The American Academy of Family Physicians’ (AAFP’s) brief analysis of family medicine results from the annual National Resident Matching Program® Main Residency Match, or NRMP Match, provides a snapshot of the incoming physician workforce at its most significant inflection point: the moment medical students and graduates obtain their residency training position in a medical specialty.
Data included in this report are mostly obtained from the NRMP’s Advance Data Tables published during Match Week and do not include post-Supplemental Offer and Acceptance Program® (SOAP) data.
Andrea Augustine, a future graduate of the Duke University School of Medicine, shares the exciting news that she matched into her first choice of family medicine residency programs.
The 2026 NRMP Match had the most family medicine positions available in history. The results marked more than 17 years of growth in the number of positions offered in family medicine in the NRMP Match, with the last 16 years breaking all-time records.
This year’s NRMP Match marked the largest number of applicants matching into family medicine to date, underscoring the specialty’s enduring appeal and its central role in meeting the nation’s health care needs. Yet the U.S. medical education system remains insufficiently aligned to translate this momentum into a workforce capable of meeting growing demand. Recruiting and training students most likely to enter and remain in family medicine—and ensuring residency growth keeps pace—will require coordinated action across the education pathway, the practice environment and health care financing systems that have long underinvested in family medicine.
Given the increasing rates of subspecialization among internal medicine and pediatrics trainees, family medicine residency training provides the most effective approach for meeting the nation's primary care needs. Yet, despite large public investment in medical education, the system continues to fall short of producing the family medicine workforce needed. To meet population needs, graduate medical education (GME) sponsoring institutions and medical schools must not only expand residency training capacity in family medicine but also implement targeted recruitment strategies to ensure that all available positions in family medicine are filled to better align with workforce needs. Achieving better health, greater equity and lower costs will depend not only on increasing the number of family physicians, but also on ensuring the workforce is appropriately distributed, supported and valued.
Family medicine* offered 13.4% and filled 12% of the total positions. The overall fill rate (percentage of positions offered that were filled) in family medicine was 83.7%. The following is a breakdown by applicant type:
*Includes family medicine-categorical, plus combined programs: emergency medicine-family medicine and psychiatry-family medicine.
The largest increase for family medicine over the past two years was in matched non-U.S. IMGs. Despite overall growth in the specialty, the number of positions filled with U.S. MD seniors remains 828 below the historical high of 2,340 in 1997, reflecting concerns with publicly funded U.S. medical education system’s ability to train physicians in the most-needed specialties.
The number of unfilled positions after the Main Residency Match and before the SOAP was 899, up 94 from 805 in 2025. In 2019, the number of unfilled positions started an eight-year run of consecutive increases from a previous average of 140 for most of the 2010s. Factors such as the consolidation of the American Osteopathic Association (AOA) Intern/Resident Registration Program with the NRMP Match, the COVID-19 pandemic and the unprecedented growth in family medicine residency positions all likely contributed to the rise in unfilled positions. The vast majority of family medicine positions are filled by the time the new residency class begins each year, with most filled by the time Match Week concludes.
For example, only 52 positions remained after the SOAP in 2025. The family medicine workforce is growing at a time when family physicians are desperately needed. However, to improve pre-SOAP Match rates, the pace of applicants pursuing family medicine needs to increase in proportion to the growth in family medicine.
The number of unfilled positions in family medicine in 2026 (83.7%, 85% in 2025) reflects the lowest fill rate since 2006. Between 2003 and 2018, the family medicine fill rate went from a record low of 76.2% to a record high of 96.7%. The fill rates have declined since 2018.
The composition of family medicine matches has changed drastically over the last three decades. The fill rate in family medicine for U.S. MD seniors decreased drastically from the historical high in 1996 (72.6%) to the previous historical low in 2005 (40.7%). Over the last 24 years, it has fluctuated, reaching a high of 48.3% in 2012 and then taking a sharper downturn to 27.4% in 2026. These results reflect that the pursuit of family medicine careers among students at U.S. MD schools did not regain momentum after the decline of the late 1990s and early 2000s, despite family medicine’s record growth of the 2010s and early 2020s.
The trend among U.S. MD seniors is deeply concerning for the U.S. primary care workforce. It calls for U.S. MD medical schools to recruit and graduate more students who are likely to enter primary care specialties and practice in underserved areas.
Osteopathic students and graduates continue to make a strong contribution to the family medicine workforce, with a fill rate of (25.5%) despite having less than half (40%) of the number of total graduates matching. That composition has remained fairly steady in the 2020s after a sharp increase in the 2010s, partly due to AOA and NRMP Match consolidation. However, the percentage of U.S. DOs matching in family medicine (17.7%) has declined steadily over the same period, with a slightly sharper decline in the last three years.
