Ideal USMLE score for an IMG?

What is the ideal USMLE score for an international medical graduate?

You may say that "This is a stupid blog!", but I beg the readers to read carefully.

We all know that the USMLE scores have three components:

1] Pass or Fail
This is the most simple component to explain. The test result will read "pass" if you successfully achieved the minimum score/s required by USMLE. "Fail" will be seen if you did not make it to the minimum score/s.

2] Two-digit score
The passing score as of the moment is 75. The mean score for US graduates is 82. The two-digit score goes as high as 99, and the 100 score does not exist. It is implied that IMGs must aim for a grade of 99 in Steps 1 to 3 to have a better chance of being accepted in their residency of program of choice.

3] Three-digit score
The passing three-digit score varies from Step 1 to 3 (except for Step 2 CS, which is reported only as pass/fail). According to the official USMLE website, the range of the exam results ranges from 140 to 260 (two standard deviations from the mean of 221 [as corrected by RSingh07, because it used to be 200 in 2007] for US graduates); however, this is where the problem/confusion starts.

As in most comments/blogs/discussions, IMGs tend to look at the two-digit score probably because of convenience. Most would type in "My grades are 99/98/pass..." or "I got 99/99/pass/99..." However, I found out from an American (he is really an American and a US medical student) that program directors generally do NOT look at the two-digit score. US residency programs look at our three-digit score.

Why is this so? This is because of the inherent limitation of the two-digit scoring system.

The highest possible score that an examinee can obtain using the two-digit scoring system is 99. If you equate to the three-digit scoring system, all students with a three-digit score of more than 240 will get a score of 99. Therefore, anyone who scores above 240 equates to a 99 grade in the two-digit scoring system.

What that this have to do with the IMGs' application? EVERYTHING.

Since we have a lot of talented, smart and well-experienced IMGs, the US residency programs are currently drowned in a sea of grades with 99 on Steps 1 to 3. And since most IMGs are over-qualified and have other publications, experiences and awards added to their application, US residency programs would have to pick the best of the best of the best. (No, this is not a typographical error.)

For example:
We have 100 applicants with grades of 99. We will pick only five (5) applicants for interview. In the sea of applicants, we have 10 people with the exact qualifications (e.g., 99/99/pass/99, with USCE, with publications and research, good English speaking ability, good PS, et cetera). How do we sort them out?

If I were the program director, I would start looking at the three-digit scores. There are many IMGs with scores of 281, 274, 268, 265 and so on. With the three-digit scoring system, sky is the limit when it comes to how high an examinee can obtain in the exam.

Although there are many programs out there that says that they do not discriminate foreign applicants from the local (US) ones, we have to read in between the lines. Others will give a cut-off of, for example, 85, but will further add that they look at the whole application and NOT just the scores. My point is that, let's be realistic! Matching to a US residency is not an exact science. The residency programs lessen the quantity of their applicants by increasing the "quality" of the eligibility and criteria, i.e., increasing the cut-off scores.

And because of that - the higher the three-digit score, the better the chance of an interview to be returned.

Let me know your ideas about this post! Have you heard of this "style" of the programs before? Leave a comment, send a PM about it or discuss it with fellow IMGs!