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. For historical comparison, this analysis also includes insights into match data reported by the American Osteopathic Association regarding the AOA Intern/Resident Registration Program (AOA Match) in the years 2019 and prior.
While the residency match results continue an 11-year trend of increasing numbers of positions offered and filled in family medicine, the pace needs to accelerate dramatically to reach a national goal of 25% of U.S. allopathic and osteopathic seniors and graduates pursuing family medicine. The U.S. medical education system is far from delivering the primary care 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, other primary care and a few subspecialty care specialties. Health care, education, and societal systems 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—while also accounting for the composition, distribution, and quality—are needed to improve the health of Americans and the sustainability of the health care system.
Family medicine matches were up for every applicant type except U.S. MD seniors and graduates, not contributing a much-needed share to the growth of the family medicine workforce.
The number of US MD seniors matching was down year-over-year for the second time in a decade (60 fewer matches than 2019) and remains significantly below (783) the historical peak of 2,340 in 1997. Only 8.6% of U.S. MD seniors matched in family medicine.
*Includes family medicine-categorical, plus combined programs: emergency medicine-family medicine, family medicine-osteopathic neuromusculoskeletal medicine, family medicine-preventive medicine, and psychiatry-family medicine.
In 2020, the most significant growth for family medicine came in the number of DO seniors who matched to family medicine residencies. One hundred four more DO seniors matched to family medicine when comparing the 2020 NRMP results (1,399 DO seniors) with 2019 results combining both the NRMP (989) and AOA (306) matches. Offset by the decline in U.S. MD seniors who matched to family medicine in 2020, 44 more U.S. MD and DO seniors matched to family medicine year-over-year.
The 2020 NRMP Match results continue an 11-year trend of increases in the number of family medicine positions offered and filled. Results also indicated growth in the number of students entering family medicine of all applicant types except for U.S. MDs, with only the second year-over-year decrease in U.S. MD seniors matching to family medicine during the last 11 years. The number of family medicine positions filled in the 2020 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 783 below the historical high of 2,340 in 1997, and leaves the workforce input still half of where it needs to be to achieve 25% of U.S. medical graduates matching to family medicine by 2030 (12.6%).
The 2020 results also reflect the lowest fill rate for the specialty since 2010. The gap between positions offered and positions filled in family medicine had 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, many of the 350 family medicine positions unfilled after the first round of the 2020 NRMP Match are anticipated to be filled during the NRMP Supplemental Offer and Acceptance Program® (SOAP). In 2018, only 11 family medicine positions were unfilled post-SOAP, and 33 in 2019.
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%, and continued a downward trend in 2020 to 33.2%. 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 number of osteopathic students matching in family medicine, shifting the trend line for positions filled and offered and increasing the proportion of positions filled with DO students and graduates. It is also likely due to program growth, as a significant number of new family medicine residency programs were accredited late into the application cycle and likely listed positions with intention to fill during the SOAP.
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. MD medical schools, especially, to admit and graduate classes more likely to enter primary care specialties and serve in underserved areas. It is the only sector not contributing to growth in the family medicine workforce.
|Filled with U.S. MD Senior||1,481||1,530||1,648||1,617||1,557|
|Positions Unfilled (Pre-SOAP)||155||141||119||280||350|
|Fill Rate for U.S. MD Senior||45.4%||45.3%||45.1%||39.2%||33.2%|
|Rate of U.S. MD Seniors Matching to Family Medicine||8.7%||8.8%||9.3%||9.1%||8.6%|
|Fill Rate by U.S. DO Seniors||N/A||N/A||N/A||N/A||29.9%|
|Rate of U.S. DO Seniors Matching to Family Medicine||N/A||N/A||N/A||N/A||23.4%|
|Fill Rate of DO Seniors and DO Graduates Combined||11.8%||17.1%||19.2%||24.0%||N/A|
|Rate of DO Seniors and DO Graduates Matching to Family Medicine||16.1%||19.6%||18.6%||19.5%||N/A|
|Fill Rate by U.S. IMG||22.4%||19.5%||20.1%||18.1%||16.8%|
|Rate of U.S. IMG Matching to Family Medicine||25.5%||23.7%||25.3%||24.9%||25.0%|
|Fill Rate by Non-U.S. IMG||11.7%||10.0%||9.0%||8.9%||8.6%|
|Rate of Non-U.S. IMG Matching to Family Medicine||10.1%||8.9%||8.3%||9.2%||9.6%|
|Fill Rate by U.S. MD Graduates||3.9%||3.9%||3.3%||3.1%||2.6%|
|Rate of U.S. MD Graduates Matching to Family Medicine||17.3%||19.5%||18.3%||18.7%||17.3%|
|Rate of U.S. DO Grads Matching to Family Medicine||N/A||N/A||N/A||N/A||26.3%|
|Fill Rate by Other||0.0%||0.0%||0.0%||0.0%||1.4%|
|Rate of Other Matching to Family Medicine||7.7%||14.3%||0.0%||8.3%||14.3%|
Data since 2000 are available as a download. These data are represented in the 10- and 20-year graphs above.
Family medicine-categorical programs offered 4,662 positions and filled 4,313 positions. The overall fill rate for family medicine-categorical programs was 92.5%.
*Defined as family medicine categorical and combined programs, internal medicine-primary, internal medicine-pediatrics, and pediatrics-primary.
In total, 593 more positions were offered in primary care specialties compared with 2019. These results show a year-over-year 11.9% increase in the number of positions offered in all primary care specialties.
A total of 34,266 PGY-1 positions were offered in all medical specialties in the 2020 NRMP Match, and 32,399 were filled. The breakdown of filled positions by applicant type is:
Some of the growth seen in the NRMP Match in recent years can be attributed to a change in the match services available to programs and students and do not reflect changes to the actual workforce input.
Historically, another prominent matching program for medical students or graduates was the AOA Intern/Resident Registration Program (AOA Match), which matched 886 graduating osteopathic medical students, including 306 into family medicine, during its final year 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, 2020 marked the first year without an AOA match as all programs transitioned to ACGME accreditation and to the NRMP Match.
The United States is the only country that trains osteopathic physicians, so the AOA Match did not include international medical graduates.
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 societal and educational support of transformed pathways before and during medical school to increase the diversity of U.S. medical graduates—in the broadest sense of the term—to better reflect and care for the U.S. population.
The cultural and systematic shifts needed to achieve this rebalancing of the U.S. physician workforce need 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.
Two significant procedural changes to the NRMP Match process affect the results data from the NRMP, meaning variances and trends do not directly reflect changes in the physician workforce pipeline.
Single Accreditation System: From 2014-2020, the U.S. graduate medical education system shifted to a single accreditation system (SAS) under the Accreditation Council for Graduate Medical Education. The 2020 Match is the first year in which there was no AOA Intern/Resident Matching Service. 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, this policy changed how programs offered their positions, with programs that had previously only offered only 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.
The NRMP Match is the largest and most representative mechanism for medical student recruitment into specialized medical residencies in the United States, and as such, serves as a barometer of workforce production.
However, the NRMP Match and AOA match are not the only mechanisms through which medical students or graduates are matched with their required graduate medical education, or residency programs, in a specialized field to lead to board certification in a medical specialty (or multiple specialties).
The following resources provide a more in-depth look at the family medicine workforce pipeline: