2013 Match Summary and Analysis

"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) for 2013. The information provided includes the number of applicants to graduate medical programs for the 2012-13 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 Division of Medical Education.

Preliminary information available from the 2013 National Resident Matching Program (NRMP) indicates that for family medicine residency programs 2,938 positions filled out of 3,062 positions offered (96.0%). This represents an increase in the number of family medicine residency positions offered and filled through the NRMP over 2012. [Included in this category are family medicine-psychiatry, family medicine-emergency medicine, family medicine –preventive medicine, and family medicine-internal medicine programs.] Two hundred and ninety-eight more family medicine positions (10.8%) were offered in 2013 compared with 2012. Three hundred and twenty-seven more positions (11.1%) were filled in 2013 compared with 2012 (2938/96.0% vs. 2611/94.5%).

Thirty-nine more U.S. seniors (1,374 vs. 1,335) chose family medicine in 2013 compared with 2012. Since more U.S. seniors participated in NRMP in 2013 compared with 2012 (17,487 vs. 16,527), the percentage of U.S. seniors who chose family medicine decreased slightly (8.4% vs. 8.5%).

One thousand more positions (15.9%) were offered in 2013 compared with 2012 in internal medicine-categorical (6,277 vs. 5,277). Twenty-two more positions (1.2%) were offered in internal medicine-preliminary (1,883 vs. 1,861). Twenty-four more positions (7.2%) were offered in 2013 in internal medicine-primary care (335 vs. 311) and four more positions (1.1%) were offered in internal medicine-pediatrics (362 vs. 365). One thousand and fifty more positions (11.8%) were offered in internal medicine-all types (8,924 vs. 7,874). One hundred and forty-one more positions (5.4%) were offered in pediatrics-categorical (2,616 vs. 2,475), with an increase of two hundred and twenty-eight positions (8.3%) offered in pediatrics-all types (2,737 vs. 2,509).

One thousand and sixteen more positions (16.3%) were filled in internal medicine-categorical in 2013 compared with 2012 (6,242 vs. 5,226), with one hundred and ninety-four more positions (6.2%) filled with U.S. seniors (3,135 vs. 2,941). One hundred and sixty-three more positions (6.3%) were filled in pediatrics-categorical in 2013 (2,606 vs. 2,443) and one hundred and five more positions (5.7%) were filled with U.S. seniors (1,837 vs. 1,732).

Three pediatric and internal medicine match position types are considered primary care. All three filled with more U.S. seniors in 2013 when compared with 2012. Thirty-one more positions (9.4%) were filled in internal medicine-primary compared with 2012 (331 vs. 300), with fourteen more positions (7.0%) being filled with a US senior (200 vs. 186). Nineteen more positions were filled (22.9%) in pediatrics-primary in 2013 compared with 2012 (83 vs. 64), and three more (10.0%) U.S. seniors filled the available positions (30 vs. 27). Nineteen more positions (5.2%) were filled in internal medicine-pediatrics compared with 2011 (363 vs. 344), and thirty-six more (11.5%) U.S. seniors chose internal medicine-pediatrics compared with the preceding year (312 vs. 276). For these three primary care specialties, sixty-nine more positions (8.9%) were filled in 2013 compared with 2012 (777 vs. 708), and fifty-three more positions (9.8%) were filled with U.S. seniors (542 vs. 489).

In the 2013 NRMP, the primary care programs experienced some change in fill rate percentage compared with 2012. The fill rate for family medicine increased 1.4%, internal medicine-primary increased 2.3%, pediatrics-primary increased by 4.0% and internal medicine-pediatrics increased 4.2%.

Twenty-two more preliminary positions in internal medicine were offered in 2013 compared with 2012 (1,883 vs. 1,861), and seventy-one more were filled in 2013 compared with 2012 (1,809 vs. 1,738). Two more U.S. seniors (0.1%) matched into internal medicine-preliminary (1,429 vs. 1,427). These students have chosen an internal medicine-preliminary year specifically as preparation for further training in another specialty.

Anesthesiology experienced an increase in positions filled (12.8%) in 2012 with one hundred and thirty-two more students choosing the specialty (1,029 vs. 897). Despite a small dip in 2004, the number of positions filled in anesthesiology has more than quadrupled since 1997. The number of positions offered increased 14.3% (1,073 vs. 919) and nineteen more U.S. seniors (2.6%) matched in anesthesiology in 2012 (744 vs. 725).

The number of positions offered and filled in diagnostic radiology increased with twenty-nine more positions (17.7%) offered (164 vs. 135) and twenty-six more positions (17.3%) filled in 2013 compared with 2012 (150 vs. 124). Eleven more U.S. seniors (10.9%) matched in diagnostic radiology compared with 2012 (101 vs. 90).

Emergency medicine offered seventy-six more positions in 2013 compared with 2012 (1,744 vs. 1,668), representing an increase of 4.4%. Seventy-three more positions (4.2%) were filled in emergency medicine compared with 2012 (1,741 vs. 1,668), with ninety-three more U.S. seniors (6.5%) selecting emergency medicine (1,428 vs. 1,335).

