2019 Match® Results for Family Medicine
The American Academy of Family Physicians’ (AAFP’s) brief analysis of the family medicine results of the annual National Resident Matching Program (NRMP) Main Residency Match® (NRMP Match) provides a snapshot of a major input into the primary care workforce pipeline. This analysis also includes insights into match data reported by the AOA (American Osteopathic Association) regarding the AOA Match.
While the residency match results continue a decade-long trend of increasing numbers of positions offered in family medicine, the pace needs to accelerate dramatically to reach 25% of all residency positions in the Match filling with U.S. MD and DO seniors and graduates in family medicine. The U.S. medical education system is far from delivering the medical workforce needed in the country it serves, and whose taxpayers fund it. The composition of residency training positions must reflect the composition needed in the workforce, and as such, needs to increase steeply in family medicine, primarily, and other primary care and a few subspecialty care specialties. Educational pipelines need to incentivize, recruit, and support a more diverse medical student population that better represents the U.S. population and that is more likely to choose primary care careers and serve in underserved areas. Substantial increases in the family medicine and primary care workforce are needed to improve the health of Americans and the sustainability of the health care system.
2019 NRMP Match Highlights
- 3,848 medical students and graduates matched to family medicine residency programs in 2019, the most in family medicine’s history as a specialty, and 313 more than 2018. The results marked a decade of growth in overall positions offered and filled for family medicine in the NRMP Match.
- Of those matches, 1,617 positions were filled with U.S. allopathic medical school (MD) seniors, 31 fewer than 2018.
- The number of US MD seniors matching was down year-over-year for the first time in a decade and remains significantly below (723) the historical peak of 2,340 in 1997. Only 9.1% of U.S. MD seniors matched in family medicine.
- Family medicine offered 4,128 positions, 474 more than 2018 and 12.8% of positions offered overall.
- A total of 4,286 students and graduates matched to family medicine in 2019 when combining the results of the NRMP Match, the AOA Match (306), and the Military Match (132).
- The NRMP does not differentiate U.S. osteopathic medical school (DO) seniors or graduates in the advance data tables it publishes on Match Day, preventing calculation of total U.S. students and graduates matching to family medicine residencies. When combining results of the 2018 NRMP and AOA Matches, a total of 2,975 U.S. seniors or graduates matched in family medicine, representing 12.6% of all U.S. students or graduates matched, far off the goal of at least 25% by 2030.
A Closer Look at the 2019 NRMP Match Results
A total of 32,194 PGY-1 positions were offered in all medical specialties in the 2019 NRMP Match, and 30,550 were filled. Of those, 17,763 were filled with seniors in Liaison Committee on Medical Education (LCME)-accredited U.S. schools of medicine (MD-granting), 5,076 were filled with seniors or graduates of Commission on Osteopathic College Accreditation (COCA)-accredited U.S. osteopathic colleges of medicine (DO-granting), and 674 were filled with previous graduates of U.S. MD-granting schools.
In the 2019 NRMP Match:
- Family medicine* offered 12.8% and filled 12.6% of the total positions
- The overall fill rate in family medicine was 93.2%
- The fill rate for U.S. MD seniors in family medicine was 39.2%
*Includes family medicine-categorical, plus combined programs: emergency medicine-family medicine, family medicine-osteopathic neuromusculoskeletal medicine, family medicine-preventive medicine, and psychiatry-family medicine.
The nation’s family physicians, through the America Needs More Family Doctors: 25x2030 Collaborative, are calling for 25% of all U.S. medical school seniors and graduates—both allopathic and osteopathic—to match into family medicine by the year 2030. This vital and ambitious goal was envisioned and is supported by the eight family medicine organizations that represent Family Medicine for America’s Health to better deliver the primary care workforce needed for a high-functioning, affordable U.S. health care system.
Achieving this goal will take both reform of the nation’s graduate medical education system to provide the composition of training opportunities that reflect the workforce needs of the U.S., increasing residency training in family medicine and other primary care specialties and a few subspecialties. It will also take support of the premedical pipeline through societal and educational support of transformed pathways to and through medical school to increase the diversity of U.S. medical graduates—in the broadest sense of the term—to better reflect the U.S. population.
The cultural and systematic shifts needed to achieve this rebalancing of the U.S. physician workforce are in need of immediate attention across sectors and communities including teaching hospitals, payers, health policy makers, employers, and individuals. The nation’s primary care workforce shortage is already affecting patients and communities in every single state and exacerbated with each passing day. Family medicine is calling for dramatic changes to be implemented immediately across the pipeline, process of medical education, practice transformation, and payment reform, building with each year, toward the 2030 goal.
