The Government’s War Against American Doctors

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A controversy involving Rochester General Hospital in New York brought that question into sharp focus. A viral post alleged that 80 of 82 resident physicians were foreign-trained working under H‑1B or J‑1 VISAS, leaving only two positions for Americans.

That is a serious allegation. It also remains unverified. Medical-school rosters do not establish citizenship or VISA status, and the hospital’s published response did not provide that breakdown. Still, the questions deserve answers.

How many American applicants applied? How many were interviewed? How were applicants selected? And what role did VISA sponsorship play?

Before we can answer those questions honestly, we need to understand three things: 1. How residency selection works; 2. How H‑1B and J‑1 differ; and 3. What the numbers actually tell us.

A country concerned about having enough doctors should also be concerned about whether qualified Americans have a fair opportunity to complete their training.

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Before we decide whether Johnny was passed over, we need to understand how applicants and residency programs find each other.

Many positions are filled through the National Resident Matching Program (NRMP), commonly called “the Match.” Applicants apply to programs and interviews. Then both sides make choices: applicants rank the programs where they want to train, and programs rank the applicants they are willing to train. A computer algorithm compares those lists. It starts with the applicant’s preferences and attempts to place that person in the highest-ranked program that can accept them under the matching rules. Programs’ rankings and available positions also determine the outcome.

So, the questions begin before the computer runs: Who received an interview? What qualifications did the program value? Who was ranked — and who was left off the list? A hospital’s final roster only tells us who arrived. By itself, it does not tell us why another applicant did not.

There is another part of Johnny’s predicament: how residency training is funded. The Balanced Budget Act of 1997 established hospital-specific limits (CAPS) on the number of American residents Medicare would support to help prevent an oversupply of doctors, generally based on each hospital’s 1996 training levels. Hospitals can train residents above those limits, but must cover the additional costs through other resources. The 1997 Act doesn’t affect H‑1B and J‑1 sponsored foreign-trained residency doctors. But they raise a separate question that deserves attention alongside fair selection: If America post-1997 now needs more doctors, why aren’t we supporting enough opportunities to train American ones?

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This distinction stopped me, because it changes how we read the numbers. An international medical graduate, or IMG, attended medical school outside the United States under the applicable reporting definitions. That label describes an educational background. It does not, by itself, establish citizenship.

An American citizen who attended medical school abroad can be an IMG. A noncitizen IMG may be a permanent resident who does not need employer VISA sponsorship, or someone who does. But the NRMP reports these groups separately — and even distinguishes outcomes for noncitizen IMGs who require sponsorship from those who do not. A foreign medical-school name on a roster does not prove that an American lost a position to a VISA holder.

That is Why the Rochester Citizenship and VISA Breakdown Matters.

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These figures describe active applicants in each group. The supplemental process — called SOAP — offers eligible unmatched applicants another opportunity to obtain an unfilled position. But the U.S. MD and DO rows describe school enrollment, not citizenship; they also concern graduating seniors, rather than everyone who graduated in a previous year.

Nationally, seniors at U.S. medical schools had substantially higher placement rates than either IMG group. That deserves to be stated plainly. Those national results cannot explain every hospital’s decision or every applicant’s experience. Nor should we overlook the American citizens who studied abroad and faced substantially lower placement rates. Which brings us to the next question:

When a residency program accepts a physician who needs VISA sponsorship, what do H‑1B and J‑1 actually permit — and what obligations come with them?

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H‑1B and J‑1 often appear together in headlines. But they serve different purposes, carry different obligations, and provide targeted preferences for foreign doctors only.

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The J‑1 physician program is an educational exchange. ECFMG, a division of Intealth, sponsors physicians participating in approved U.S. clinical training programs. The hospital provides the training; ECFMG provides the visa sponsorship.

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One route, known as Conrad 30, allows qualifying physicians to obtain a waiver tied to a commitment to practice medicine for at least three years serving underserved communities in the U.S. Physicians using this route generally fulfill that service in H‑1B status. So, a physician may arrive for temporary training and later qualify to stay and work under a separate legal provision. That “preference” is now built into the law.

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The Migration Policy Institute’s analysis of 2021 Census data found that 26% of U.S. physicians and surgeons were foreign-born — approximately one in four. That includes naturalized American citizens; it does not mean one in four doctors holds a temporary work VISA.

The share is higher in some fields. An American Board of Internal Medicine study released in August 2026 found that 47.2% of the physicians studied in internal medicine and its subspecialties were born abroad, including doctors educated at U.S. medical schools.

These figures show how substantial a role physicians born abroad play in American medicine. They also reinforce why we must distinguish birthplace, citizenship, medical education, and VISA status before drawing conclusions.

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