Obstetrics-gynecology offered nineteen more (1.5%) positions (1,259 vs. 1,240) and filled twenty-five more positions (2.0%) compared with 2012 (1,248 vs. 1,223). Thirty-one more U.S. seniors (3.3%) chose obstetrics-gynecology in 2013 (944 vs. 913).

Surgery-categorical offered thirty-nine more (3.3%) positions (1,185 vs. 1,146) and filled thirty-seven more positions (3.1%) compared with 2012 (1,180 vs. 1,143). Forty more U.S. seniors (4.2%) chose surgery-categorical in 2013 (954 vs. 914).

The AAFP reports the Match numbers of medical students entering family medicine, and other primary care specialties, to understand the trends that impact primary care workforce development policies.

The number of family medicine residency positions offered in the Match increased this year by 298. Overall, 327 more medical students matched into family medicine. The highest number of offered family medicine residency positions in the Match occurred in 1998, during the growth of “managed care”, peaking at 3293 positions. Between 1998 and 2008, however, family medicine experienced a net loss of 390 residency positions with at least 40 family medicine residency programs closing.¹ By 2009, only 2555 positions were offered in the Match. From 2008 to 2012, a small recovery in offered positions occurred, with an increase in 110 positions (2654 to 2764). The threefold higher increase in positions offered in the Match this year could be due to several factors.

New family medicine residencies

Between 2008 and 2011, only ten new Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residencies were approved. Since 2011, the number of new programs has almost doubled. Between January 2012 and March 2013, 18 new family medicine residencies have been approved by the ACGME. While an exact number of positions in these new programs is not yet known, estimating 4 to 7 residents per first year class would only account for 72-126 new positions.

The “All-in” policy

The increase in positions offered may also reflect a change in NRMP policy. 2013 is the first year of the “All-in” NRMP policy², that stipulates residencies who participate in the 2013 Match cannot sign applicants who could start between February and July 2013 outside of the Match. Residencies that previously may have signed agreements with eligible applicants (osteopathic or international medical school graduates) may have entered all their positions in the Match this year. This may account for the majority of the increase in the number of positions available in family medicine and probably also of the 1000 more offered positions in internal medicine.

This “All-in” policy may have had little effect on graduating US allopathic medical students; however, for osteopathic and international graduates, the “All-in” may have had significant impact. More applicants may have participated in the Match since they now could not sign agreements outside of the Match. This is the second year of the NRMP’s Supplemental Offer and Acceptance Program (SOAP) which offers successive match cycles to non-matched applicants. Family medicine residency positions not filled on the initial match day will enter the SOAP. Since the SOAP process is new and will cause the final report of the gap between the positions offered and filled to narrow, this year’s “All-in” policy affects the ability to accurately compare this year’s Match fill rate to previous years.

Increased medical school enrollment

The osteopathic match occurred in February 2013. D.O. students matching into osteopathic family medicine residencies increased 11%, from 433 to 472 students.³ Osteopathic medical school growth has substantially increased over the last 10 years, with the number of osteopathic medical schools expanded from 19 in 2002 to 37 in 2013, including branch campuses and satellites.⁴ Osteopathic medical school first year enrollment has approximately doubled from 2,968 to 5,627 from 2002 to 2012.⁵ Many of the family medicine residency positions in the osteopathic match are in programs that train both MD and DO students, since 114 family medicine residencies are dually accredited by the ACGME and the American Osteopathic Association (AOA). Allopathic medical schools have also expanded their enrollment by over 30% since 2003.⁶ The majority of the increase is due to more students matriculating on original or new branch campuses, but 15 new medical schools are in the process of the Liaison Committee on Medical Education (LCME) accreditation.⁷ Osteopathic medical school graduates can also participate in the allopathic Match. The AAFP Residency Survey completed every June is the only means to describe the medical school status of all family medicine residents. When it is completed, the ratio of osteopathic to allopathic residents in allopathic residencies will be determined.

Primary care workforce

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. All the residencies whose graduates will provide primary care noted an increase in the fill rate. The fill rate for family medicine increased 1.4%, internal medicine-primary increased 2.3%, pediatrics-primary increased by 4.0%. The internal medicine categorical filled 1000 more positions; however, more than 80% of these internal medicine residents will subspecialize.⁸ A more accurate indicator of practicing primary care physicians is measuring primary care production 2 years after the completion of the initial residency.⁹ Ninety percent of family medicine residents practice primary care 5 years after medical school graduation;¹⁰ 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.⁸

The US 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.¹¹ 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 US seniors choosing family medicine is trending upward. As the health care environment begins to recognize the value of primary care, we anticipate this trend will continue. That being said, a thirty percent increase in medical school enrollment, as championed by the Association of American Medical Colleges (AAMC),¹² has not translated into increased US seniors entering family medicine; thus, increased efforts to enroll and support medical students interested in primary care and accelerating changes in the health care system beneficial to primary care are needed.