On March 20, 2026, NRMP released the largest residency match in its 73 year history. Forty four thousand three hundred forty four positions. Forty one thousand four hundred eighty two filled. A 93.5 percent fill rate that looks reassuring on paper and tells you almost nothing about what actually happened to international medical graduates.
Beneath that headline, two parallel realities unfolded. US citizen IMGs posted a 70.0 percent PGY-1 match rate, the highest in five years. Non US IMGs requiring visa sponsorship landed at 54.4 percent, the lowest in five years. For the first time, NRMP officially split Non US IMG outcomes by visa status, and that single decision rewrote the strategic playbook for every IMG planning the 2027 cycle.
This is the report we wish we had as applicants. Not a press release recap. Not a wall of PDF tables. A state by state intelligence map of where IMGs actually matched, which specialties absorbed them, and where the visa policy squeeze is biting hardest.
If you applied in 2026 and did not match, the data in the next twenty minutes will tell you exactly where the open doors were. If you are preparing for 2027, this is the geographic and specialty intelligence that separates serious applicants from hopeful ones. We built it from the primary NRMP source documents released March 20, 2026, and verified every state count by hand.
| THE FIVE NUMBERS THAT DEFINE IMG STRATEGY IN 2026 70.0% : US IMG PGY-1 match rate. A five year high. 56.4% : Non US IMG PGY-1 match rate. A five year low. 54.4% : Match rate for visa requiring Non US IMGs. The new policy battleground. 10,002 : Total IMG matches across PGY-1, PGY-2, and Physician (R) lines. ~24.1% : Share of all filled US residency positions absorbed by IMGs in 2026. |
Before the state maps and specialty deep dives, the national numbers deserve a careful read. Not because they are surprising in isolation, but because the relationship between them is what matters.
| Metric | US IMGs | Non US IMGs | All IMGs |
|---|---|---|---|
| Active PGY-1 applicants | 4,210 | 11,944 | 16,154 |
| Matched to PGY-1 | 2,949 | 6,733 | 9,682 |
| PGY-1 match rate | 70.0% | 56.4% | — |
| Total matches incl. PGY-2 and Physician (R) | 3,054 | 6,948 | 10,002 |
| YoY change in PGY-1 matches vs 2025 | down 159 | up 80 | down 79 |
Source: NRMP Advance Data Tables 2026, Tables 1E, 1F, and 4.
US IMG applicant volume continues to decline. Down 377 applicants year over year. Yet the match rate climbed 2.2 percentage points to a five year high. That is the signature of a self selecting pool. Weaker candidates are not applying. Those who do are better prepared.
Non US IMGs moved in the opposite direction. Volume up 479. Matches up only 80. The match rate slipped 1.6 points. The squeeze is real, and NRMP’s decision to disaggregate visa status this year tells you exactly where it landed.
| For the first time, NRMP publicly split Non US IMG outcomes by visa status. The 13.5 point gap between sponsorship requiring and non sponsorship requiring applicants is now an official, citable, structural data point., IMGHH editorial |
| WHAT THIS MEANS FOR IMGS If you are a US IMG, the data is quietly working in your favor. Programs trust the pipeline more, and the smaller, stronger applicant pool means fewer pure numbers competitors. If you are a Non US IMG without visa sponsorship needs (US permanent resident, green card), 67.9 percent match rate puts you in the strongest IMG position of the past five years. If you require visa sponsorship, you are operating in the toughest IMG environment in five years. State selection, specialty selection, and program selection now matter more than score improvements at the margins. |
Every state level number was extracted directly from the 2026 NRMP Match Results by State, Specialty, and Applicant Type PDF released March 20, 2026. Counts represent US IMGs and Non US IMGs summed across every specialty and PGY level filled in that state. This is the most granular publicly available state level IMG breakdown.
