I am currently a PGY-2 in the Diagnostic Radiology Residency Program at Emory University in Atlanta, Georgia and applied for Match during the 2022-23 cycle. I’m breaking down this post on Matching in a Radiology Residency program into predominantly two parts. Although most of what I write comes from my experience of applying to the Diagnostic Radiology program, a lot of it also applies to integrated IR, although the specifics of experience needed may vary.

The first portion covers the general steps for applying and matching into a Diagnostic or Interventional Radiology residency program. The second part dives into the current U.S. residency climate for Diagnostic Radiology and tips to make yourself a competitive applicant. I have also added details regarding application expenses and radiology salaries, as also shared my story in short subsequently.

Part 1: Match into a Radiology Residency

A. Pass the USMLE Exams:

• Clearing the USMLE exams is a prerequisite. This includes Step 1, Step 2 Clinical Knowledge (CK), and Step 3. Over the last decade, Diagnostic Radiology has only grown more competitive, a trend that accelerated after COVID. Reasons for this include higher demand for radiologists, better work-life balance, job flexibility, and being well compensated. Since 2020, Step 1 is now Pass/Fail, which means a lot of emphasis now falls on Step 2 CK scores. Step 1 covers basic sciences, while Step 2 CK is more clinically focused, so getting a good Step 2 score is important.
• If you’re aiming for H1B-sponsored programs, Step 3 will be required. For J1 visa applicants, Step 3 isn’t mandatory for matching, but you’ll need to complete it before the end of PGY-1 (Preliminary or Transitional Year).

B. NMRP Match: 

• You have to apply for residency through the National Resident Matching Program (NRMP). Visit the official NRMP site for details.
• The Electronic Residency Application System (ERAS) application for applying for the match opens for uploading your documents in early September. Once all your major documents are ready, you can submit them (and certify them) for programs to review.
• Once certified, no changes can be made except updates to Letters of Recommendation (LORs), personal statements, or new transcripts.
• In mid-to-late September, applications are made available to programs at 9 a.m. ET.
• Step 3 completion is mandatory if you are applying to H1B visa-based programs. Ideally, aim to have your Step 3 results by the time applications open in September.

 C. Apply to Both Preliminary and Advanced Programs:

• Per ACGME guidelines, you need to complete a prerequisite year with at least 36 weeks in direct patient care before starting your Diagnostic Radiology residency. Most residents do a Transitional Year or a Preliminary year in Medicine or Surgery. The choice between these options depends on your interests. For example, future IR residents might choose a Surgery prelim year for more hands-on experience, though it’s not required.
• Note that apart from the Diagnostic Residency program, the US now also has a separate Integrated IR residency program, which is a 6-year training pathway, including a 1-year preliminary or transitional year (PGY-1) and 5 years of advanced radiology training. All five years of radiology training occur at the same institution.
• During the first three years (R1–R3), residents follow a diagnostic radiology (DR) schedule to meet board requirements. In the fourth year (R4), additional IR training begins, with the final PGY-6 year focused on IR-specific education.
• IR-integrated programs are highly competitive and require prior exposure to the field through clinical electives and research.
• Alternatives include the ESIR (Early Specialization in IR) pathway, where DR residents focus on IR during their final year, or a two-year IR fellowship after completing a 5-year diagnostic radiology residency, resulting in seven total years of training.

D. Interviewing and Ranking for Preliminary and Advanced Programs:

• You’ll be submitting two separate applications, one for a preliminary year and another for an advanced Diagnostic Radiology program, so you can tailor your personal statements, CV, and LOR for each. Keep in mind that applying to both will increase your application costs. You’ll also need to interview separately for each and submit a rank order list (ROL) that nests prelim programs under advanced Radiology programs. This way, you can rank prelim programs based on your Radiology match outcomes.
• Ranking residency programs involves balancing factors such as location, program reputation, work-life balance, academic opportunities, visa policies, and personal preferences. I would always recommend ranking programs in the order of your genuine interest and not based on assumptions about match probability.

E. Match Outcomes:

The matching process can go a few different ways:

• Matched to both prelim and advanced programs: Congrats, you’re all set!
• Didn’t match either: You can go through the Supplemental Offer and Acceptance Program (SOAP) or reapply next year.
• Matched into an advanced program but not prelim: You’ll need to secure a prelim spot independently.
• Matched into prelim but not advanced: You didn’t match into a Radiology program and may need to use SOAP or reapply next year. It’s rare to find an immediate R1 spot since those usually open due to a new position or resident withdrawal.

Part 2: How to be a competitive Diagnostic Radiology applicant

Diagnostic Radiology program have lately become competitive, so it’s crucial to stand out. Here are a few ways to boost your application:

A. Radiology Electives and Letters of Recommendation: Doing a Radiology elective during your last year of medical school gives you great exposure to the U.S. healthcare system, especially with PACS, EMR, and enterprise imaging. It’s also the best time to make connections and get letters of recommendation, ideally from faculty you’ve worked with directly in Radiology.

B. Research Fellowship: A research fellowship at an academic institution can make your application strong. These fellowships can range from one to three years, depending on the contract. This is a great route for anyone interested in research before applying to residency, as you’ll have chances to apply for grants, attend conferences, present research, and network. These connections and experiences will deepen your application and show a strong commitment to academic Radiology. Most research fellowship positions sponsor a J1 visa and will often ask for a minimum time commitment based on the available grant funding and the supervisor’s research plans, so it is important to discuss your residency plans with the supervisor early on. Do understand the respective visa implications though, as a J1 visa would imply the need to do a three-year waiver job if you wish to settle in the US anytime later, unless you go back to your home country and stay there for a minimum of two years.

C. Selecting the right program: You can research International Medical Graduate (IMG)-friendly states and programs by reviewing prior NRMP Match data and seeking feedback from peers or mentors. Some forums, such as the FREIDA database on the AMA website provide detailed lists of IMGs enrolled in each residency programs. In addition to IMG-friendliness, you will also need to consider factors such as visa sponsorship (J-1 or H1B), and geographic preferences.

Part 3: Application expenses and residency salaries

• Application and Registration Fees:
  • ECFMG Pathway Approval Fee: $925
  • ERAS Token Fee: $165 (non-refundable)
  • Electronic Transcript Fee: $80
  • NRMP Registration Fee: $70
  • J-1 Visa Sponsorship Application: $370
• Application Fees: Costs can range from $500 to over $2,000, depending on the number of programs applied to. For detailed fee information, visit the ERAS Fee Schedule.
• USMLE Costs: Approximately $2,500 for all steps. Additional details are available at ECFMG Fees.
• If you travel to the US for interviews and observerships/fellowships, that would certainly be a substantial additional cost.
• Resident Salaries: Salaries vary by institution and location but typically range from $55,000 to $70,000 annually, with benefits included.
• Needless to say, the expenses get eventually more than well-compensated during residency itself.

Part 4: My story

My interest in coming to the U.S. was driven by a desire to explore academic medicine. To further this goal, I applied for research fellowship positions and worked in a research lab developing AI-based prognostic tools using imaging scans. This experience not only allowed me to collaborate closely with radiologists but also ignited my passion for the field. I was fortunate to learn from exceptionally skilled radiologists and benefited greatly from the guidance of many individuals, including both radiologists and residents, throughout this journey.