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U.S. IMG vs Non-U.S. IMG Residency Match: 2026 Data

April 21, 2025

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Updated October 28, 2026 with 2026 Main Residency Match data from the NRMP. 2025 figures are shown for comparison.

The 2026 NRMP Main Residency Match was the largest on record: 53,373 registered applicants and 44,344 positions, 2.6% more positions than in 2025. For international medical graduates, the results split sharply depending on one thing: whether you are a U.S. IMG or a Non-U.S. IMG.

Applicant groupActive applicants 2026Matched to PGY-1Match rate 2026Match rate 2025
U.S. IMGs4,2102,94970.0%67.8%
Non-U.S. IMGs11,9446,73356.4%58.0%
Source: NRMP, 2026 Main Residency Match, Advance Data Tables (Table 4) and Results and Data.

Understanding IMG Categories: U.S. IMG vs Non-U.S. IMG

The NRMP defines IMGs in two distinct groups:

  • U.S. IMG: A graduate of an international medical school who is a U.S. citizen.
  • Non-U.S. IMG: A graduate of an international medical school who is not a U.S. citizen. This includes green-card holders/U.S. permanent residents, even when they do not need visa sponsorship.

NRMP categories are based on citizenship, not visa sponsorship. NRMP explicitly classifies green-card holders as non-U.S.-citizen IMGs. Compare citizenship-based Match statistics separately from a program’s work-authorization and sponsorship requirements.

1. Two Pools Moving in Opposite Directions

  • U.S. IMGs: 4,210 active applicants, 8.2% fewer than in 2025 (4,587). Their match rate rose to 70.0%, the highest in five years (61.4% in 2022).
  • Non-U.S. IMGs: 11,944 active applicants, 4.2% more than in 2025 (11,465). Their match rate fell to 56.4%, the lowest in five years.
  • U.S. IMGs filled 7.2% of all PGY-1 positions; Non-U.S. IMGs filled 16.4%.

2. Visa Sponsorship: The Split Inside Non-U.S. IMGs

NRMP’s 2026 Match announcement broke the non-U.S. group down by visa need:

  • Foreign-born IMGs requiring visa sponsorship: 54.4% PGY-1 match rate, a five-year low. Their best year was 2023, at 59.1%.
  • Foreign-born IMGs not requiring sponsorship (U.S. permanent residents): 67.9%, a five-year high.

That is a 13.5-point gap between two groups NRMP otherwise counts together. NRMP notes that recent federal immigration policy changes have increased attention to visa sponsorship in residency recruitment. If you need a visa, confirm each program’s accepted work authorization and sponsorship policy before you apply.

3. Primary Care Is Still the Gateway

Specialty (PGY-1)Positions 2026Fill rate 2026Fill rate 2025Share filled by IMGs 2026
Internal Medicine (Categorical)11,19495.2%96.7%42.3%
Family Medicine5,49183.6%85.0%33.7%
Pediatrics (Categorical)3,12694.4%95.3%30.4%
Source: NRMP, 2026 Main Residency Match, Advance Data Tables (Tables 1, 2 and 7) and Results and Data.

All three filled slightly less in 2026 than in 2025, and all three remain the largest entry points for IMGs.

4. Other Specialties With a Large IMG Share in 2026

  • Pathology: 34.7% of filled positions went to IMGs (220 of 634)
  • Neurology: 22.4% (224 of 999)
  • Psychiatry: 16.3% (399 of 2,451)

5. Transitional and Preliminary Year Slots: Strategic Entry Points

  • Surgery-Preliminary: 1,207 positions; 664 filled in the Match, 290 of them by IMGs (43.7%).
  • Medicine-Preliminary: 1,565 positions; 177 filled by IMGs.
  • Transitional Year: 1,937 positions; 202 filled by IMGs.

These one-year positions give U.S. clinical experience and letters, but they do not guarantee a categorical position afterwards. See Preliminary vs Categorical Residency.

6. SOAP Grew in 2026 — But It Is Still a Backup

In 2026, 2,851 positions were placed in SOAP, 330 more than in 2025 (2,521). That is still a small number next to the thousands of unmatched applicants each year, so plan to match through the main algorithm.

Top 5 Questions IMGs Are Asking Right Now

  1. Is it getting harder for Non-U.S. IMGs? The group’s match rate fell to 56.4% in 2026 while its applicant pool grew 4.2%. Inside the group, applicants who need visa sponsorship matched at 54.4%, against 67.9% for U.S. permanent residents.
  2. Which specialties take the most IMGs? By number: Internal Medicine, Family Medicine and Pediatrics. By share of filled positions, among specialties with at least 500 positions: Surgery-Preliminary (43.7%), Internal Medicine (42.3%), Pathology (34.7%) and Family Medicine (33.7%).
  3. Does a green card or U.S. citizenship help? U.S. citizen IMGs matched at 70.0% in 2026. Permanent residents are still counted as Non-U.S. IMGs, but matched at 67.9% because they do not need sponsorship. Confirm each program’s policy.
  4. Are Prelim/TY years worth it? They can give U.S. experience and strong letters, and IMGs filled 43.7% of Surgery-Preliminary positions matched in 2026. They do not guarantee a categorical spot.
  5. Should I count on SOAP? No. SOAP had 330 more positions in 2026 (2,851), but 9,696 active applicants did not match to a PGY-1 position.

IMGPrep Match Smarter Not Harder!!

Sources: NRMP, 2026 Main Residency Match Advance Data Tables; Results and Data, 2026 Main Residency Match (May 2026); 2026 Main Residency Match By the Numbers; NRMP 2026 Match announcement (visa sponsorship figures). IMGPrep is not affiliated with the NRMP.