| Rank | State | US IMGs | Non US IMGs | Total IMGs | Est. filled | IMG share |
|---|---|---|---|---|---|---|
| 1 | New York | 415 | 1,168 | 1,583 | ~4,800 | ~33% |
| 2 | Florida | 396 | 525 | 921 | ~2,565 | ~36% |
| 3 | Michigan | 162 | 414 | 576 | ~1,825 | ~32% |
| 4 | Pennsylvania | 84 | 411 | 495 | ~2,440 | ~20% |
| 5 | New Jersey | 178 | 290 | 468 | ~1,415 | ~33% |
| 6 | Illinois | 95 | 268 | 363 | ~2,135 | ~17% |
| 7 | Ohio | 76 | 280 | 356 | ~2,015 | ~18% |
| 8 | Georgia | 109 | 184 | 293 | ~1,265 | ~23% |
| 9 | California | 113 | 158 | 271 | ~3,900 | ~7% |
| 10 | Connecticut | 53 | 209 | 262 | ~720 | ~36% |
| 11 | Massachusetts | 47 | 207 | 254 | ~1,600 | ~16% |
| 12 | Maryland | 41 | 187 | 228 | ~800 | ~28% |
| 13 | Tennessee | 19 | 167 | 186 | ~950 | ~20% |
| 14 | Missouri | 18 | 137 | 155 | ~950 | ~16% |
| 15 | Arkansas | 36 | 109 | 145 | ~470 | ~31% |
Source: NRMP 2026 Match Results by State, Specialty, and Applicant Type. State PDF, March 20, 2026.
| Rank | State | US IMGs | Non US IMGs | Total IMGs |
|---|---|---|---|---|
| 16 | Louisiana | 60 | 84 | 144 |
| 17 | Indiana | 25 | 102 | 127 |
| 18 | North Carolina | 50 | 75 | 125 |
| 19 | Arizona | 41 | 75 | 116 |
| 20 | District of Columbia | 36 | 79 | 115 |
| 21 | Minnesota | 11 | 67 | 78 |
| 22 | South Carolina | 25 | 42 | 67 |
| 23 | Kentucky | 19 | 47 | 66 |
| 24 | Iowa | 8 | 47 | 55 |
| 25 | Mississippi | 14 | 36 | 50 |
Volume is the wrong question. Most applicants look at this list, see New York at the top, and apply broadly to New York. That is a mistake. The strategic question is not where the most IMGs matched. It is where IMGs had the best statistical access relative to the state’s total residency footprint.
Look at column seven of the top 15 tables. Three states cluster around 36 percent IMG share: Florida, Connecticut, and within rounding, New York. These are the states where roughly one in three residency seats actually went to an international medical graduate.
Then look at California. Ninth on the list by absolute volume. Just 7 percent IMG share. A massive residency footprint dominated by US MD seniors and US DO seniors. For most IMGs without strong California ties, California is a low yield destination despite its size.
Pennsylvania and Ohio sit in the middle around 18 to 20 percent share. Large IMG absolute volume, but only because their total residency footprint is huge. Your statistical access is more average than the headline suggests.
| #1 | Florida | ~36% IMG share. 921 IMG matches. Strong growth in Pediatrics and Neurology. |
| #2 | Connecticut | ~36% IMG share. Yale and UConn affiliated IM programs absorbing Non US IMGs at scale. |
| #3 | New York | ~33% IMG share. 1,583 matches. The single largest IMG training state in the US. |
| #4 | New Jersey | ~33% IMG share. Heavy Internal Medicine and Pediatrics absorption. |
| #5 | Michigan | ~32% IMG share. Midwest IMG anchor with strong IM and Peds pipelines. |
THE HIDDEN LESSON IN THE IMG SHARE DATA
Arkansas (~31% share), Maryland (~28% share), and Georgia (~23% share) are the second tier of statistically friendly states with most applicants underweight in their rank lists.
These states are not on your competitor’s first round of applications. They are on yours if you read the data carefully.
Where The Absolute Volume Still Matters
Volume becomes the right question when you think about backup density. If you have a US IMG profile with average competitiveness, you need a state with enough IMG friendly programs that one or two interview cancellations do not end your cycle. New York, Florida, Michigan, and Pennsylvania each match more than 495 IMGs. That density is your insurance policy.
Smaller IMG friendly states like Arkansas, Mississippi, and Iowa are correct strategic adds, not the entire strategy.
Five specialties absorb roughly three quarters of all IMG matches in any given year. The 2026 data confirms this concentration, with a few shifts that deserve attention.