The family medicine community commits itself to leading and supporting this change, partnering with the public and private sector, medical schools and residencies, sponsoring institutions, policymakers and public officials, payers, communities, and their patients to change the trajectory.
10-Year Data: Family Medicine Positions Offered and Filled: March 2009-2019 (does not include AOA Match data)
A few procedural changes to the NRMP Match process are reflected in the results of the program this year and in recent history, meaning that variances and trends do not purely represent actual changes in the physician workforce pipeline.
As the U.S. graduate medical education system moves toward a single accreditation system (SAS) under the Accreditation Council for Graduate Medical Education, the results of the NRMP Match reflect residency programs and positions consolidating from other matching services to the NRMP. The 2019 Match reflects this more than any year since the SAS announcement in 2014, as the AOA Intern/Resident Matching Service held its final match in February 2019 with significantly fewer participating programs and students. This means that a portion of the growth in family medicine in the NRMP Match does not reflect new training positions, but rather the shift from one matching service to another.
The NRMP’s All-In Policy, instituted in 2013, also caused a change in the way programs offered their positions, with programs that had previously only offered a portion of their positions in the NRMP Match now offering all their positions in the Match. Again, some of the increases for family medicine, and overall, in the years since then have been a result of a shift in how positions were filled rather than reflective of new training opportunities or an increasing workforce.
NRMP Match 2019 Details
Compared with 2018, family medicine residency programs in the 2019 NRMP Match:
- Offered 474 more positions (4,128 vs. 3,654)
- Matched 313 more students and graduates (3,848 vs. 3,535)
- Matched 31 fewer U.S. MD seniors (1,617 vs. 1,648)
- Had an overall fill rate of 93.2%, down from 96.7% the year prior and the lowest fill rate since 2010
- Had a historically low fill rate for U.S. MD seniors (39.2%; 45.1% in 2018)
- Offered 12.8% of all positions in the Match (12% in 2018)
- Matched 9.1% of all U.S. MD seniors in the Match (9.3% in 2018)
The 2019 NRMP Match results continue a decade-long trend of increases in the number of family medicine positions offered and filled, but the first year-over-year decrease in U.S. MD seniors matching to family medicine during that ten-year stretch. The number of family medicine positions filled in the 2019 NRMP Match is the highest in the history of the specialty, and has been each year since 2013. However, the number of positions filled with U.S. MD seniors remains 723 below the historical high of 2,340 in 1997, and far below the number needed to achieve 25% of U.S. medical graduates matching to family medicine by 2030.
20-Year Data: Family Medicine Positions Offered and Filled - March 1999-2019 (does not include AOA Match data)
The 2019 results also reflect a change in the ten-year trend for fill rate with the lowest fill rate for the specialty since 2010. Until this year, the gap between positions offered and positions filled in family medicine steadily diminished each year until a record high fill rate of 96.7% was achieved in 2018. The fill rate for family medicine has increased significantly since 2003 when it hit a low of 76.2%. If recent history is an indicator, most of the 280 family medicine positions unfilled after the first round of the 2019 NRMP Match are anticipated to be filled during the NRMP Supplemental Offer and Acceptance Program® (SOAP), resulting in nearly 100% of family medicine positions offered in the NRMP Match to fill. In 2017, only 3 family medicine positions were unfilled post-SOAP, and 11 in 2018.
By contrast, the fill rate in family medicine for U.S. MD seniors decreased drastically between 1996 (72.6%) and 2005 (40.7%) and had increased each year since to 46.6% in 2018. In 2019 the fill rate for U.S. MD seniors in family medicine reached a historic low of 39.2%. This result is likely impacted by family medicine positions moving from the AOA to the NRMP Match, causing a significant increase in the number of positions offered in family medicine and the anticipated increase in osteopathic students matching in family medicine (data not yet available from the NRMP), shifting the trend line for positions filled and offered and increasing the proportion of positions filled with DO students and graduates.
It is unknown the extent to which the SAS, the number and timing of new programs entering the Match process, or the increasing average number of programs to which students are applying contribute to these results. Regardless, this trend is deeply concerning for the U.S. primary care workforce and calls for U.S. medical schools to admit and graduate classes more likely to enter primary care specialties and serve in underserved areas.
Family Medicine Positions Offered and Filled: 5- and 20-Year Data
|Filled with U.S. MD Senior||1,422||1,481||1,530||1,648||1,617|
|Positions Unfilled (Pre-SOAP)||156||155||141||119||280|
|Fill Rate for U.S. MD Senior||44.2%||45.4%||45.3%||45.1%||39.2%|
|Rate of U.S. MD Seniors Matching to Family Medicine||8.4%||8.7%||8.8%||9.3%||9.1%|
Data since 1999 are available as a download(12 KB XLSX). These data are represented in the 10- and 20-year graphs above.
