The 2026 NRMP Match once again offered a higher number of family medicine (FM) positions than ever before: 5,512 to be exact. This marks the 17th consecutive year of increasing slots available for FM training in the U.S. And yet, while positions offered continue to increase, the number of students (especially U.S. MD students) matching into FM remains stagnant.
Historically, main Match results left approximately 100-200 spots unfilled in FM during the first two decades of this century, with 2,500-3,500 positions being offered depending on the year. Since 2018, the number of FM positions offered has increased by an astounding 50% (from 3,654 to 5,512), while the number of FM positions filled has only increased by a lagging 30% (3,535 to 4,613). Despite this rapid growth, the amount of U.S. MD students matching into FM has declined by 9%. The growth in positions filled is attributable to increasing matches into FM by U.S. DO students (100% increase since 2018) and non-U.S. IMG students (192% increase since 2018). These physicians may have difficulty matching into more competitive specialties and over the years have subsequently helped fill the explosion of FM positions. Of note, 2026 SOAP data is not yet publicly available.
On its surface, it may seem that family medicine just has a “Match problem,” in which ever-increasing spots coupled with waning interest from U.S. allopathic graduates and lagging interest overall has led to a greater gap between positions offered and positions filled. While this is true and concerning, I believe the “Match problem” is actually much larger than that: This decreasing fill rate may be indicative of significant headwinds against the FM specialty.
There are no shortage of misconceptions in medicine, and family medicine is no different. I previously wrote an Op-Med article on the historical underpinnings of the general practitioner role and how the metamorphosis into family medicine as a specialty in and of itself has left a lasting, albeit incorrect, impression of FM physicians as less trained than their colleagues in other specialties. All physicians have worked incredibly hard to get to where they are now. The last thing a medical student wants to do after all of that work is go into a field where they do not feel they are respected.
Besides the training misconception, structural issues persist. Whether it is the degradation of independent practice and the rise of being an employee (although DPC and concierge are increasingly viable options) or misconceptions that family medicine physicians make much less money than other physicians, there is no shortage of issues chipping away at the respect that FM deserves.
In addition, there is a broad and pervasive misunderstanding of the scope of FM within the health care system. The amount of not just medical students, but also nurses and other health care workers who think FM physicians can only work in outpatient primary care settings is alarming. Most do not understand that hospitalists, ER physicians, OB physicians, wound care physicians, and yes, outpatient primary care physicians, can all be family medicine-trained. This misconception of the available career paths for family medicine physicians can contribute to students feeling pigeonholed into one line of work if they were to pursue FM. Those of us in the specialty know that this couldn’t be further from the truth. But unfortunately, the truth doesn’t always matter. Once students have a perception of a specialty, right or wrong, correct or incorrect, changing these thoughts can be exceedingly difficult.
Beyond the misunderstandings of our scope of practice and pay, the legislatures of 27 different states have decided that NPs with a fraction of the training of physicians can practice autonomously without any physician supervision. While this has long been argued as a solution to health care access issues in the U.S., there is a significant unintended consequence brewing: the disincentivization for medical students to pursue primary care. Why would you pursue the practice of medicine in primary care if lawmakers continue to say you can do the same job with much less time, training, and debt?
Finally, there has been no true coordinated effort to increase interest and incentivize medical students to pursue family medicine. I believe this is where the solution lies to many of our problems, but certainly not all of them. At the end of the day, we have to make it more palatable for medical students to choose FM if we want fill rates to grow. From a societal and organized medicine perspective, we need campaigns to increase medical student awareness of the vast amount of things FM physicians can do. This will allow students to see the variety of career paths within FM and dispel incorrect notions that FM physicians are limited in available practice settings. At the same time, respect will likely be garnered subconsciously as the understanding of family medicine’s breadth and capacity increases.
From a governmental perspective, there are significant reasons to invest in primary care. It is well-documented that better primary care (whether that is supply, continuity, access, etc.) is associated with several positive health care outcomes, including decreased mortality and lower health care costs. Therefore, it is in the government’s interest to incentivize medical students to pursue family medicine, among other primary care specialties, as a way to not only meet the needs of an aging population but also to improve the health of our population as a whole.
Examples of this do exist but similarly styled programs could be improved and grown, as well as better advertised, to draw interest from students. At the state level in Indiana, Indiana State University, in conjunction with Indiana University, offers the Rural Health Scholarship which is valued at full in-state undergraduate tuition for a select number of students working toward attending medical school and practicing medicine in rural Indiana and Illinois. Federally, the National Health Service Corps gives scholarship support in exchange for a time-limited commitment to service in a health professional shortage area. Programs that encourage, attract, and incentivize med students to pursue family medicine and/or primary care through tangible benefits and scholarships with reasonable obligations after training before students have decided on their specialty would certainly help us attract and retain students.
All in all, those of us in family medicine chose it because we love it. We enjoy the variety of our work, the flexibility it affords us, and the connections we make with our patients. We know the joys and the pitfalls of our specialty. It is imperative to the future of our specialty that we show medical students that family medicine is much more than what many believe it to be. Beyond this, we must work to combat incorrect narratives and limit legislative interference that makes the specialty less palatable to students. Finally, we should consider developing novel programs at the state and federal levels that provide financial benefits to students in exchange for commitments to practice in the areas we need most. Offering more FM positions is not the answer: we have to move the needle on those choosing it.
Dr. Del Carter is a family medicine resident physician in Tallahassee, FL. He enjoys traveling, watching Florida Gators sports, working on cars and motorcycles, and spending time with friends and family. He can be found on Instagram and X at @DelCarterMD. Dr. Carter was a 2024–2025 Doximity Op-Med Fellow, and continues as a 2025–2026 Doximity Op-Med Fellow.
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