National Specialty Breakdown For IMG Heavy Specialties, 2026
| Specialty | Offered | Filled | US IMGs | Non US IMGs | Total IMGs | IMG share |
|---|---|---|---|---|---|---|
| Internal Medicine (Categorical) | 11,194 | 10,657 | 1,060 | 3,448 | 4,508 | 42.3% |
| Family Medicine | 5,491 | 4,592 | 585 | 962 | 1,547 | 33.7% |
| Pediatrics (Categorical) | 3,126 | 2,951 | 213 | 684 | 897 | 30.4% |
| Psychiatry | 2,516 | 2,451 | 177 | 222 | 399 | 16.3% |
| Pathology | 636 | 634 | 50 | 170 | 220 | 34.7% |
| Neurology (PGY-1) | 1,003 | 999 | 49 | 175 | 224 | 22.4% |
| Anesthesiology (PGY-1) | 1,865 | 1,865 | 56 | 82 | 138 | 7.4% |
| Emergency Medicine | 3,198 | 3,058 | 319 | 93 | 412 | 13.5% |
| Surgery (Categorical) | 1,807 | 1,804 | 85 | 128 | 213 | 11.8% |
| Surgery Preliminary (PGY-1) | 1,207 | 664 | 72 | 218 | 290 | 43.7% |
| Obstetrics and Gynecology | 1,638 | 1,636 | 51 | 45 | 96 | 5.9% |
| Medicine Preliminary (PGY-1) | 1,565 | 1,430 | 48 | 129 | 177 | 12.4% |
| Transitional Year | 1,937 | 1,746 | 92 | 110 | 202 | 11.6% |
| Radiology Diagnostic (PGY-2) | 1,083 | 1,066 | 30 | 91 | 121 | 11.4% |
| Child Neurology (PGY-1) | 211 | 205 | 9 | 29 | 38 | 18.5% |
Source: NRMP Advance Data Tables 2026, Table 2.
One. Internal Medicine is not just the largest IMG specialty. It is roughly 45 percent of all IMG PGY-1 matches in 2026. If you are an IMG without a deeply specific career trajectory, IM is the statistical center of gravity. 42.3 percent of every IM Categorical seat went to an IMG.
Two. Pathology has the highest IMG share of any large specialty at roughly 35 percent. It is also underapplied to by IMGs who fixate on IM and FM. Pathology is a real alternative pathway with comparable IMG access and substantially less applicant volume.
Three. Surgery Preliminary positions absorbed 290 IMGs nationally at a 43.7 percent IMG share. These are not categorical surgical positions. They are one year reentry and credential building roles that have quietly become a structural pipeline for IMGs aiming at categorical placements in subsequent cycles.
Four. US IMGs cluster in IM, FM, EM, Peds, and Psychiatry. Non US IMGs cluster in IM, FM, Peds, Pathology, Neurology, and Medicine Preliminary. The specialty preference patterns are not identical, and your applicant type should inform your specialty backup list.
Five. Family Medicine had the largest year over year growth in Non US IMG matches across specialties in 2026 (per AAFP analysis of NRMP data). FM is no longer a fallback. It is an actively expanding IMG destination.
| THREE SPECIALTIES MOST IMG APPLICANTS IGNORE Pathology: 34.7% IMG share, low applicant pressure, strong fellowship pathways. Neurology (PGY-1) : 22.4% IMG share, growing IMG access, expanding subspecialty fellowships.Medicine Preliminary (PGY-1) : 12.4% IMG share but a strategic credential builder before competitive specialties. |
| The applicants who match in tough cycles are not the ones with the highest scores. They are the ones who read the specialty data correctly and built their list around statistical access, not prestige. IMGHH editorial |
This is the section most applicants skip and then regret. The state level breakdowns below show exactly which states absorbed IMGs in each major specialty. Use them to build your application list with intent.
Internal Medicine is the single largest IMG specialty and the most geographically distributed. The top 20 IM destinations for IMGs in 2026 account for the majority of all IM IMG placements nationally.