Family Medicine Programs
Family medicine – categorical programs offered 4,107 positions, filled 3,827 positions, and filled 1,617 positions with U.S. MD seniors. The overall fill rate for family medicine – categorical programs was 93.2%.
Family medicine – combined programs filled at 100% in the 2019 NRMP Match, which is fairly consistent with past performance.
- Emergency medicine-family medicine filled 4 positions, 1 with a U.S. MD senior.
- Family medicine-osteopathic neuromusculoskeletal medicine filled 1 position.
- Family medicine-preventive medicine filled 4 positions, 3 with U.S. MD seniors.
- Psychiatry-family medicine filled 12 positions, all with U.S. MD seniors.
Other Primary Care Specialties
In the 2019 NRMP Match:
- Primary care* positions were 15.5% of the positions offered overall (5,004 of 32,194) and 15.4% of the positions filled overall (4,706 of 30,550).
- Primary care residency programs filled with U.S. MD seniors at a rate of 44.1% (2,207 of 4,706), down significantly from 49.3% the year prior and a recent historical average of 49.6%.
- Of the U.S. MD seniors matched, 12.4% were in primary care residencies (2,207 of 17,763).
*Defined as family medicine categorical and combined programs, internal medicine-primary, internal medicine-pediatrics, and pediatrics-primary.
In total, 305 more positions were offered in primary care specialties compared with 2018. These results show a year-over-year 11.2% increase in the number of positions offered in all primary care specialties.
Compared with the 2018 NRMP Match:
- Medicine-primary (primary care internal medicine) filled 14 more positions in 2018 (386 vs. 372) and matched 10 more with U.S. MD seniors (239 vs. 229).
- Medicine-pediatrics (med-peds) filled 7 more positions (383 vs. 377) and matched 9 more U.S. MD seniors (315 vs. 306).
- Pediatrics-primary (primary care pediatrics) filled 3 more positions (89 vs. 86) and matched the same number of U.S. MD seniors (36).
Family Medicine Positions Offered and Filled in the AOA Match
2019 AOA Family Medicine Results
Another prominent matching program for medical students or graduates is the AOA Intern/Resident Registration Program (AOA Match), which matched 886 graduating osteopathic medical students in February 2019. Historically, this program matched students into graduate medical education programs that were either solely accredited by the AOA or are dually accredited by the AOA and the Accreditation Council for Graduate Medical Education (ACGME). However, 2019 marked the final AOA Match as all programs are transitioning to ACGME accreditation and had significantly fewer participating programs and students as many shifted to the NRMP Match.
The United States is the only country that trains osteopathic physicians, so the AOA Match does not include international medical graduates.
In the 2019 AOA Match, family medicine residency programs:
- Offered 467 positions, down 346 from 2018
- Matched 306* osteopathic medical students, down 199 from 505 in 2018
- Matched 38.6% of students matching, significantly higher than the proportion of family medicine matches through the NRMP Match
- Had a fill rate of 65.5%
*Includes family medicine-categorical and emergency medicine-family medicine.
Unmatched family medicine positions typically are offered by the AOA through an informal supplemental matching process, and many of those in the AOA Match are likely to be enrolled in the NRMP Match.
Family Medicine Matches
In 2018, for every 10 U.S. MD students or graduates who matched to family medicine:
- 6.8 DO students or graduates match,*
- 4.2 U.S. citizen international medical graduates match, and
- 1.9 non-U.S. citizen international medical graduates match.
*Calculated using a combination of NRMP and AOA match results with data from the NRMP Results and Data: 2018 Main Residency Match and the AOA Summary of Positions Offered and Filled by Program Type 2018. Data are not yet available from the NRMP to calculate results for 2019.
From 2014-2018 and across both the NRMP and AOA matches:
- The rate at which osteopathic medical students and graduates have matched to family medicine has decreased slightly, from 24.0% to 22.9%. However, due to growth in the number and class sizes of osteopathic medical schools, the number of osteopathic medical students and graduates matching to family medicine has increased 29%, from 931 to 1,206.
- Total osteopathic student matches are growing faster than the rate at which those students are matching to family medicine (35.7% growth in DO matches since 2014, from 3,384 to 5,270).**
**Data sources are the NRMP Results and Data: Main Residency Match reports years 2014-2018 (http://www.nrmp.org/main-residency-match-data/(www.nrmp.org)(www.nrmp.org)) and the AOA Summary of Positions Offered and Filled by Program Type years 2014-2018 (https://natmatch.com/aoairp/aboutstats.html(natmatch.com)(natmatch.com)). Data are not yet available from the NRMP to calculate results for 2019.