"Family physicians are committed to continuing, comprehensive, compassionate, and personal care for their patients. They are concerned with the care of people of all ages, and understand that health and disease involve the mind, body, and spirit and depend in part on the context of patients’ lives as members of their family and community."
— The Future of Family Medicine Report, 2004
The information in this report is based on data from the National Resident Matching Program (NRMP®) Advance Data Tables: 2014 Main Residency Match®, as well as other sources. The information provided includes the number of applicants to graduate medical programs during the 2013-14 academic year, specialty choice, and trends in specialty selection. This information will be useful to advocates of family medicine—including family medicine departments and residency programs—as well as legislators who are interested in trends predicting the primary care workforce of the future.
This report is prepared by the American Academy of Family Physicians Medical Education Division.
Combining all of the positions filled in 2014 as of March —including data from the American Osteopathic Association (AOA) Intern/Resident Registration Program Match1 and the NRMP Main Residency Match Advance Data2 — U.S. allopathic family medicine residencies filled 109 more positions over 2013, 89 of which were filled with U.S. seniors (81.7% of new positions filled with U.S. seniors). This is likely to represent the vast majority of positions offered and filled in 2014, however, to account for all positions filled in 2014, data published by the NRMP during the late spring of 2014 which includes positions filled through its Supplemental Offer and Acceptance Program (SOAP) and data from the AAFP’s annual Residency Census in the late summer will need to be considered to capture real medical student matriculation to U.S. allopathic family medicine residencies. The AAFP published its complete Family Medicine Graduate Medical Education and Match Analysis in the fall of 2014 (see "Further Match Analysis" below).
The following articles were authored by AAFP staff members Stanley M. Kozakowski, MD; Philip W. Crosley, MBA; and Ashley Bentley, MBA. They include further analysis of the Match with data from the AAFP's annual residency census and medical school study.
Entry of US Medical School Graduates Into Family Medicine Residencies: 2013-2014(www.stfm.org) (Family Medicine)
Results of the 2014 National Resident Matching Program: Family Medicine(www.stfm.org) (Family Medicine)
What follows is analysis and outlook for family medicine and primary care in the U.S. based mostly on the NRMP’s Advance Data Tables: 2014 Main Residency Match, also taking into account the 2014 AOA Match and related medical school and residency data, information, and trends. The information points to overall increases in production of family medicine physicians, reflecting more interest in family medicine careers by U.S. medical students, but with a growing primary care workforce need that’s greater than the current rate of increase in U.S. medical school production of family medicine residents or available family medicine residency positions.
In the 2014 National Resident Matching Program® (NRMP®) Match, family medicine residencies filled 62 more positions (family medicine includes family medicine categorical, plus combined programs: emergency medicine-family medicine, family medicine-preventative medicine, medicine-family medicine, and psychiatry-family medicine) than in 2013 (3,000 vs. 2,938); U.S. seniors matching to family medicine residencies increased by 42 (1,416 vs. 1,374). Family medicine residencies offered 70 more positions in the Match than the year prior, for a total of 3,132 positions offered (vs. 3,062 in 2013). This marks the fifth straight year that family medicine has increased positions offered and filled; beginning with an increase in 2010, family medicine residencies have increased positions offered by 577, positions filled by 671, and positions filled with U.S. seniors by 333. The fill rate for family medicine residencies in the NRMP Match has increased over the last decade to 95.8%, down only slightly from 2013 (96%), but up from 91.4% in 2010 and 82.4% in 2005. The fill rate for U.S. seniors is 45.2% in 2014, up slightly from 44.9% in 2013, and down slightly from the decade’s peak at 48.3% in 2012.
Family medicine combined programs filled at 100%, a fairly consistent trend. Psychiatry – family medicine filled 10 positions, eight with U.S. seniors; Family medicine – preventative medicine filled five positions, three with U.S. seniors; Emergency medicine – family medicine filled four positions, all with U.S. seniors; and medicine – family medicine filled four positions, three with U.S. seniors.
Family medicine categorical programs filled 2,977 positions out of 3,109 offered, 1,398 of those with U.S. seniors.
Family medicine positions make up 11.7% of the total offered in the NRMP Match (no change from 2013), and 8.6% of the total positions filled with U.S. seniors (26,678 total positions offered, 16,399 filled with U.S. seniors). The percentage of matched U.S. seniors matching to family medicine was up slightly from 8.3% in 2013.
Most (87%) of family medicine programs filled in the NRMP Match prior to the Supplemental Offer and Acceptance Program (SOAP), the process by which unmatched applicants in the Main Residency Match are paired with unfilled residency positions through the NRMP during Match Week. Overall, 88.6% of programs filled in the NRMP Match prior to the SOAP process.
