community partnerships

Here are targeted questions you can ask to assess substance abuse training quality and scope:

For the Program Director or Clinical Faculty

1. “Can you describe the typical clinical rotations and patient mix for addiction medicine trainees here?”
What you’re looking for:

• Balance of inpatient vs. outpatient
• Variety of substances and populations (e.g., pregnant patients, adolescents, co-occurring SMI, homelessness)
• Any strong niche (e.g., pain/addiction, HIV/HCV, criminal justice)

2. “How are trainees involved in starting and managing medications for opioid use disorder (MOUD), alcohol use disorder, and other substance use disorders?”
Why this matters:

• You need extensive experience with buprenorphine, methadone coordination, naltrexone, acamprosate, disulfiram, etc.
• Shows you understand core pharmacologic tools of addiction medicine.

3. “What does your inpatient addiction consult service look like, and how much autonomy do fellows/residents have in managing those patients?”
Listen for:

• Whether consults are regular or sporadic
• How often you’re the primary prescriber vs. “suggestion only”
• Team structure (multidisciplinary vs. solo physician)

4. “How do you incorporate harm reduction into clinical practice here?”
Strong programs might mention:

• Naloxone distribution
• Safer injection education, fentanyl test strips
• Collaboration with syringe services programs
• Overdose prevention initiatives

5. “How do you ensure that trainees are comfortable managing complex co-occurring conditions—like psychiatric illness, chronic pain, or infectious diseases—in patients with addiction?”
Shows you know addiction medicine intersects with many fields.

For Current Fellows or Senior Residents

6. “What clinical experiences ended up being most valuable for you in feeling independent and ready for practice?”
You’ll hear what actually matters day‑to‑day, not just what’s on the brochure.

7. “Do you feel you get enough volume and variety to be confident with MOUD, alcohol withdrawal, and complicated polysubstance cases?”
You want a clear “yes” with specifics.

8. “How well do you feel the program prepares you for your intended career path—academic, community, outpatient, hospital-based, or a mix?”

IMG‑Specific Angle

As a US citizen IMG, you can subtly highlight your awareness of gaps you might bring:

“Coming from an international school, I’ve had variable exposure to structured addiction services. How does the program help standardize and deepen trainees’ substance use care skills, especially early on?”

This frames you as self‑aware and eager to grow.

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Education, Mentorship, & Career Development: Questions to Ask Program Leadership

You’re not just learning to prescribe buprenorphine—you’re building a career. Your interview questions for them should probe how the program invests in your future.

Educational Structure & Curriculum

9. “Can you walk me through the didactic curriculum for addiction medicine trainees? How is it integrated with clinical work?”
Good signs: protected time, structured series, board review, interdisciplinary speakers.

10. “How do you teach communication skills around motivational interviewing, stigma reduction, and working with families?”
Shows you appreciate the psychosocial and communication demands of the specialty.

11. “Do trainees have opportunities to teach medical students, residents, or other disciplines about addiction?”
Teaching experience is helpful for academic careers and your CV.

Mentorship & Feedback

12. “How is mentorship structured here? Are fellows assigned a mentor, or do they select someone aligned with their interests?”

13. “How often do trainees receive formal feedback, and what does that process look like?”
You want regular, actionable feedback, not just an end‑of‑year summary.

14. “Are there recent graduates I could speak with about their career paths and how the program supported their goals?”

Career Planning & Board Prep

15. “How does the program support trainees preparing for the addiction medicine board exam?”

16. “What types of positions have recent graduates gone into—academics, community practice, integrated primary care, public health, etc.?”
You’re looking for alignment with your goals and proof that graduates are employable.

Showcasing Your Priorities as a US Citizen IMG

When you ask what to ask program director-type questions, you can weave in your own goals:

“My long‑term goal is to work in a safety‑net system serving high‑risk populations in the US. How does your program help fellows position themselves for those roles after training?”

This reframes the conversation around your commitment to US patient populations rather than where you trained.

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Program Culture, IMG Support, and Fit: Questions You Must Ask

As a US citizen IMG, you need to know not only how good the training is, but also how you’ll be treated. These can be delicate questions, but there are tactful ways to get honest answers.

