WHEN DO AMERICANS COME FIRST IN THEIR OWN STATE? I saw a post claiming that Rochester General Hospital filled 80 of 82 residency positions with foreign visa workers. Before I repeat that number as fact, I want Rochester Regional Health to answer a very simple question publicly: How many of its current residents are American citizens or permanent residents, and how many require J-1 or H-1B visa sponsorship? Then I want that same question answered in Buffalo, Syracuse, Albany, Niagara Falls and New York City. Because this is much bigger than one hospital. In the 2026 national residency Match, 20,934 U.S. MD seniors competed for positions, along with 8,503 U.S. DO seniors, 4,210 U.S.-citizen international medical graduates and 11,944 non-U.S.-citizen international medical graduates. Non-U.S.-citizen IMGs obtained residency positions despite having a substantially lower overall match rate than U.S. MD and DO seniors. So here’s the question New Yorkers should be allowed to ask without being called names: When a New York hospital sponsors a foreign physician for a residency or subsequent H-1B employment, was a qualified American applicant available for that position? And if Americans applied and weren’t selected, what were the objective selection criteria? There’s another piece most people probably don’t know. New York State actively participates in the federal Conrad 30 program. The state can support waivers allowing certain J-1 physicians to remain here and transition to H-1B status when they agree to work full-time for at least three years serving federally designated underserved areas or populations. New York says explicitly that the purpose is improving access to health care for New Yorkers. That’s the state’s rationale, and it deserves to be reported accurately. But citizens are equally entitled to ask about the other side of the equation. Are these physicians filling positions that American physicians genuinely aren’t filling? Are hospitals recruiting internationally because particular communities have documented physician shortages? Or are American physicians competing directly against visa-sponsored physicians for positions Americans actually want? Those are empirically answerable questions. And there’s an important distinction that social media keeps mangling: foreign medical graduate does not mean foreign citizen. An American citizen can graduate from a medical school overseas. Citizenship, medical-school location and visa status are three different variables. The NRMP itself reports U.S.-citizen IMGs separately from non-U.S.-citizen IMGs for precisely this reason. That’s why I don’t want photographs, surnames or assumptions. I want the numbers. I want every major New York teaching hospital to disclose how many residency positions are occupied by U.S. citizens, permanent residents, J-1 physicians and H-1B physicians. Then New Yorkers can decide what they think about the policy using actual evidence. Because increasingly, my experience of New York leaves me asking an uncomfortable question: Is New York State being administered with its own citizens as its first obligation, or have New Yorkers become merely one constituency among many competing for opportunities in the state they finance? That’s my opinion and my question. Now give us the data. Transparency would end the argument rather quickly. If international physicians are filling genuine shortages that Americans aren’t filling, the numbers will demonstrate it. If they’re routinely taking highly sought-after positions while qualified Americans are being turned away, the numbers will demonstrate that too. Either way, New Yorkers deserve something more probative than rhetoric. #AStoneGroove #SilentMajoritySpeaks