What’s trending
This year marked the largest Match Day in history, with 44,344 residency positions offered (up 2.6% over 2025) and a 93.5% fill rate. While the growth in training capacity appears encouraging, two trends have significant implications for health system leaders: declining interest in primary care and new barriers to recruiting international medical graduates (IMGs).
Results from this year’s Match highlight the worsening physician shortages in primary care:
- Primary care specialties offered 412 more positions than last year, but the collective fill rate declined 1.4% from 2025.
- Fill rates declined across all primary care specialties: internal medicine was down 1.6%, pediatrics down 0.9%, and family medicine down 1.4%.
- 16% of all family medicine positions were initially unfilled, with a total of 899 of 5,491 positions remaining open.
To address the perennial problem of filling family medicine positions, the National Resident Matching Program announced plans to convene a first-of-its-kind “Blue Ribbon Panel” of family medicine leaders this year. The panel will examine medical student interest, residency recruitment dynamics, and other factors influencing the specialty’s future.
At the same time, immigration policy is emerging as a structural constraint on workforce supply. This is the first cycle since President Trump issued a presidential proclamation increasing the fee for new H-1B petitions from approximately $3,500 to $100,000. The 2026 Match results suggest this issue may be a growing concern for health systems as match rates for non-US citizen IMGs experienced significant shifts:
- For all IMGs, the match rate fell to the lowest in 5 years at 56.4%.
- IMGs who require visa sponsorship were especially impacted, falling to the lowest match rate in 5 years at 54.4%.
- In contrast, IMGs who do not require visa sponsorship had the highest match rate in 5 years at 67.9%
As it stands, the H-1B application change would affect recruitment for several roles in healthcare, including physicians. In response, lawmakers introduced a bipartisan bill last week that would exempt physicians and other healthcare workers from the new fee and shield them from any additional fees beyond what is already included in existing immigration law.
Why it matters
Workforce shortages are already straining care delivery. Hospitals, community health centers, and other critical healthcare facilities are facing serious workforce shortages. This threatens access to care as demand rises with the aging population and increasing disease burden.
While the US has a general physician shortage, primary care is most pronounced. Its projected supply adequacy is just 81% by 2036. Rural populations are impacted the most as 66.4% of Primary Care Health Professional Shortage Areas (HPSAs) are in rural communities.
IMGs represent approximately 23% of practicing physicians and fill critical gaps in areas like primary care and psychiatry.
Their role is more pronounced in underserved communities. The percentage of H-1B-sponsored physicians is nearly two times higher in rural counties and nearly four times higher in the highest poverty counties. A decrease in sponsored physicians could disproportionately affect communities that already experience the greatest workforce shortages.
Hospitals can bring residents in through the J-1 visa program, which has not been impacted by increased fees. But this year’s Match results suggest that program directors may be reluctant to take the risk following last summer’s pause on J-1 visa interviews, which left many residents unable to start on time.
Given the heightened financial pressures health systems are facing, the increased fee of $100,000 per visa is simply untenable for many. To continue providing cost-effective, high-quality care to their communities, health systems will need to treat visa planning as an access issue, not just an immigration issue.
Health systems can start mitigating risk by:
- Identifying incoming physicians most exposed to visa-related disruptions
- Developing backup plans for delayed starts
- Evaluating alternative pathways, including J-1 visas and other lawful options
Within this environment of administrative and legislative uncertainty, hospital leaders will need to prepare contingency plans to ensure adequate recruitment and coverage in the coming year.
Related Links
Association of American Medical Colleges:
Hospitals and health systems depend on H-1B visa-sponsored physicians. So, what happens now?
American Medical Association:
Largest Match Day on record: Dive into the 2026 numbers
Fierce Healthcare:
Bipartisan bill would exempt health workers from $100K visa fee