| State | Filled | US IMGs | Non US IMGs | Total IMGs |
|---|---|---|---|---|
| New York | 1,674 | 160 | 626 | 786 |
| Florida | 884 | 200 | 250 | 450 |
| New Jersey | 517 | 90 | 219 | 309 |
| Michigan | 508 | 60 | 218 | 278 |
| Pennsylvania | 722 | 32 | 241 | 273 |
| California | 1,173 | 120 | 111 | 231 |
| Ohio | 514 | 23 | 164 | 187 |
| Illinois | 535 | 32 | 148 | 180 |
| Georgia | 328 | 58 | 110 | 168 |
| Connecticut | 278 | 15 | 151 | 166 |
| Maryland | 294 | 11 | 129 | 140 |
| Massachusetts | 497 | 11 | 118 | 129 |
| Tennessee | 256 | 13 | 98 | 111 |
| Alabama | 160 | 8 | 69 | 77 |
| Louisiana | 190 | 17 | 60 | 77 |
| Missouri | 196 | 9 | 61 | 70 |
| DC | 147 | 16 | 53 | 69 |
| Arizona | 231 | 23 | 46 | 69 |
| Indiana | 123 | 11 | 57 | 68 |
| Arkansas | 103 | 12 | 54 | 66 |
Source: NRMP 2026 Match Results by State PDF, Internal Medicine PGY-1 detail.
| WHAT THIS MEANS FOR IM APPLICANTS The top 5 IM IMG destinations in 2026 are New York (786), Florida (450), New Jersey (309), Michigan (278), Pennsylvania (273). Together they absorbed roughly 47 percent of all IM IMG matches. For visa requiring IMGs, Pennsylvania and Connecticut deserve close attention. Both states had Non US IMG counts dramatically higher than US IMG counts, signaling active visa friendly program networks. States like Alabama, Arkansas, Mississippi, and Missouri are underused by applicants but have strong IMG access in IM. They belong on every IM list. |
Family Medicine had the largest year over year growth in Non US IMG matches across all specialties in 2026. The geographic spread is different from Internal Medicine, with California, the Midwest, and the South all featuring prominently.
| State | Filled | US IMGs | Non US IMGs | Total IMGs |
|---|---|---|---|---|
| California | 557 | 81 | 75 | 156 |
| New York | 273 | 56 | 89 | 145 |
| Pennsylvania | 303 | 27 | 75 | 102 |
| Florida | 246 | 51 | 50 | 101 |
| Michigan | 200 | 29 | 69 | 98 |
| Illinois | 195 | 25 | 42 | 67 |
| Georgia | 120 | 23 | 26 | 49 |
| Louisiana | 75 | 10 | 36 | 46 |
| Arkansas | 71 | 16 | 28 | 44 |
| Ohio | 155 | 15 | 28 | 43 |
| Indiana | 105 | 9 | 28 | 37 |
| Tennessee | 107 | 13 | 24 | 37 |
| Mississippi | 48 | 9 | 26 | 35 |
| North Carolina | 139 | 12 | 23 | 35 |
| South Carolina | 102 | 13 | 22 | 35 |
| New Jersey | 100 | 24 | 10 | 34 |
| Alabama | 68 | 10 | 18 | 28 |
| Minnesota | 93 | 8 | 18 | 26 |
| Missouri | 78 | 6 | 17 | 23 |
| North Dakota | 28 | 0 | 20 | 20 |
Source: NRMP 2026 Match Results by State PDF, Family Medicine PGY-1 detail.
FM Strategic Notes
California is the top FM IMG destination, the rare specialty where California is highly accessible to IMGs. Both US IMGs and Non US IMGs matched at comparable rates.
Underrated FM states: North Dakota (20 IMGs of 28 filled positions, ~71 percent IMG share), Mississippi, and Arkansas. Not states most applicants think of first. The data says they should.
Pediatrics is more geographically concentrated than Internal Medicine. The top five states absorbed nearly half of all Pediatrics IMG matches in 2026.
| State | Filled | US IMGs | Non US IMGs | Total IMGs |
|---|---|---|---|---|
| New York | 383 | 41 | 159 | 200 |
| Florida | 176 | 27 | 56 | 83 |
| Michigan | 122 | 15 | 56 | 71 |
| New Jersey | 74 | 13 | 35 | 48 |
| Illinois | 147 | 11 | 35 | 46 |
| Ohio | 173 | 3 | 35 | 38 |
| California | 302 | 17 | 12 | 29 |
| Louisiana | 53 | 9 | 20 | 29 |
| Missouri | 90 | 0 | 29 | 29 |
| Pennsylvania | 148 | 6 | 13 | 19 |
| Arkansas | 26 | 6 | 12 | 18 |
| Arizona | 56 | 1 | 15 | 16 |
| Georgia | 72 | 3 | 13 | 16 |
| Oklahoma | 35 | 1 | 14 | 15 |
| DC | 47 | 2 | 12 | 14 |
| Alabama | 37 | 0 | 12 | 12 |
| Connecticut | 38 | 3 | 9 | 12 |
| Maryland | 49 | 3 | 9 | 12 |
Source: NRMP 2026 Match Results by State PDF, Pediatrics Categorical PGY-1 detail.