Of the primary care specialties (family medicine and family medicine combined programs, internal medicine – primary, internal medicine – pediatrics, internal medicine – preventative medicine, and pediatrics – primary), family medicine saw the largest increase in positions offered and filled. Family medicine consistently offers and fills the majority, about four-fifths, of all primary care positions.
Medicine – primary (primary care internal medicine) filled two more positions than 2013 (333 vs. 331), with 202 positions filling with U.S. seniors out of 335 total positions offered.
Medicine – pediatrics (Med-peds) filled one fewer position than the year prior at 362, filling 284 of those with U.S. seniors—a decrease of 28 positions filled with U.S. seniors than 2013. Eight more medicine-pediatrics positions were offered over the year prior (374 vs. 366).
Pediatrics – primary (primary care pediatrics) filled eight fewer positions (75 vs. 83), tacking on an increase of four U.S. seniors (34 vs. 30) and filling at 100% overall.
Medicine – preventative medicine offered and filled seven positions again in 2014, filling two with U.S. seniors, one fewer than the year prior.
The average fill rate for all primary care specialties in 2014 is 96.2%, with 49.4% filled by U.S. seniors.
All primary care made up 14.7% of the positions offered and filled in the Match (3,923 of 26,678 positions offered; 3,777 of 25,687 positions filled), and 11.9% of the positions filled with U.S. seniors (1,938 of 16,390).
Internal medicine residencies (including combined programs) offered in the 2014 Match increased by 284, however, all of those increases were in positions potentially leading to subspecialties (9,208 vs. 8,924). Of all internal medicine and pediatrics, positions, 11,828 positions were Matched of 12,016 total offered, 7,091 of those with U.S. seniors (60%). Adjusting for positions likely to lead to primary care delivery as defined above (internal medicine – primary, internal medicine – pediatrics, internal medicine – preventative medicine, and pediatrics – primary), other internal medicine and pediatrics positions make up the vast majority of positions offered (11,225 of the 12,016 positions). Positions identified as primary care within internal medicine and pediatrics specialties matched at a higher rate with U.S. seniors at 67.2% (522 positions of 777 total matches) than those potentially leading to subspecialties.
Of the 48 specialty categories that offered positions in the NRMP Match in 2014, 41 had higher fill rates with U.S. seniors than family medicine categorical programs, with the combined family medicine programs all having higher fill rates with U.S. seniors than non-combined family medicine programs (45% for family medicine, 60% for family medicine – preventative medicine, 75% for medicine – family medicine, 80% for psychiatry – family medicine, and 100% for emergency medicine – family medicine).
Specialties that tend to be popular career choices for medical students are likely to be so because of a number of factors, including perceptions about lifestyle and a real income gap. Some of these have been labeled as “E-ROAD” programs (emergency medicine, radiology, orthopedics, anesthesiology, and dermatology), and those filled with a higher proportion of U.S. seniors than primary care programs (79% vs. 49%), reflecting that these specialties continue to be attractive to U.S. seniors.
Family medicine’s growth in total number of positions offered was second only to internal medicine – categorical, which offered 247 more positions this year, over family medicine 70 additional positions. Third on that list is anesthesiology with 49 additional positions, followed by emergency medicine with 43 additional positions, and neurology with 41 additional positions. PGY-1 transitional year positions represent the only positions to be significantly reduced in the 2014 Match (868 offered in 2014 vs. 937 in 2013), and also represent the largest market share change for any specialty with a 0.3% reduction in share of offered positions. This reflects overall growth and reduction rates in positions offered relative to the share each specialty holds in the Match. The reduction in transitional year positions is consistent with a recommendation of the Council on Graduate Medical Education (COGME) in its 21st report to eliminate transitional year positions and excess preliminary non-categorical positions over time.3
In the 2014 American Osteopathic Association (AOA) Intern/Resident Registration Program Match in February 2014 matched 47 more students into family medicine residencies in 2014 over the year prior (519 vs. 472). Family medicine offered 880 positions in the 2014 osteopathic match, for a fill rate of 59%. All of the students participating in this match are U.S. seniors.
New family medicine residencies
The rate of growth for family medicine residencies since 2011 has been significantly higher than in years prior. Between 2008 and 2011, only ten new Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residencies were approved.4 During the 2014 cycle, 11 new family medicine residencies were accredited, with 14 new accredited the year prior. The total number of ACGME-accredited family medicine categorical (traditional) residencies that had the potential to offer positions in the NRMP Match for 2014 is 482 programs. The NRMP reports that 480 programs listed for family medicine, but some uncertainty exists about whether those all represent singular family medicine residency programs, or whether some singular programs, such as combined family medicine programs, were able to list positions under more than one category of family medicine, such as family medicine and family medicine – preventative medicine. This makes exact calculations impossible with published data, but leads the AAFP to conclude that the vast majority of family medicine positions offered by ACGME-accredited family medicine residencies are filled using the NRMP Match.