For the Program Director

17. “How would you describe the culture of the program and the division? What kind of trainee tends to thrive here?”
Listen for specific traits: collaborative, independent, advocacy-oriented, etc.

18. “What support systems are in place to promote trainee well‑being and reduce burnout, particularly given the emotional load of addiction work?”
Addiction medicine can be emotionally taxing. You want evidence of awareness and support.

19. “How has the program supported diversity, equity, and inclusion—particularly for trainees from non‑traditional or international backgrounds?”
This directly speaks to your identity as a US citizen IMG without making it adversarial.

20. “Are there current or past US citizen IMGs or other IMGs in the program whom I might reach out to about their experience here?”
If the answer is no, that’s informative. If yes, follow up.

For Current Fellows or Residents (Including Any IMGs)

21. “How approachable are the faculty and leadership when concerns come up?”

22. “Have you felt supported when you’ve made mistakes or had difficult clinical situations?”

23. “Do you see any differences in how IMGs or US citizen IMGs are perceived or treated—by faculty or by other trainees?”
Ask this privately and respectfully. You’re not looking for dirt; you’re seeking reality.

24. “What’s one thing you wish you had known about the program’s culture before you started?”

Reading Between the Lines

Red flags may include:

• Vague answers about culture (“we’re like a family” but no specifics)
• No examples of DEI efforts or IMG support
• Defensiveness when you ask about diversity or background

Strong programs will answer clearly and may volunteer examples (IMG graduates in leadership roles, structured mentorship, etc.).

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Research, Policy, and Public Health: Questions for Addiction Medicine Leaders

Many addiction medicine programs are deeply involved in research, advocacy, and systems‑level change. As a US citizen IMG, being engaged in projects that improve US addiction care can strengthen your CV and future job prospects.

Research Opportunities

25. “What kinds of research or quality improvement projects are available to trainees in addiction medicine here?”
Look for a range: clinical research, implementation science, overdose prevention, health services, etc.

26. “Is there protected time for research or scholarly work? How often do fellows or residents present at conferences or publish?”

27. “How are trainees matched with research mentors, especially if they come in with less prior research experience?”
You’re signaling that your background may be different but you are eager to contribute.

Policy & Advocacy

28. “Are there opportunities to get involved in policy work or advocacy related to substance use disorders—locally, statewide, or nationally?”
Strong addiction medicine programs often have:

• Engagement with state health departments
• Legislative testimony
• Community coalition involvement

29. “Have trainees been involved with initiatives around overdose prevention, medication access, or decriminalization/harm reduction?”

Community & Systems-Level Engagement

30. “How does the program collaborate with community organizations, criminal justice systems, or public health agencies to address addiction?”

31. “Do trainees get exposure to different care settings—such as methadone clinics, FQHCs, shelters, and correctional facilities?”

These questions show you’re thinking beyond the clinic, which is vital in addiction medicine.

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Practical & Logistical Topics: What to Ask Without Sounding Unprepared

You absolutely should ask about schedule, workload, and logistics—but do it in a way that reflects professionalism and respect.

Schedule, Call, and Workload

For fellows or senior residents:

32. “What does a typical week look like—in terms of clinics, consults, didactics, and admin time?”

33. “How often are you on call, and what does call usually involve?”

34. “Do you feel the workload is manageable, and do you have enough time to read, complete notes, and have a life outside of work?”

For the program director:

35. “How have you structured the schedule to balance robust clinical exposure with time for learning and self‑care?”

Compensation, Benefits, and Location

Questions about salary and benefits can be directed to the coordinator or current trainees:

36. “Where do most trainees live, and how is the commute?”

37. “Are there any housing, transportation, or childcare supports that the program or institution offers?”

38. “Is it common for trainees to moonlight, and if so, in what settings? How do you ensure that doesn’t conflict with educational goals or duty hour limits?”

For US Citizen IMGs Returning to the US

As an American studying abroad, re‑integrating into the US system can be a big life transition:

39. “Do you have trainees who were US citizen IMGs or trained entirely outside the US? How did the program help them adjust to US systems and documentation expectations?”

