Opinion: Are international medical graduates taking residency spots from Americans? We did the math

OpinionFirst Opinion Are international medical graduates taking residency spots from Americans? We did the math The data don’t support the narrative taking hold on social media Manage alerts for this article Email this article Share this article By Manal Khan, Abishek Bala, and Sarah MohiuddinApril 30, 2026 Khan is associate program director for the child/adolescent psychiatry fellowship at University of California, Los Angeles. Bala is associate program director of the child/adolescent psychiatry fellowship at Central Michigan University. Mohiuddin serves as the training director of the child and adolescent psychiatry fellowship and as chair of graduate medical education resident well‑being at Michigan Medicine. The 2026 Main Residency Match was the largest in the program’s 74-year history. With 48,050 active applicants, 41,482 residency training positions were filled. Among the celebrations, however, Match Day announcements triggered a surge of posts on X and other social media platforms calling for new restrictions on international medical graduates (IMGs) in the match, claiming that U.S. medical graduates (USMGs) had been displaced. These calls came from a range of voices: anti-immigration commentators and political figures with no medical background as well as physicians channeling workforce frustration into criticism of non-U.S. IMGs. Critics found headshots of incoming residents, posted by programs to celebrate their matches, and recirculated without consent to fuel this narrative. Certain policymakers and social media figures with large followings have amplified these claims and are actively pursuing legislation to restrict visa sponsorship for internationally trained physicians.Advertisement With the broader rise in anti-immigrant rhetoric, such claims warrant systematic examination. We reviewed the 2026 National Resident Matching Program (NRMP) data and found no evidentiary basis for the displacement hypothesis. Enacting policies on its premise would deepen the physician workforce crisis it purports to address. The 2026 NRMP match data reveals that the match rate for U.S. medical students graduating with an M.D. degree was 93.5% and a D.O. degree was 93.2%. According to the American Medical Association, the match rate of U.S. medical students has held steady between 92% and 95% since 1982. By contrast, the postgraduate year-1 (PGY-1) match rate for non-U.S. IMGs — physicians who are neither U.S. citizens nor permanent residents — was 56.4%. This rate has declined to an all-time low in the past five years despite a 52% surge in active IMG applicants between 2022 and 2026.Advertisement In total, 2,772 PGY-1 positions went unfilled, which included 899 positions in family medicine, 537 in internal medicine, 175 in pediatrics, and 65 in psychiatry. The total number of unmatched USMG seniors — M.D. and D.O. combined — was 1,942. Even if every unmatched USMG had filled an open position, nearly 800 slots would have remained empty. Specialty-specific data reveals that USMGs and non-U.S. IMGs are not competing for the same PGY-1 positions. Non-U.S. IMGs make up a minuscule portion of applicants in specialties that USMGs historically dominate. In dermatology, internal medicine, thoracic surgery, and plastic surgery, U.S. M.D.s filled between 90% and 100% of available positions. Non-U.S. IMGs, by contrast, filled between zero and 3.6% of positions in those same specialties. Non-U.S. IMGs are over-represented in certain specialties such as internal medicine, family medicine, and pediatrics. They had the highest match rates of 60% and 54.2% in medicine-preventive medicine and pediatrics-primary, respectively. At the conclusion of the match, pediatrics-primary had four unfilled positions. According to the Physician Compensation Report published by Doximity in 2025, pediatrics, family medicine, and internal medicine are among the lowest-paying specialties. Plastic surgery, thoracic surgery, and dermatology feature among the highest paying specialties according to the same report. The graduating class of 2025 from U.S. medical schools noted that their top three considerations for choosing a career path post-graduation were work-life balance, stable/secure future, and ability to pay off debts. Pediatrics, internal medicine, and family medicine are not only compensated at a lower rate compared to other specialties, but they also have high burnout rates. Specialties with low compensation and high burnout rates are the ones that rely on the IMG workforce. USMGs graduate with an average debt of $200,000 and therefore, due to structural design, must prioritize specialties with better compensation. A 2024 survey done by the Association of American Medical Colleges showed that 63% of graduating medical students planned on using loan-forgiveness programs, and out of those, 88% noted an intention to pursue the public service loan forgiveness program. With stricter regulations going into effect in July 2026, the future of the PSLF program remains uncertain, and could contribute to worsening physician shortages in the U.S.Advertisement USMG and non-U.S. IMG applicants do not compete for positions in the same programs. Programs that predominantly recruit non-U.S. IMGs and those that predominantly recruit USMGs represent structurally distinct tiers, with minimal overlap in applicant pools. Interview allocation is a program-level decision driven by academic performance, clinical excellence, research productivity, and program-specific priorities. Specialty-level data confirm that match outcomes for USMGs are not meaningfully shaped by aggregate non-U.S. IMG participation rates. To assess program-level stratification, we analyzed trainee composition and program type across all accredited U.S. pediatric residency programs using the AMA’s Fellowship and Residency Electronic Interactive Database Access. The top 15 programs with the highest non-U.S. IMG representation are all community or community/university programs. The non-military pediatrics residency programs with the lowest number of IMG trainees are overwhelmingly university programs (11/15). Therefore, IMG and USMG applicants are not only applying to different specialties, but they are also matching into different programs. Further, non-U.S. IMG physicians demonstrate distinct clinical practice trends. Non-U.S. IMGs are disproportionately overrepresented in underserved, densely populated communities marked by lower income levels, greater health needs, and fewer physicians per capita. Post-residency, many non-U.S. IMGs who are on a J1 visa (the most common visa type for these physicians) work in medically underserved areas to waive the home country requirement. Non-U.S. IMG physicians are also overrepresented in clinical roles and underrepresented in teaching, administrative leadership, and research roles. Therefore, IMG physicians are also not competing with USMGs with regards to geographical location, practice setting, and career trajectory. The displacement narrative obscures the identifiable policy decisions that created both the specialty maldistribution and the projected workforce crisis. Medicare graduate medical education reimbursement was capped at 1996 resident counts under the Balanced Budget Act of 1997, creating a structural disincentive for federally supported training expansion even as U.S. medical school enrollment grew substantially over the subsequent three decades. Despite this constraint, USMG match rates remained stable while non-U.S. IMG match rates have declined as applicant volume grew, the inverse of what a displacement model would predict.Advertisement The U.S. faces a projected physician shortage of up to 86,000 by 2036, with primary care accounting for a disproportionate share of the deficit. The Resident Physician Shortage Reduction Act, which would add 14,000 Medicare-supported positions over seven years, has been introduced in the 119th Congress but has not been voted on. Even full implementation would not guarantee adequate coverage of specialty, geographic, and payer-mix disparities, nor would it address the structural inequities in health care access that drive them. Restricting non-U.S. IMG participation in graduate medical education will not improve outcomes for U.S. graduates. What it will do is widen the gaps in family medicine, internal medicine, pediatrics — the specialties already underserved, in the communities already underserved — and the burden will fall, as it consistently has, on the patients least equipped to absorb it. Manal Khan, MBBS, is an assistant clinical professor of psychiatry and associate program director for the child/adolescent psychiatry fellowship at University of California, Los Angeles. Abishek Bala, M.D., M.P.H., is an assistant clinical professor of psychiatry, clerkship director of psychiatry, and associate program director of the child/adolescent psychiatry fellowship at Central Michigan University. Sarah Mohiuddin, M.D., is a clinical associate professor at Michigan Medicine with expertise in medical education and autism spectrum disorders. She serves as the training director of the child and adolescent psychiatry fellowship and as chair of graduate medical education resident well‑being at Michigan Medicine. 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