The All-in Policy
This year marks the second that the “All-in” policy has been in existence at the NRMP5, requiring residency programs to list all of their positions in the NRMP Match, or none, without splitting positions between the NRMP Match and other methods to fill with very few exceptions (programs dually accredited by the AOA and the ACGME can split positions between the AOA and NRMP Matches).6 With the institution of the All-in policy for the 2013 Match, family medicine residencies offered 298 more positions than 2012, compared with only 70 new positions offered in 2014 over 2013. Prior to the All-in policy, real change from the year prior was difficult because residencies varied year-to-year in how they filled their positions, not offering a consistent percentage through the NRMP Match. The All-in policy is likely to make calculations of real change year-over-year more valid and reliable, though still not exact with published data.
Exceptions to the All-in policy, along with other factors including the NRMP Supplemental Offer and Acceptance Program (SOAP), result in a variance between the number of positions filled in the Match and the number of students that matriculate as first-year residents. The AAFP’s Match analysis published in the fall of 2014 will take into account actual matriculation into family medicine residencies as captured by the AAFP annual Residency Census.
Increased medical school enrollment
Medical school enrollment is increasing at a faster rate than residency program positions. Medical school graduates and match rates into family medicine residencies by school for 2014 will be researched following the July 1, 2014, start date for residencies and published during the fall of 2014 by the AAFP through its annual Residency Census; information reflecting medical school accreditation and new graduates as of 2013 is reflected below.
Eleven Liaison Committee on Medical Education (LCME)-accredited U.S. allopathic medical schools have received full accreditation since 2009, but had not yet graduated a class as of 2013.7 Four new U.S. allopathic medicine schools graduated a class in 2013, with a total of 169 students graduating from those schools, and only six of those students matriculating in family medicine residencies in July 2013 (3.6% average for those four schools), significantly lower than the average number of medical school graduates who choose family medicine (8.6%). Seven medical schools are in a preliminary stage (applicant status) of LCME accreditation as of March 2014.
At the beginning of the 2013-14 academic year, 20,055 students matriculated into U.S. allopathic medical schools. Total enrollment was 83,472, up 1,501 students from 2013 and up 12,656 positions over the past 10 years.8
In 2014, there were 30 colleges of osteopathic medicine over 41 sites across the U.S., according to the American Association of Colleges of Osteopathic Medicine (AACOM).9 This represents an increase of four sites over 2013, and more than double the number of sites in existence since 2002 (22 new sites). The total enrollment as of the 2012-13 academic year for osteopathic medical colleges was 21,741.
Medical schools typically report all students entering pediatrics, internal medicine, and family medicine as their primary care production. This tactic overestimates the number of physicians who will practice primary care because they do not accurately account for medical schools’ graduates’ future medical practice, as noted in the section of this report titled “Contrast with Positions Potentially Leading to Subspecialties.” Data from the 2014 NRMP Match reveals that the percentage of U.S. medical graduates entering primary care residencies remains stagnant at slightly below 12% for the past five years.
Ninety percent of family medicine residents practice primary care five years after medical school graduation; thus, this year’s increases in the number of new family medicine residencies and the number of US medical school graduates entering family medicine is encouraging, but nowhere near enough to reach the recommendation in the 20th Annual Report “Advancing Primary Care” from the Council on Graduate Medical Education (COGME) that states the U.S. physician workforce should be “at least 40% primary care physicians” to ensure the nation’s health care access and improve the health care expenditures and outcomes for the future.10
The AAFP’s Family Physician Workforce Reform policy11 reflects demographics of the U.S. population and to make primary care and family medicine workforce projections and recommendations based on the health care needs of the changing U.S. population. As stated in the policy, in order to ensure health care access for all Americans, the annual production of new family physicians will need to grow from its current state of approximately 3,500 to 4,475 by 2025. While data from the 2014 NRMP Match demonstrates that more students are matching into family medicine programs, and this is an encouraging step in the right direction, this growth will need to continue to expand even more over the next decade to achieve the target of 4,475 graduates per year.
The U.S. needs sufficient family physicians to be the foundation of a health care system that meets the triple aim: improved patient care, improved quality, and lower costs.12 The increased number of new family medicine residencies is a positive sign that institutions that previously did not have family medicine residencies are adding them. The number of U.S. seniors choosing family medicine continues to trend upward. As the health care environment more significantly recognizes the value of primary care, the AAFP is hopeful that this trend will continue.
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National Resident Matching Program Data