Match Brings Slight Uptick in Applicants Entering Specialty

The National Resident Matching Program, known as the Match, placed 26 more candidates in family medicine residencies this year, giving the specialty a slight uptick in numbers for the third year in a row. "We're seeing a modest indicator of a turnaround in the numbers," says AAFP President Larry Fields, M.D., of Ashland, Ky.

The 2,318 applicants who matched into family medicine residencies filled 85 percent of available positions, a higher Match fill rate than the specialty has had since 1998 (see chart).

Although 20,072 applicants selected residencies through the Match this year, only 3,032 matched into clearly identified primary care programs, including

The same number of U.S. medical school seniors -- 1,132 -- matched into family medicine residencies this year as did last year. The seniors filled 41.5 percent of the 2,727 available positions this year, a percentage that has stayed steady for four years. Overall, however, the number of available family medicine residency openings was down for the eighth consecutive year as residencies have closed or downsized.

"We're starting to hear our medical students say out loud that the educational debt they have and the potential income in subspecialties are pushing them away from primary care," says Fields. "That should be a clarion call to our elected officials that they need to address the disparity in payment levels between cognitive and procedural specialties. Otherwise, we'll have a bunch of highly trained proceduralists and nobody to take care of the general population. It's my job and that of the AAFP to see that the disparity gets corrected."

Fields holds out hope for an income shift soon, starting with Medicare. "The Academy has been working during the past year to have the values of evaluation and management codes changed so that the cognitive codes our family physicians and other primary care physicians use so often are more appropriately valued in relation to procedural codes," says Fields. "Hopefully, our efforts are about to pay off, perhaps as early as January."

Also, in the past, educational analysts have suggested that lifestyle challenges (e.g., unpredictable schedules and limited family or personal time) might be steering U.S. medical students away from primary care. However, as reported in the September issue of Academic Medicine, a survey of fourth-year medical students at two U.S. medical schools found that students considered family medicine to be in the middle range in terms of whether it was lifestyle-friendly or lifestyle-unfriendly. In addition, within that middle range, family medicine ranked higher than pediatrics (whether general or subspecialist) and internal medicine (whether general or subspecialist). The article's abstract notes, "Contrary to previous reports, the students' responses indicate they perceived the primary care specialties as lifestyle-intermediate compared to other specialties."

Perry Pugno, M.D., director of the AAFP Division of Medical Education, says that although lifestyle and income are important issues, "the students who are choosing a career in family medicine are clearly making their commitment to meeting the needs of the American people a higher priority" than lifestyle and income.