2018 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.
2018 NRMP Match Highlights
- 3,535 medical students and graduates matched to family medicine residency programs in 2018, the most in family medicine’s history as a specialty, and 298 more than 2017.
- Of those matches, 2,470 positions were filled with graduates of U.S. medical schools.
- 1,648 positions were filled with U.S. MD seniors, an increase of 118 since 2017, yet still fewer than the historical peak (2,340 in 1997), and only 9.3% of U.S. MD seniors matching. Another 121 positions were filled with previous graduates of U.S. allopathic schools.
- 701 positions were filled with U.S. osteopathic medical school seniors or graduates, up 125 from 2017. When combined with results of the 2018 AOA Match, a total of 1,206 osteopathic medical students matched to family medicine residency positions.
- When combining results of the NRMP and AOA Matches, a total of 2,975 U.S. seniors or graduates matched in family medicine. This represents 12.6% of all U.S. students or graduates matched, far off the goal of at least 25% by 2030.
- Family medicine offered 3,654 positions, 276 more than 2017, yet only 12% of positions offered overall.
- This is the ninth straight year that the family medicine match results climbed year-over-year, and the second largest year-over-year increase during that stretch.
While the residency match results continue a decade-long trend of increasing numbers of positions offered, filled, and filled with U.S. seniors and graduates in family medicine, the pace needs to exceed dramatically to reach 25% of all residency positions in the Match filling with U.S. 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.
A Closer Look at the 2018 NRMP Match Results
A total of 30,489 PGY-1 positions were offered in all medical specialties in the 2018 NRMP Match, and 29,249 were filled. Of those, 17,740 were filled with seniors in Liaison Committee on Medical Education (LCME)-accredited U.S. schools of medicine (MD-granting), 3,771 were filled with seniors or graduates of U.S. osteopathic colleges of medicine (DO-granting), and 668 were filled with previous graduates of U.S. MD-granting schools.
Progress Toward 25% of U.S. Medical Graduates Entering Family Medicine Residency Training by 2030
In the 2018 NRMP Match:
- Family medicine* offered 12.0% and filled 12.1% of the total positions
- The overall fill rate in family medicine was 96.7%
- The fill rate for U.S. MD seniors in family medicine was 45.1%
- The fill rate for U.S. DO seniors in family medicine was 19.2%
*Includes family medicine-categorical, plus combined programs: emergency medicine-family medicine, family medicine-osteopathic neuromusculoskeletal medicine, family medicine-preventive medicine, medicine-family medicine, and psychiatry-family medicine.
The nation’s family physicians, through representation in organized medicine, are calling for 25% of all residency matches to be graduates of U.S. medical schools—both allopathic and osteopathic—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.
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., as well as societal and educational support of transformed pathways to and through medical school such that U.S. medical graduates reflect the diversity—in the broadest sense of the term—of the U.S. population.
Cultural and systematic shifts such as what the family medicine community is calling for take time. Yet, 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, 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 2008-2018 (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 under the Accreditation Council for Graduate Medical Education, the results of the NRMP Match reflect residency programs and positions moving to the NRMP. The 2018 Match reflects this more than any year since the SAS announcement in 2014, as the AOA Intern/Resident Matching Service saw its first decline in participation since the announcement. 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 of 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 2018 Details
Compared with 2017, family medicine residency programs in the 2018 NRMP Match:
- Offered 276 more positions (3,654 vs. 3,378)
- Matched 298 more students and graduates (3,535 vs. 3,237)
- Matched 118 more U.S. MD seniors (1,648 vs. 1,530)
- Matched 125 more osteopathic medical students or graduates (701 vs. 576)
- Had a slight increase in overall fill rate year-over-year (96.7% vs. 95.8%), marking the highest fill rate in the specialty’s history
- Had a similar fill rate for U.S. MD seniors (45.1% vs. 45.3%)
- Had an increase in fill rate for osteopathic medical students and graduates (19.2% vs. 17.0%)
- Offered 12.0% of all positions in the Match (11.7% in 2017)
- Matched 9.3% of all U.S. MD seniors in the Match (8.8% in 2017)
- Matched 18.6% of all DO students and graduates in the Match
The 2018 NRMP Match results continue a nine-year trend of increases in the number of family medicine positions offered, positions filled, and positions filled with U.S. MD seniors. In fact, the number of family medicine positions filled in the 2018 NRMP Match is the highest number filled 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 692 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 1998-2018 (does not include AOA Match data)
The 2018 results also show a fill rate above 96%, meaning that the gap between positions offered and positions filled in family medicine has diminished over time. The fill rate for family medicine has increased significantly since 2003 when it hit a low of 76.2%. Of the 119 positions unfilled in family medicine in 2018, most are anticipated to be filled during the NRMP Supplemental Offer and Acceptance Program®, resulting in nearly 100% of family medicine positions offered in the NRMP Match to fill. By contrast, the fill rate in family medicine for U.S. MD seniors decreased drastically between 1996 (72.6%) and 2005 (40.7%) and has increased slightly since to 46.6% in 2018, but has remained below 50% since 2001.This reflects a great opportunity and responsibility for U.S. medical schools to admit and graduate classes more likely to enter primary care specialties and serve in underserved areas.