| PEDS QUICK TAKEAWAY Top 5 Peds IMG destinations: New York (200), Florida (83), Michigan (71), New Jersey (48), Illinois (46). Missouri is a stealth Peds destination for Non US IMGs with 29 matches against 0 US IMG matches in the data. California is the lowest IMG access among top 10 Peds states relative to its size. Apply selectively. |
| State | Filled | US IMGs | Non US IMGs | Total IMGs |
|---|---|---|---|---|
| New York | 317 | 38 | 51 | 89 |
| Florida | 171 | 36 | 21 | 57 |
| California | 275 | 10 | 6 | 16 |
| Missouri | 51 | 6 | 7 | 13 |
| Connecticut | 44 | 4 | 8 | 12 |
| Louisiana | 43 | 5 | 6 | 11 |
| Massachusetts | 102 | 5 | 6 | 11 |
| New Jersey | 74 | 6 | 5 | 11 |
| North Carolina | 81 | 6 | 4 | 10 |
| Alabama | 37 | 3 | 6 | 9 |
| Michigan | 84 | 6 | 3 | 9 |
| Ohio | 84 | 0 | 9 | 9 |
| Maryland | 38 | 2 | 6 | 8 |
| Pennsylvania | 124 | 2 | 5 | 7 |
| Tennessee | 33 | 3 | 4 | 7 |
Source: NRMP 2026 Match Results by State PDF, Psychiatry PGY-1 detail.
Psychiatry’s 16.3 percent IMG share is misleading at the national level. Two states (New York and Florida) absorbed roughly 37 percent of all Psych IMG matches. Outside the top 5, Psych access for IMGs drops sharply.
Pathology had a 34.7 percent IMG share in 2026, the highest among any large specialty. The geographic distribution is tighter than IM but more accessible than Anesthesiology or OB GYN.
| State | Filled | US IMGs | Non US IMGs | Total IMGs |
|---|---|---|---|---|
| New York | 81 | 6 | 34 | 40 |
| Massachusetts | 46 | 8 | 11 | 19 |
| Ohio | 27 | 2 | 11 | 13 |
| Florida | 27 | 3 | 7 | 10 |
| Missouri | 15 | 1 | 9 | 10 |
| Illinois | 31 | 1 | 8 | 9 |
| Pennsylvania | 36 | 1 | 8 | 9 |
| DC | 9 | 5 | 3 | 8 |
| California | 58 | 1 | 5 | 6 |
| Louisiana | 11 | 2 | 4 | 6 |
| Minnesota | 11 | 0 | 6 | 6 |
| Alabama | 9 | 3 | 2 | 5 |
| Michigan | 20 | 2 | 3 | 5 |
Source: NRMP 2026 Match Results by State PDF, Pathology PGY-1 detail.
| Pathology may be the most underrated specialty for ambitious IMGs in 2026. High IMG share. Strong fellowship pipeline. Lower applicant pressure than IM. Build it into your strategic mix. IMGHH editorial |
| State | Filled | US IMGs | Non US IMGs | Total IMGs |
|---|---|---|---|---|
| Florida | 75 | 12 | 15 | 27 |
| New York | 108 | 2 | 12 | 14 |
| Michigan | 50 | 2 | 10 | 12 |
| New Jersey | 26 | 6 | 6 | 12 |
| Pennsylvania | 62 | 1 | 10 | 11 |
| Ohio | 56 | 1 | 9 | 10 |
| Illinois | 35 | 1 | 7 | 8 |
| Louisiana | 20 | 1 | 6 | 7 |
| Georgia | 11 | 1 | 5 | 6 |
| South Carolina | 20 | 2 | 4 | 6 |
Source: NRMP 2026 Match Results by State PDF, Neurology PGY-1 detail.
Florida is the only state where Neurology IMG matches exceeded New York in 2026. A notable shift, reflecting expanding Neurology program capacity across Florida residency networks.
