2008 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) Advanced Data Tables for 2008. The information provided includes the number of applicants to graduate medical programs for the 2008-09 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.

I. 2008 Family Medicine Match Results and Comparison to Recent Trends (See Table 1)

Preliminary information available from the 2008 National Resident Matching Program (NRMP) indicates that for family medicine residency programs 2,404 positions filled out of 2,654 positions offered (90.6%). This represents an increase in both the number of positions filled and the percentage of family medicine residency positions filled through the NRMP over 2007. [Included in this category are family medicine-psychiatry, family medicine-emergency medicine, and family medicine-internal medicine programs.] Thirty-three more family medicine positions (1.3%) were offered in 2008 compared with 2007. Ninety-one more positions (3.9%) were filled in 2008 compared with 2007 (2,404/90.6% vs. 2,313/88.2%).

Sixty-five more U.S. seniors (1,172 vs. 1,107) chose family medicine in 2008 compared with 2007. Slightly more U.S. seniors participated in NRMP in 2008 compared with 2007 (15,242 vs. 15,206), with a resulting increase (8.2%) in the percentage of U.S. seniors who chose family medicine. 2008 marks the first time in over a decade that more U.S. seniors participating and matching through the NRMP matched into family medicine in comparison with the previous year.

II. Comparison with Other Primary Care Specialties—Family Medicine, Internal Medicine, and Pediatrics (See Table 2-9, 11)

Sixty more positions (1.3%) were offered in 2008 compared with 2007 in internal medicine-categorical (4,858 vs. 4,798). Sixteen more positions (0.8%) were offered in internal medicine-preliminary (1,901 vs. 1,885). Ten fewer positions (3.6%) were offered in 2008 in internal medicine-primary care (264 vs. 274) and sixteen fewer positions (4.2%) were offered in internal medicine-pediatrics (362 vs. 378). Fifty-four more positions (0.7%) were offered in internal medicine-all types (7,450 vs. 7,396). Fifty-four more positions (2.3%) were offered in pediatrics-categorical (2,382 vs. 2,328), resulting in an increase of forty-five more positions (1.8%) offered in pediatrics-all types (2,496 vs. 2,451).

Thirty-one more positions (0.7%) were filled in internal medicine-categorical in 2008 compared with 2007 (4,751 vs. 4,720), with twenty fewer positions (0.7%) filled with U.S. seniors (2,660 vs. 2,680). Thirty more positions (1.3%) were filled in pediatrics-categorical in 2008 (2,295 vs. 2,265) and eighty-four fewer positions (5.0%) were filled with U.S. seniors (1,610 vs. 1,694).

Three of the categories of pediatrics and internal medicine are considered primary care. Of these, all three filled with fewer U.S. seniors in 2008 when compared with 2007. Ten fewer positions (3.8%) were filled in internal medicine-primary compared with 2007 (254 vs. 264), with one fewer position (0.6%) being filled with a US senior (166 vs. 167). Eight fewer positions were filled (9.3%) in pediatrics-primary in 2008 compared with 2007 (78 vs. 86), but ten fewer (18.9%) U.S. seniors filled the available positions (43 vs. 53). Nineteen fewer positions (5.5%) were filled in internal medicine-pediatrics compared with 2007 (326 vs. 345), and twenty-seven fewer (9.8%) U.S. seniors chose internal medicine-pediatrics compared with the preceding year (248 vs. 275). For these three primary care specialties, seventeen fewer positions (2.4%) were filled in 2008 compared with 2007 (678 vs. 695), and 38 fewer positions (7.6%) were filled with U.S. seniors (457 vs. 495).

In the 2008 NRMP, the primary care programs experienced minimal change in fill rate percentage compared with 2006. The fill rate for family medicine increased 2.4%, internal medicine-primary decreased 0.2%, pediatrics-primary increased 2% (100% vs. 98%) and internal medicine-pediatrics decreased 1.2%.

III. Contrast with Positions Potentially Leading to Subspecialties (See Tables 9-13)

Sixteen more preliminary positions in internal medicine were offered in 2008 compared with 2007 (1,901 vs. 1,885), and twenty-five more positions were filled in 2008 compared with 2007 (1,774 vs. 1,749). Twenty fewer U.S. seniors (1.3%) matched into internal medicine-preliminary (1,471 vs. 1,491). These students have chosen an internal medicine-preliminary year specifically as preparation for further training in another specialty.

IV. Contrast with Other Specialty Trends

Anesthesiology experienced an increase in positions filled (15.7%) in 2008 with eighty-eight more students choosing the specialty (649 vs. 561). Despite a small dip in 2004, the number of positions filled in anesthesiology has more than quintupled since 1996. The number of positions offered increased 15.8% (666 vs. 575) and seventy-six more U.S. seniors (17.0%) matched in anesthesiology in 2008 (524 vs. 448).

The number of positions filled in diagnostic radiology increased with sixteen more positions (11.3%) filled in 2008 compared with 2007 (157 vs. 141). Ten more U.S. seniors (0.8%) matched in diagnostic radiology compared with 2007 (135 vs. 125). The 2008 NRMP match marks the highest number of positions filled since 1996.

Emergency medicine offered 111 more positions in 2008 compared with 2007 (1,399 vs. 1,288), representing an increase of 8.6%. Eighty-eight more positions (6.8%) were filled in emergency medicine compared with 2007 (1,370 vs. 1,282), with fifty-six more U.S. seniors (5.5%) selecting emergency medicine (1,083 vs. 1,027).

Obstetrics-gynecology offered eight more (0.7%) positions (1,163 vs. 1,155) and filled two more positions (0.2%) compared with 2007 (1,151 vs. 1,149). One more U.S. senior (0.1%) chose obstetrics-gynecology in 2008 (838 vs. 837).

V. Discussion

The AAFP continues to track and report on the annual NRMP results as these have significant implications for physician workforce, healthcare reform, healthcare access, and healthcare policy. In 2006, the AAFP adopted its workforce policy to identify the number of family physicians that should be produced by 2020 in order to produce and prepare the physician workforce best equipped to provide the type of care that the nation states that it wants and needs.^1,2 While the results of the 2008 NRMP Match show an increase in the number of U.S. seniors choosing family medicine for the first time in over a decade, overall NRMP results show that students continue demonstrate a preference for non-primary care specialties as evidenced by the decrease in U.S. seniors choosing internal medicine-primary, pediatrics-primary, or internal medicine-pediatrics.

As medical schools increase their class sizes by 30% in keeping with AAMC workforce policy³, the AAFP believes that careful attention must also be given to the type of care that the enlarged physician workforce will provide to ensure an efficient and economically viable model for healthcare delivery. A remarkable and hopefully groundbreaking report from the Government Accountability Office reviewed multiple workforce studies by various organizations and specifically pointed to the need for gathering more data that projects the need for primary care physicians.⁴ The GAO report goes on to recognize the value of primary care within the health system by stating,

"Ample research in recent years concludes that the nation’s over reliance on specialty care services at the expense of primary care leads to a health care system that is less efficient. At the same time, research shows that preventive care, care coordination for the chronically ill, and continuity of care—all hallmarks of primary care medicine—can achieve better health outcomes and cost savings."

The June 2006 American Medical Association’s Council on Medical Education Report #12 "Impact of Increasing Specialization and Declining Generalism in the Medical Profession" specifically addressed the issue of primary care workforce challenges. (Note: This report included general surgeons as "generalists'.)⁵ Specific recommendations include the development of policy regarding workforce balance, monitoring of physician specialty need, and "physician reimbursement changes which would make generalist physician practice more attractive.'

Lifestyle and income have become more important to medical students; however the many influences on choice of specialty remain complex. It is important to note that when considered with other specialties, family medicine was determined 'lifestyle intermediate" and was ranked as more "lifestyle friendly" than internal medicine subspecialties, for example.⁶ While increasing student debt is negatively associated with a choice of primary care career, the relationship is complex and may be confounded by other demographic factors^.7

VI. Outlook for Family Medicine

This year, 2,404 individuals chose to become family physicians. These are individuals who have chosen to provide care to children and adults, women and men, throughout the continuum of the life cycle. They will provide care in rural and urban settings. These future family physicians will provide a personal medical home for their patients, reflecting one-quarter of the office visits to all physicians in the U.S.⁸

In 2006, the American Academy of Family Physicians began a national demonstration project—TransforMED—to implement the recommendations of the Future of Family Medicine. The goal of the project is to demonstrate how the family medicine model of care can concurrently improve patient access, healthcare outcomes, and physician satisfaction^.9 It is necessary to demonstrate to medical students that family medicine can provide great career satisfaction and financial stability. The P4 Initiative ('Preparing the Personal Physician for Practice") is a six-year project launched in 2006 by the American Board of Family Medicine and the Association of Family Medicine Residency Directors in conjunction with TransforMED. The goal of this initiative is to inspire and examine substantial innovation that focuses on changing the way family physicians are trained to practice medicine in the current world and for the future.

Initial outcomes from these projects reaffirm discussion among the other family medicine organizations about the need to educate the public, business leaders, and decision-makers about the concept of the Patient Centered Medical Home (PCMH). In February 2007, the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), American College of Physicians (ACP) and the American Osteopathic Association (AOA) developed a set of joint principles that describe a new level of primary care called the Patient-Centered Medical Home.¹⁰ A patient-centered medical home is an approach to providing comprehensive primary care for people of all ages and medical conditions. It is a way for a physician-led medical practice, chosen by the patient, to integrate health care services for that patient who confronts a complex and confusing health care system. Undoubtedly, implementation of a broad-based PCMH initiative will be dependent on an adequate supply of family physicians.

The Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the North American Primary Care Group, and the AAFP Foundation join the AAFP in continuing efforts to communicate the message of family medicine to medical students. The family medicine organizations also continue student interest efforts in four defined evidence-based areas of focus: 1) identification and preparation of inspiring and competent family physician mentors and role models, 2) focus on admission characteristics of students likely to choose family medicine, which includes identifying and inspiring the pipeline for future medical students, 3) effective communication about the image of family medicine to medical students and to the broader community, and 4) effective education of medical students about the family medicine model of care.

A strong family medicine workforce is dependent on at least 3 factors: recruitment of students to the specialty, comprehensive training of family medicine residents to provide patient-centered care within the framework of a medical home, and support of practicing family doctors who provide the kind of care that the nation says it wants and needs. The challenge for the future is to clearly communicate with policymakers, educators, medical students, and the public the importance of a well-trained, adequately equipped, and equitably distributed family physician workforce for America.