Family Medicine Programs
Family medicine – categorical programs offered 3,629 positions, filled 3,510 positions, and filled 1,628 positions with students and graduates of U.S. MD-granting schools. The overall fill rate for family medicine – categorical programs was 96.7%.
Overall, family medicine combined programs filled at 100% in the 2018 NRMP Match, which is fairly consistent with past performance.
- Emergency medicine-family medicine filled 4 positions, 3 with U.S. MDs and 1 with a DO.
- Family medicine-osteopathic neuromusculoskeletal medicine filled 4 positions, all with DO students/graduates.
- Family medicine-preventive medicine filled 3 positions, all with U.S. MDs.
- Medicine-family medicine filled 2 positions, both with U.S. MDs.
- Psychiatry-family medicine filled 12 positions, all with U.S. MDs.
Other Primary Care Specialties
In the 2018 NRMP Match:
- Primary care* positions were 14.9% of the positions offered overall (4,500 of 30,232) and 15% of the positions filled overall (4,370 of 29,040).
- Primary care residency programs filled with U.S. MD seniors at a rate of 49.3% (2,219 of 4,370).
- Of the U.S. MD seniors matched, 12.5% were in primary care residencies (2,219 of 17,740).
*Defined as family medicine categorical and combined programs, internal medicine-primary, internal medicine-pediatrics, and pediatrics-primary.
In total, 317 more positions were offered in primary care specialties compared with 2018. These results show a year-over-year 7.5% increase in the number of positions offered in all primary care specialties.
Compared with the 2017 NRMP Match:
- Medicine-primary (primary care internal medicine) filled 31 more positions in 2018 (372 vs. 341) and matched 5 more with U.S. MD seniors (229 vs. 224).
- Medicine-pediatrics (med-peds) filled 21 more positions (377 vs. 356) and matched 15 more U.S. MD seniors (306 vs. 291).
- Pediatrics-primary (primary care pediatrics) filled 4 more positions (86 vs. 82) and matched 5 more U.S. MD seniors (36 vs. 31).
2018 AOA Family Medicine Results
Another prominent matching program for medical students or graduates is the AOA Intern/Resident Registration Program (AOA Match), which matched 1,680 graduating osteopathic medical students in February 2018. This program matches students into graduate medical education programs that are either solely accredited by the AOA or are dually accredited by the AOA and the Accreditation Council for Graduate Medical Education (ACGME). The United States is the only country that trains osteopathic physicians, so the AOA Match does not include international medical graduates. It is important to review the results of the AOA Match in the context of the transition to the Single Accreditation System for graduate medical education. As programs transition to ACGME accreditation, the number of programs and students participating in the AOA Match has started to decrease.
In the 2018 AOA Match, family medicine residency programs:
- Offered 813 positions, down 148 from 2017
- Matched 505 osteopathic medical students, down 107 from 612 in 2017*
- Matched 25.4% of positions offered overall and 33.7% of completed matches overall, significantly higher than the proportion of family medicine matches through the NRMP Match.
- Had a fill rate of 62.1%, which is lower than the NRMP Match’s fill rate for family medicine
*Includes family medicine-categorical, emergency medicine-family medicine, and integrated family medicine-osteopathic neuromusculoskeletal 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 may also be enrolled in the NRMP Match.
Family Medicine Matches
For every 10 U.S. MD students or graduates who match 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.
Over the last five years 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)) and the AOA Summary of Positions Offered and Filled by Program Type years 2014-2018 (https://natmatch.com/aoairp/aboutstats.html(natmatch.com)).