A social media post claiming that a Rochester, New York, hospital filled nearly all of its internal medicine residency positions with foreign medical graduates has triggered a debate over international medical graduates. It also highlights visa sponsorship and access to U.S. residency training.
The post, shared on X, claimed that 82 residency spots at Rochester Regional Health went to 80 foreign medical graduates on H-1B or J-1 visas, while only two went to U.S. graduates.
However, Rochester Regional Health’s publicly available residency information does not independently substantiate the 82-position figure or the claimed breakdown by visa status.
The hospital’s website lists current residents in its Unity Hospital Internal Medicine Residency Program by postgraduate year and identifies the medical schools they attended. The current list includes graduates of medical schools in countries including India, Pakistan, Jordan, Egypt, Libya, the United Arab Emirates, Bahrain and others, alongside graduates of U.S. institutions.
The program’s official page says it accepts international medical graduates and sponsors J-1 visas. It also states that its positions are filled through the National Resident Matching Program. The residents page, meanwhile, lists two chief residents and residents in PGY-1, PGY-2 and PGY-3 classes. It does not identify each resident’s immigration or visa status.
That distinction is important because a medical school outside the United States does not, by itself, establish that a resident is currently in the country on an H-1B or J-1 visa. The public roster identifies medical-school backgrounds but does not provide visa information.
Viral post draws political attention
The post prompted comments from political figures and others questioning how residency positions are allocated and whether more information should be made public. Anthony D’Esposito, identified in the post as an inspector general, called on Rochester Regional Health to disclose how many residency positions went to H-1B and J-1 visa holders and how many American applicants were considered.
“Show us the numbers,” D’Esposito wrote, according to the post. He said an executive order concerning visa abuse had put the issue under scrutiny and that officials would work with the White House Task Force on Fraud to investigate potential abuse.
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New York state Sen. Jeremy Cooney criticized the claims as “racist and ridiculous,” while pointing to what he described as a shortage of health care providers. Missouri Sen. Eric Schmitt has separately argued that the U.S. medical system and other labor markets can disadvantage Americans in favor of foreign workers. His office has previously called for greater scrutiny of H-1B and other employment-related immigration programs.
Schmitt has argued that foreign-worker programs can displace qualified Americans, while supporters of international medical graduates point to their role in filling residency positions and addressing physician shortages.
Foreign medical graduates are a significant part of U.S. residency training
The broader national data show that international medical graduates constitute a substantial portion of the U.S. physician-training system.
The Medicare Payment Advisory Commission reported in 2025 that physicians educated at U.S. and Canadian medical schools filled 77% of residency positions in 2023, with graduates of international medical schools filling the remaining 23%. It also noted that specialties such as internal medicine, family medicine and pediatrics tend to rely heavily on international medical graduates because of difficulties filling some positions.
The National Resident Matching Program’s 2026 data show significant differences in Match outcomes between U.S. medical graduates and international medical graduates.
Among 20,934 U.S. MD seniors who were active applicants in the 2026 Main Residency Match, 93.5% matched to PGY-1 positions and 97.8% obtained positions when Match and Supplemental Offer and Acceptance Program placements were combined.
Among non-U.S. citizen international medical graduates, the PGY-1 match rate was 56.4%, while the overall placement rate was 59.9%. U.S.-citizen international medical graduates had a 70% PGY-1 match rate and a 77.8% overall placement rate.
The figures show that U.S. medical graduates continue to have substantially higher Match rates than international medical graduates nationally, although the data do not establish why individual applicants were or were not selected by a particular residency program.
Medicare funding adds another layer to the debate
The controversy also touches on the public funding used to support residency training. A December 2025 Government Accountability Office report said Medicare paid about $22 billion in 2023 to support graduate medical education residency positions at more than 1,400 hospitals. Medicare payments are intended to offset the costs hospitals incur in training residents partially.
Medicare supports graduate medical education through direct graduate medical education payments and an indirect medical education adjustment. The latter is designed primarily to account for higher patient-care costs at teaching hospitals and is not simply a payment for a resident’s training costs.
That funding has fueled questions over whether taxpayer-supported residency positions should be subject to additional rules concerning citizenship or immigration status. Current federal policy, however, does not establish a general requirement that Medicare-funded residency positions be reserved for U.S. citizens.
2024 USMLE controversy
The debate has also brought renewed attention to the 2024 controversy involving USMLE scores associated with examinees connected to Nepal. In January 2024, the USMLE program announced that it had identified anomalous examination performance associated with Nepal. It said highly irregular patterns could indicate prior unauthorized access to secure examination content and that affected examinees would have to take validation examinations.
Court records later stated that the National Board of Medical Examiners had invalidated the scores of 832 examinees after statistical analysis identified highly irregular results. The case involved allegations by one examinee that the process discriminated against Nepali applicants. A federal judge denied a preliminary injunction, finding that the record supported the conclusion that the NBME’s actions were based on credible reports of cheating rather than discriminatory animus against Nepalis.
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The USMLE and ECFMG actions affected eligibility for the 2024 residency Match because invalidated scores no longer satisfied the medical science examination requirement for ECFMG certification.
The episode, however, does not establish that foreign medical graduates generally engage in examination misconduct, nor does it provide evidence about the qualifications or visa status of the physicians currently listed at Rochester Regional Health.
What the Rochester data show
Rochester Regional Health’s Unity Hospital Internal Medicine residency roster clearly demonstrates a substantial presence of international medical graduates.
Among the PGY-3 residents listed by the hospital, for example, the medical schools include institutions in St. Lucia, Libya, Pakistan, India, the United Arab Emirates, Egypt and Bahrain. The PGY-2 and PGY-1 lists similarly include graduates of medical schools in multiple countries as well as U.S. medical institutions.
But the publicly available roster does not provide a complete applicant pool, interview pool, visa status or citizenship information. It therefore cannot establish how many Americans applied, how many were interviewed or rejected, or whether a particular applicant was disadvantaged because of immigration status.
The hospital’s own policy also says applicants are evaluated using medical school transcripts, MSPE or dean’s letters, recommendation letters, USMLE scores and other criteria.
The viral claim has therefore raised a legitimate question about transparency around residency recruitment, but the publicly available evidence does not currently support all of the numerical conclusions in the social media post. The broader issue remains part of a national discussion over physician shortages, international medical graduates, residency funding and how the United States should balance its physician workforce needs with opportunities for graduates of U.S. medical schools.