Family Medicine Match Rate Increases Slightly Again in 2013

Results of the 2013 National Resident Matching Program (NRMP) -- commonly referred to as the Match -- are in, and for the fourth consecutive year, the number of medical students choosing family medicine increased.

A total of 2,938 positions were filled out of 3,062 positions offered for a fill rate of 96 percent compared with the 2012 fill rate of 94.5 percent. Family medicine positions available in 2013 were the most offered since the 2001 Match. Add to that the fact that 1,374 U.S. seniors -- 39 more than in 2012 -- matched to family medicine, the highest number since 2002.

On the other hand, the number of U.S. seniors has increased, so the fill rate in 2013 in family medicine was 44.9 percent, or a 3.4 percent decrease from 2012.

AAFP President Jeff Cain, M.D., of Denver, characterized the Match results as a "call to action moment" for family medicine. "The results of the 2013 Match highlight the AAFP's ongoing efforts to position family medicine as a solution to the country's health care challenges," said Cain. "Students are hearing that choosing family medicine offers them a chance to enter a rewarding career with a bright future, and we need to continue to focus on that message and build momentum moving forward."

Comparing some of the statistics for the 2013 Match to previous years is risky because not only did the methodology of counting students change, but percentages were skewed because the number of available slots rose dramatically.

According to Stan Kozakowski, M.D., director of the AAFP Medical Education Division, 2013 marked the first time since 2001 that the number of family medicine residency positions topped 3,000. He attributed part of that increase to an explosion in the number of new family medicine residency programs.

"Between January 2012 and March 2013, 18 new family medicine residences were approved by the Accreditation Council for Graduate Medical Education," said Kozakowski. "We calculated the programs could account for 72 to 126 new positions in 2013."

In addition, according to a preliminary 2013 match report prepared by the AAFP Medical Education Division, the NRMP's new Match methodology -- dubbed the "all in" policy -- likely affected the number of positions available.

For the first time in 2013, residencies participating in the Match were not able to sign agreements with eligible applicants outside of the Match. In 2013, programs had to decide whether to fill spots inside or outside of the Match protocol.

The new rule meant programs that in the past had signed agreements before the Match process probably entered all of their available positions in the 2013 Match. In previous years, some graduating seniors from osteopathic and international medical schools were picked up before the Match because of their ability to enter residencies between February and July.

According to Kozakowski, the availability of more slots affected the denominator of the equation used to calculate pertinent Match percentages, thus making comparisons between years difficult.

According to the same AAFP report, medical school enrollment is on the rise in both osteopathic and allopathic U.S. medical schools. In particular, the number of osteopathic medical schools increased dramatically in the past decade, from 19 schools in 2002 to 37 in 2013 with the inclusion of branch and satellite campuses. First-year enrollment between 2002 and 2012 surged from 2,968 to 5,627.

Allopathic medical schools also increased enrollment by 30 percent since 2003, and 15 new medical schools are pending accreditation by the Liaison Committee on Medical Education.

Although it might seem that more medical students in the system would be just the boost primary care needs to strengthen its ranks, the 2013 Match proved otherwise. "Unfortunately, this year's Match numbers are proof that increasing enrollment in our medical schools did not translate into an increase in the percentage of U.S. seniors entering family medicine," said Cain.

"Our work is far from finished," he added, noting that the country still is far short of recommendations made in a 2010 report titled "Council on Graduate Medical Education (COGME) Twentieth Report, Advancing Primary Care" (66-page PDF; About PDFs).

Authors of the COGME report called for an increase in the percentage of U.S. primary care physicians from 32 percent to 40 percent of the total U.S. physician workforce. Authors also called for a narrowing of the payment gap between primary care and specialty care physicians.

If health care policymakers expect physicians and other health care professionals to provide the higher quality health care and lower costs offered by the patient-centered medical home model, then stakeholders must make the necessary investments to produce and maintain a robust primary care workforce, said Cain.

As for the AAFP, "We must continue our efforts to show students the value that family medicine brings to the U.S. health care system," said Cain. "In addition, the Academy must support graduate medical education reforms that are good for primary care because continuing to tilt our health care system in a way that favors a higher ratio of subspecialists in the physician workforce moves our country in the wrong direction."

Despite some concerns about the 2013 Match results, Cain ticked off several positive trends that signal the student interest pendulum is poised to swing family medicine's way in the near future. For example, AAFP student membership numbers have surged to an all-time high of 20,600. Medical student attendance at the AAFP's National Conference for Medical Students and Family Medicine Residents increased to a new high of 889 in 2012.

Furthermore, family medicine interest groups -- located on medical school campuses and vital to AAFP efforts to expose medical students to the joys and challenges of family medicine -- are at a record high of 147 groups.

"I believe that students can see the value of what we do as family physicians, both for our patients and for our country, and that's an important step in reaching our goals, said Cain.