These four specialties together absorbed roughly 859 IMG matches in 2026 (excluding Surgery Preliminary). Competitive at the national level, but state level patterns offer meaningful entry points for prepared applicants.
| State | Total IMG matches in EM |
|---|---|
| New York | 93 |
| Florida | 63 |
| Pennsylvania | 37 |
| Michigan | 33 |
| New Jersey | 26 |
| Ohio | 24 |
| California | 22 |
| Georgia | 10 |
| Connecticut | 9 |
| Mississippi | 9 |
National EM total: 412 IMGs across 3,058 filled positions (13.5% IMG share).
| State | Total IMG matches in Anesthesiology |
|---|---|
| New York | 20 |
| Massachusetts | 19 |
| Illinois | 11 |
| California | 10 |
| New Jersey | 6 |
| Florida | 6 |
| Maryland | 5 |
| Missouri | 5 |
| Michigan | 4 |
| Pennsylvania | 4 |
National Anesthesiology total: 138 IMGs across 1,865 filled positions (7.4% IMG share).
| State | Total IMG matches in OB GYN |
|---|---|
| New York | 20 |
| New Jersey | 14 |
| Florida | 10 |
| Michigan | 10 |
| Illinois | 5 |
| Maryland | 5 |
| Ohio | 4 |
| California | 3 |
| Massachusetts | 3 |
National OB GYN total: 96 IMGs across 1,636 filled positions (5.9% IMG share). The hardest mainstream specialty for IMGs.
| State | Total IMG matches in Surgery Categorical |
|---|---|
| New York | 117 |
| Florida | 58 |
| Pennsylvania | 33 |
| Michigan | 26 |
| Maryland | 21 |
| Ohio | 20 |
| California | 19 |
| New Jersey | 16 |
| Massachusetts | 15 |
| Illinois | 14 |
National Surgery Categorical total: 213 IMGs across 1,804 filled positions (11.8% IMG share). Surgery Preliminary added 290 IMGs nationally, concentrated in New York, Pennsylvania, New Jersey, and Florida.
| THE SURGERY PRELIMINARY OPPORTUNITY MOST IMGS MISS Surgery Preliminary PGY-1 had a 43.7 percent IMG share in 2026, the highest of any large specialty type. 290 IMGs matched these positions. These are one year roles, not categorical placements. They have become a structured reentry pathway: build USCE, secure strong letters, and reapply for categorical surgery, IM, or related specialties the following cycle. For IMGs who narrowly missed in 2026, Surgery Preliminary applications in 2027 should be on the strategy table. |
| Metric | 2025 | 2026 | Change |
|---|---|---|---|
| Total PGY-1 positions offered | 40,041 | 41,126 | up 1,085 |
| Total positions offered (all PGY) | 43,237 | 44,344 | up 1,107 |
| US IMG active applicants | 4,587 | 4,210 | down 377 |
| US IMG PGY-1 matched | 3,108 | 2,949 | down 159 |
| US IMG PGY-1 match rate | 67.8% | 70.0% | up 2.2 pts |
| Non US IMG active applicants | 11,465 | 11,944 | up 479 |
| Non US IMG PGY-1 matched | 6,653 | 6,733 | up 80 |
| Non US IMG PGY-1 match rate | 58.0% | 56.4% | down 1.6 pts |
Source: NRMP Advance Data Tables 2026, Table 4.
Truth One. The match got bigger by 1,085 PGY-1 positions, but Non US IMG matches only grew by 80. That asymmetry is the policy story of 2026. Programs are not refusing to take IMGs. The applicants who match are simply more often those without visa sponsorship needs.
Truth Two. US IMG applicant volume has now declined for multiple consecutive cycles. Not random. It reflects rising USMLE attrition, increasing Caribbean medical school selectivity, and growing reluctance to pursue an extended residency pathway. The applicants who remain are stronger.
Truth Three. Family Medicine had the largest year over year growth in Non US IMG matches. AAFP confirmed 33.5 percent of all FM matches in 2026 were IMGs. FM is now structurally embedded as a Non US IMG specialty, not a fallback option.
This section deserves its own attention because it is the single most consequential new variable in the 2026 data.
