NOT AGAIN — Over the past decade, the U.S. has steadily increased the number of residency positions, reaching 43,237 total positions in 2025, the highest ever. Yet even with that growth, the system still struggles to fully align supply with demand. Every year, 93–94% of U.S. MD seniors match, and over 92% of DO seniors match, meaning the vast majority of U.S. graduates secure positions. At the same time, nearly 10,000 international medical graduates (IMGs) matched into U.S. residency programs in 2025, filling critical gaps in the system. Even after the main match, 2,500+ residency positions remained unfilled and had to be offered through SOAP, a process specifically designed to fill vacancies that U.S. grads did not take. IMGs are not “taking” spots at scale, they face much lower match rates (≈58–68%) compared to U.S. graduates, meaning they are competing for and often filling the positions others leave behind. The facts remain — U.S. grads overwhelmingly match at high rates — Certain specialties and locations remain undesirable — And thousands of positions would go unfilled without IMGs Without international doctors, entire parts of the U.S. healthcare system, especially rural and primary care, would be understaffed. How did we end up wanting to blow up everything that adds value to America?