Graduates of U.S. allopathic schools have filled less than one half of the family medicine positions offered in the National Resident Matching Program (NRMP) Match since 2001. Overall fill rates in July have been relatively stable at approximately 94 percent. Family medicine has become reliant on international medical graduates (IMGs), who in 2004 made up 38 percent of first-year residents.
During the early 1990s, family medicine training positions increased by more than one third, adding about 900 positions, and the specialty enjoyed a revival of medical student interest.1 Allopathic graduates’ interest in family medicine has fallen precipitously since its height in 1996, when allopathic graduates filled almost three out of four training positions. Despite a poor fill rate in the NRMP Match each March (Table 1),2 by the start of the internship year in July, around 94 to 97 percent of positions are filled (Table 2).3
TABLE 1 Family Medicine Positions Filled in the March NRMP Match
| 1998 | 1999 | 2000 | 2001 | 2002 | 2003 | 2004 | |
|---|---|---|---|---|---|---|---|
| Positions available | 3,293 | 3,244 | 3,183 | 3,074 | 2,962 | 2,920 | 2,864 |
| Percentage filled by U.S. seniors | 66 | 62 | 57 | 49 | 47 | 42 | 41 |
| Percentage filled by IMGs | 10 | 13 | 15 | 16 | 20 | 24 | 26 |
| Percentage filled | 85 | 83 | 82 | 76 | 79 | 76 | 79 |
NRMP = National Resident Matching Program; IMG = international medical graduate. Information from reference2.
TABLE 2 First-Year Family Medicine Positions Filled by July
| 1998 | 1999 | 2000 | 2001 | 2002 | 2003 | 2004 | |
|---|---|---|---|---|---|---|---|
| Positions available | 3,723 | 3,644 | 3,623 | 3,528 | 3,523 | 3,480 | 3,501 |
| Percentage filled by IMGs | 15 | 15 | 19 | 30 | 32 | 38 | 38 |
| Percentage filled | 96 | 97 | 96 | 96 | 95 | 96 | 94 |
IMG = international medical graduate.
Information from the American Academy of Family Physicians and reference 3.
The absolute number of allopathic students currently choosing family medicine has declined only slightly compared with the period before the 1990s; but in the context of the larger number of medical residency positions available, the decline has been steep. The combination of a substantial increase in family medicine training positions and a drop in U.S. medical graduates’ interest has yielded an almost threefold rise in the number of IMGs who fill first-year family medicine positions. In 2004, IMGs composed 38 percent of first-year family medicine residents, up from 15 percent in 1998. Currently, IMGs make up about 16 percent of the family medicine physician workforce. It remains to be seen how this internationalization of family medicine will affect the specialty in the United States, and medicine as a whole worldwide.