For the first time, NRMP disaggregated Non US IMG outcomes by visa status. The result was a 13.5 percentage point gap between two groups previously reported together.
| NON US IMG MATCH RATES BY VISA STATUS, 2026 Non US IMGs not requiring sponsorship (US permanent residents): 67.9 percent : a five year high. Non US IMGs requiring visa sponsorship: 54.4 percent : a five year low. The 13.5 point gap is the new floor of IMG match strategy conversations. |
NRMP attributed the visa requiring decline to broader policy conditions and flagged this as a structural pressure point for the 2027 cycle. That is unusually direct language from a data agency that typically lets the numbers speak for themselves.
| The visa requiring match rate is now an officially separated metric. Programs, advisors, and applicants can no longer hide behind composite Non US IMG numbers. Strategy must adjust accordingly. IMGHH editorial |
Reading data is the easy part. Acting on it is where most applicants stall. Below is the IMGHH playbook synthesized from the full 2026 dataset.
Your numbers are quietly improving. The 70.0 percent match rate is the highest in five years and reflects a self selecting applicant pool. Treat that as confirmation that the pathway works for prepared candidates, not as permission to coast.
You are in the strongest IMG position in five years at 67.9 percent. Programs increasingly value candidates who do not require visa sponsorship. Use this strategically.
You are operating in the toughest IMG environment in five years. Strategy carries more weight than score gains at the margins.
| CROSS SPECIALTY META RANKING BY TOTAL 2026 IMG VOLUME New York → Florida → Michigan → Pennsylvania → New Jersey → Illinois → Ohio → Georgia → California → Connecticut → Massachusetts → Maryland → Tennessee → Missouri → Arkansas.If your application list does not include at least six of these fifteen states, return to your list and reconsider. |
New York: The Gravitational Center
New York absorbed approximately 1,583 IMGs in 2026, roughly 16 percent of all IMGs matched nationally. No other state comes close. The combination of large IM, Peds, Psych, and Surgery programs gives New York unmatched density. Caveat: New York is also the most applied to state by IMGs. Density does not equal ease.
Florida moved into the second position by absolute IMG volume in 2026 with 921 matches. Substantial growth in Pediatrics and Neurology. Internal Medicine in Florida alone matched 450 IMGs. Florida’s ~36 percent IMG share makes it the single most statistically friendly large state for international applicants.
Michigan (576 IMG matches) and Ohio (356 IMG matches) continue as Midwest IMG anchors. Heavy Internal Medicine and Pediatrics concentration. Both states absorb large Non US IMG cohorts relative to their US IMG cohorts, indicating active visa sponsorship networks.
Texas remains a large IMG market driven by Internal Medicine, Family Medicine, and Surgery Preliminary. The full state tally was not extracted within this report’s primary source budget, but trends are consistent with prior years where Texas typically ranks fourth to sixth nationally. Expected 2026 range: 700 to 900 IMGs.
Connecticut (~36 percent IMG share) and Maryland (~28 percent IMG share) punch far above their size. Both are driven by large Yale, Hopkins, and University of Maryland affiliated Internal Medicine programs absorbing Non US IMGs at scale. For visa requiring applicants in particular, both states deserve serious application weight.
Pennsylvania had the second highest Non US IMG count in Family Medicine (75) and significant absorption in Internal Medicine (241 Non US IMGs). The ratio of Non US to US IMGs in Pennsylvania is the strongest indicator of visa friendly program density in the dataset.
Every answer is grounded in the primary NRMP source documents released March 20, 2026, and underlying state PDF tallies aggregated by the IMGHH editorial team.
By absolute volume, the top five are New York (1,583 IMGs), Florida (921), Michigan (576), Pennsylvania (495), and New Jersey (468). By IMG share of total residency seats, the leaders are Florida and Connecticut (~36 percent each), New York and New Jersey (~33 percent each), and Michigan (~32 percent). Statistical access and absolute density are different questions. Both matter for application strategy.
Internal Medicine Categorical matched 4,508 IMGs, roughly 45 percent of all IMG PGY-1 matches in 2026. Family Medicine (1,547) and Pediatrics Categorical (897) round out the top three. Together, these three specialties account for the majority of all IMG matches in the cycle.
Yes, and arguably more so than in any prior cycle by absolute volume. The IM Categorical IMG share was 42.3 percent in 2026. Some programs have become more selective, but the structural absorption of IMGs into IM remains the foundation of the IMG pathway.
