The morning of July 1, I walked into the hospital as a resident physician for the first time. I had survived Caribbean medical school, clinical rotations in New York City, the chaos of COVID descending on that city right as I was graduating, a research fellowship I worked for free, and a visa process that had stretched across years. I had matched. I had made it.

Six months later, I resigned.

I want to tell you what happened in between — not because I want sympathy, but because I think it matters for how our profession selects the people who will one day care for your patients, and mine.

My path to residency was never going to be straightforward. I attended medical school in the Caribbean, which meant I was ineligible for a J-1 visa, and my home country's policies required that I obtain their medical license to qualify. So, I pursued an H-1B instead, a far more complex and expensive route, but the only one available to me. I stayed in New York City, took a research fellowship without pay, passed Step 3, and obtained my full Educational Commission for Foreign Medical Graduates certification. I matched to a preliminary surgery position at a community hospital in New Jersey.

My H-1B was approved on June 28th. I started on July 1st. And almost immediately, we discovered a problem: I needed a Social Security number to be paid, and to get a Social Security number, I needed U.S. Citizenship and Immigration Services to formally update my immigration status. My previous visa — a B-1 used for my clinical rotations and research fellowship — didn't allow for it. And because of COVID restrictions, I couldn't leave the country to resolve it quickly.

So I worked. I rounded, I took calls, I did the work of a PGY1. And I did it without a paycheck.

My colleagues and attendings quietly passed the hat. Nearly a thousand dollars found its way to me — enough to cover back rent, a lifeline I will never forget. But the bureaucratic timeline didn't bend to human need. Month after month passed. By the fifth month, the math had become brutal: I could either stay and face losing my housing, or I could resign and return to Japan.

I chose to leave.

I want to be precise here, because I've heard the assumptions. I wasn't struggling clinically. I wasn't overwhelmed by the demands of residency. I left because a system built for a different kind of applicant had no mechanism to protect someone in my situation. The immigration and payroll infrastructures simply weren't designed for an edge case like mine, and no one — not my program, not the hospital, not I — could move fast enough to fix it in time.

What came next was years of rebuilding. I joined a surgical research group as a volunteer, then eventually secured a funded research fellowship at a hospital in the U.S. Today, I take eight calls per month. I perform the same responsibilities as a PGY-1. I work alongside residents from an ACGME-accredited program that rotates through our hospital. I have watched those residents. Some struggle with the re-entry after even a year away from clinical work. I understand why programs care about that gap.

My gap is now more than five years from medical school graduation. On paper, I look like someone who drifted away from medicine. In practice, I have never left.

The 2026 Match results, released March 2026, put a sharper edge on what this means. As expected, the NRMP reported that non-U.S. citizen IMGs requiring visa sponsorship matched at just 54.4% — a five-year low — while their counterparts who are permanent residents matched at a five-year high of 67.9%. The gap between those two numbers is not a gap in clinical ability. It is a gap shaped by policy conditions, institutional risk aversion, and the kind of complexity that screening algorithms are not built to parse.

This is where I want to speak directly to the programs reviewing IMG applications — particularly those now using AI-assisted screening. I understand the logic of filtering by recency. I've seen with my own eyes what happens when someone returns to clinical responsibilities after years away. But a gap year on a resume is not the same as a gap in clinical competence, and our screening tools are not yet sophisticated enough to tell the difference.

There are data points that can help. State medical licenses — even partial ones outside ACGME-accredited programs — require demonstrated competency. They can be verified. My license is current. My clinical activity is current. These are facts that an algorithm filtering by graduation date will never surface.

I am not asking for special treatment. I am asking for a look. Review the license. Review the publications. Ask what the applicant was actually doing during those years before you screen them out.

Somewhere in this country, there are other physicians like me: clinically active, intellectually engaged, building careers in the margins of a system that wasn't built with them in mind. The 2026 Match data tell us the structural headwinds facing visa-dependent IMGs are growing stronger. We are waiting for someone to look past the date on our diplomas.

I'm still here. I'm still working. I would like the chance to prove it.

Ayaka Tsutsumi, MD, is a pediatric surgery research fellow at SSM Health Cardinal Glennon Children’s Hospital, where she has been clinically active for three years.

Image by z_wei / Getty