40. “Are there onboarding or orientation processes that help trainees get up to speed with local EHRs, regulations, and interprofessional workflows?”

These show maturity and foresight—that you’re anticipating a learning curve and planning ahead.

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Strategy: How to Use These Questions Effectively

Having a long list of questions is helpful, but strategy matters:

1. Prioritize 3–5 Core Questions Per Interview

You may only have 15–20 minutes with each person. Before each interview, pick:

• One question about clinical training
• One about culture/support
• One about mentorship/career
• One tailored to that person’s role (e.g., research if they’re a PI)

2. Avoid Questions Answered on the Website

If the website clearly lists rotation schedules, don’t ask, “What rotations do you have?” Instead, build on that:

“I saw on your website that you have an inpatient consult month and a methadone clinic rotation. How much flexibility is there to deepen exposure in an area that fits my interests, like co-occurring disorders or criminal‑legal system involvement?”

3. Use Conversation to Show Your Insight

When you ask interview questions for them, briefly link to your experience:

“In my clinical electives in the US, I saw a lot of fragmented care for patients with OUD being discharged from the hospital. How does your inpatient consult service coordinate with outpatient clinics to maintain continuity of MOUD?”

This turns a question into a mini‑discussion that communicates your understanding of real‑world problems.

4. Take Notes Immediately After Each Interview

Write down:

• Concrete details (e.g., “strong harm reduction focus,” “limited research but great teaching”)
• Gut feelings (e.g., “PD very supportive,” “fellows seemed burned out”)

This will be invaluable when making your rank list.

5. Use Follow‑Up Emails Wisely

After interviews, if you realize there’s something you forgot to ask:

• Send a concise, focused question to the coordinator or PD
• Or ask to be connected with a current trainee, especially a US citizen IMG, for an informal conversation

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Frequently Asked Questions (FAQ)

1. As a US citizen IMG, should I directly ask programs how they view IMGs?

You can, but it’s often more revealing to ask:

• “How has the program supported trainees from international or non‑traditional backgrounds?”
• “Can you share examples of IMGs or US citizen IMGs who have trained here and what they’re doing now?”

These invite concrete examples rather than abstract reassurance. If the program has no experience with IMGs, that doesn’t mean it’s bad—but you’ll want to weigh how comfortable they are onboarding someone with your background.

2. What are the most important questions to ask an addiction medicine program director?

If you’re limited on time, prioritize:

• Clinical depth: “What are the most distinctive clinical training experiences fellows get here?”
• Culture: “What qualities do your most successful trainees share?”
• Career outcomes: “Where have recent graduates gone, and how did the program help them get there?”
• Support: “How do you support trainee well‑being in such an emotionally demanding field?”

These hit training quality, fit, and long‑term prospects in just a few questions.

3. How can I tailor my questions to highlight my interest in an addiction medicine fellowship?

Frame questions around long‑term goals and commitment to addiction work:

• “My goal is to work in community addiction treatment serving underserved populations. What opportunities here would prepare me for that path?”
• “How do fellows participate in QI or research projects focused on overdose prevention or improving MOUD access?”

This signals to the program that you’re thinking beyond residency and see addiction medicine as a career, not just a rotation.

4. Is it okay to ask about moonlighting, salary, and vacation during interviews?

Yes—but be thoughtful about timing and tone. These topics are usually best directed to:

• Current fellows/residents
• Program coordinator

You might say:

“I’ve reviewed the GME information on salary and benefits. I was curious how trainees actually experience the cost of living here and whether moonlighting plays a role for most fellows.”

This shows you’ve done your homework and are asking from a practical, not purely financial, mindset.

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By preparing thoughtful, targeted questions and tailoring them to each program and interviewer, you turn the interview from a one‑sided evaluation into a real conversation about fit, values, and mission. As a US citizen IMG pursuing a future in addiction medicine, this is one of the most powerful ways to show that you’re ready—not just to match—but to lead in the care of patients with substance use disorders.