Potential clients frequently ask me how many programs they should apply to, but there's no easy answer, and in fact this is one of the few topics that I specifically mention in my contract that I don't handle. Even if I had attended medical school, earned the same grades and USMLE results as you did, and participated in the same experiences, I might approach the problem very differently. I don't think there's a right number, or a good number, or a safe number for any specialty. But if I were a typical IMG interested in family medicine and internal medicine, I might apply:
* To every hospital where I had rotated or completed an externship
* To every hospital where my friends are current residents in one or both of these departments
* To every hospital where my letter writers have professional colleagues in one or both of these departments
* To every hospital where my family and friends have a connection in one or both of these departments
* To every hospital where I've already had good discussions with program representatives (for example if you attended the national AAFP conference in July)
Beyond that? Any other program you pick is your choice, but the less connected you are to it based on the criteria above, the program directors might be less likely to give your application the attention it deserves. If you want to add to your list, first consider how IMG-friendly it is (are there lots of residents from schools like yours in those departments?), and then maybe if it fits other criteria you're looking for (underserved area? rural vs urban?). It's hard to say if simply living in the same state as a program normally helps, but a bilingual applicant from a border state ought to be able to demonstrate their connection to patients in that region.
So your first attempt at creating a list might have 20 programs, but it might have 200. The quantity doesn't matter to me...though it certainly might matter to you! Do you know how expensive ERAS is? After you pick your first 30 programs in a certain specialty (which isn't too expensive), ERAS starts charging you a lot more per program, and the fees add up quickly. They published an online list of fees that I recommend reviewing. 200 programs in your first choice specialty would cost almost $5000.
Applying to more places doesn't automatically get you more interviews, especially if you're seeking out programs that seem out of reach. Because every program director assesses your application separately, then sure, there's a chance at additional invitations, but if you're picking programs that are less IMG-friendly or where no Caribbean student has ever matched before, you could just be throwing money away. I strongly encourage you to contact your medical school and review their match success lists, and talk to former classmates to not only find out where they applied, but where they received interview offers. Use free resources like FREIDA and Residency Explorer to focus your search. Review program websites to see their lists of current residents; do they seem IMG-friendly? Additionally, IMGs from some schools can't get licensed in certain states; it's your responsibility to research this, because these restrictions won't stop ERAS from accepting your money.
Finally, I strongly recommend you sit down with a trusted attending to see what they think about this message and what they can do to help you get interviewed. If you need help actually preparing your application documents, getting ready for interviews, and the overall Match process, please contact me!