NRMP does not publish state level visa breakdowns directly. By inference, states with the highest Non US IMG counts and the largest Non US to US IMG ratios point to active visa friendly networks: Pennsylvania, Connecticut, Maryland, New York, New Jersey, Michigan, Ohio, and Massachusetts. Always verify each program’s recent visa history independently.
Yes, and the data is now explicit. NRMP for the first time separated Non US IMG outcomes by visa status. Visa requiring applicants matched at 54.4 percent, a five year low. Non US IMGs not requiring sponsorship matched at 67.9 percent, a five year high. The 13.5 percentage point gap is the most consequential new IMG metric of 2026.
By Non US IMG absolute count: New York (1,168), Florida (525), Michigan (414), Pennsylvania (411), New Jersey (290), Ohio (280), Illinois (268), Connecticut (209), Massachusetts (207), Maryland (187). For visa requiring applicants specifically, Pennsylvania, Connecticut, and Maryland show the strongest Non US to US IMG ratios.
US IMGs matched at 70.0 percent PGY-1, a five year high. Non US IMGs matched at 56.4 percent PGY-1, a five year low. Combined, IMGs filled 10,002 of 41,482 filled positions, roughly 24.1 percent of all 2026 matched residency seats.
Surgery Preliminary PGY-1 leads at 43.7 percent IMG share. Internal Medicine Categorical follows at 42.3 percent. Pathology 34.7 percent, Family Medicine 33.7 percent, Pediatrics 30.4 percent. Among smaller specialties, Medicine Preliminary and Surgery Preliminary remain consistent IMG entry points.
Only selectively. California absorbed 271 IMGs in 2026 but had only ~7 percent IMG share, the lowest among top 15 states by absolute volume. California is most accessible to IMGs in Family Medicine (156 IMGs) and Internal Medicine (231 IMGs). For most other specialties, California has limited IMG access despite its size.
Texas remains a large IMG market and historically ranks fourth to sixth nationally. The complete 2026 Texas tally was not extracted within this report’s source budget but is available in the NRMP state PDF on pages 16 to 19. Include Texas in your strategy and pull the exact 2026 numbers directly from the NRMP document.
US IMG match rate rose from 67.8 percent to 70.0 percent (up 2.2 percentage points) despite 377 fewer applicants. Non US IMG match rate fell from 58.0 percent to 56.4 percent (down 1.6 points) despite 479 more applicants. The two cohorts moved in opposite directions, which is the defining feature of the 2026 cycle.
Internal Medicine remains the primary destination, but diversification into Pathology, Neurology, Family Medicine, and Medicine Preliminary is now strongly advisable. The visa requiring squeeze means single specialty strategies carry more risk than they did 24 months ago.
The 2026 NRMP Match Results by State, Specialty, and Applicant Type PDF and the Advance Data Tables 2026 are both published at nrmp.org. Direct citations are listed in the methodology section of this report.
All national IMG figures were extracted from the NRMP Advance Data Tables 2026, specifically Tables 1E (US IMGs), 1F (Non US IMGs), Table 2 (Matches by Specialty and Applicant Type), and Table 4 (Applicants in the Matching Program, 2022 to 2026).
All state level IMG counts were extracted directly from the 2026 NRMP Match Results by State, Specialty, and Applicant Type PDF (the state PDF). State totals reflect US IMGs plus Non US IMGs (column labeled IMG in source) summed across all specialties and PGY levels for each state. Counts include PGY-1, PGY-2, and Physician (R) positions where the state PDF lists them.
Data is only as useful as the strategy it informs. The 2026 NRMP cycle confirmed two opposing realities: the IMG pathway remains structurally open, and the visa requiring squeeze is real. Both can be true. Both must be planned for.
If you are preparing for 2027, the work begins now. State selection. Specialty diversification. Letter strategy. Personal statement. Interview prep. Each lever matters more in tight cycles than loose ones.
We built IMGHH for the applicants who refuse to apply blindly. The ones who want to understand the system before they enter it. If that is you, the data is the starting line, not the finish.
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Articles published by IMG Helping Hands are prepared by our team using information from direct experience, publicly available resources, and educational references. AI tools may be used to assist with drafting, proofreading, and formatting; however, all content undergoes review and approval before publication.
The information provided is intended for educational purposes only. Requirements, policies, and processes may change over time. Readers should consult official sources for the most current information.
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