Osteopathic schools continue to grow, with over 300 more DO students participating in the 2026 Match than the year prior. It is concerning that 2024, 2025 and 2026 had fewer total DO seniors matching in family medicine and a sharper decline in the percentage matching in family medicine. Family medicine remains a top specialty choice for DO-trained physicians.
Comparing the composition of applicants matched to all specialties with those matched to family medicine:
Family medicine residencies have continued to grow despite federal funding limitations and other policy and legislative threats. Family medicine had more programs than any other specialty in the 2026 NRMP Match. The size of the specialty and broad distribution of programs—which train residents in more rural and underserved communities than any other specialty—may contribute to the number of unfilled positions after the main NRMP Match. Continued growth is important to achieve the needed primary care workforce.
Among U.S. MD seniors, family medicine-categorical had the third highest number of applicants excluding preliminary and transitional positions. The only specialties with more U.S. MD senior applicants were internal medicine and anesthesiology.
Family medicine-categorical had the second highest number of applicants among U.S. DO seniors. Internal medicine had more applicants (2,431), which is a new emergence within the last few years.
Family medicine-categorical also had the second highest number of applicants among U.S. IMGs (1,206) and non-U.S. IMGs (2,804), although it is notable that non-U.S. IMGs had many more internal medicine-categorical applicants (7,764).
Family medicine, including categorical and combined programs, had the most programs in the Match (857), with residencies in communities of all sizes across the U.S.
These results are a combination of all postgraduate year (PGY)-1 positions that result in eligibility for licensure and board certification in family medicine, which include family medicine-categorical and combined residency programs. The following is a breakdown by program type:
A total of 41,126 PGY-1 positions were offered in all medical specialties in the 2026 NRMP Match, and 38,354 were filled. The following is a breakdown of filled positions by applicant type:
At the time of the NRMP’s Advance Data Tables release on Match Day, 2,772 Main Match positions were unfilled.
Compared with the 2025 NRMP Match:
In the 2026 NRMP Match:
*Defined as family medicine-categorical and combined programs, internal medicine-primary, internal medicine-pediatrics and pediatrics-primary.
In total, 167 more positions were offered in primary care specialties in 2026 than in 2025. Family medicine positions are responsible for almost the entirety of that growth. These results show a year-over-year increase of 2.6% in the number of positions offered in primary care specialties, closely aligning with the increase in positions (2.64%) across all specialties.
The AAFP uses a narrower definition of primary care specialties than the NRMP and many medical schools. Family medicine residency graduates practice primary care at a higher rate (more than 90%) than any other medical specialty. Studies show that most graduates of internal medicine programs subspecialize and do not practice primary care, and close to half of graduates of pediatrics residencies practice primary care. Both internal medicine and pediatrics have a category of dedicated primary care positions, which the AAFP includes in this analysis. Although many internal medicine-pediatrics combined program graduates go on to subspecialize, the AAFP includes these positions because they are also a training pathway to primary care.
This count has some inflation by including positions that will not contribute to the primary care workforce, yet it is much less inflated than the definition used by the NRMP and many medical schools.
Note: The rapid increase in number of positions offered and filled 2014 to 2020 is reflective of the shift to a single accreditation program under the ACGME.
See the Understanding the historical data section for details.
Note: The rapid increase in number of positions offered and filled 2014 to 2020 is reflective of the shift to a single accreditation program under the ACGME.
The steady increase to positions offered in 2013 is related to the “All in Policy” requiring programs to offer all their slots via the match starting in 2013.
See the Understanding the historical data section for details.
|
2022
|
2023
|
2024
|
2025
|
2026
|
Positions Offered
|
4935
|
5107
|
5231
|
5379
|
5512
|
Positions Filled
|
4470
|
4530
|
4595
|
4574
|
4613
|
Positions Filled by U.S. MD Seniors
|
1555
|
1499
|
1535
|
1519
|
1512
|
Positions Filled by U.S. MD Grads
|
87
|
91
|
68
|
90
|
96
|
Positions Filled by U.S. DO Seniors
|
1496
|
1514
|
1493
|
1486
|
1404
|
Positions Filled by U.S. DO Grads
|
94
|
70
|
44
|
52
|
54
|
Positions Filled by U.S. IMGs
|
779
|
793
|
749
|
626
|
585
|
Positions Filled by Non-U.S. IMGs
|
458
|
562
|
706
|
801
|
962
|
Positions Unfilled (Pre-SOAP)
|
465
|
577
|
636
|
805
|
899
|
Fill Rate
|
90.6%
|
88.7%
|
87.8%
|
85.0%
|
83.7%
|
Fill Rate by U.S. MD Seniors
|
31.5%
|
29.4%
|
29.3%
|
28.2%
|
27.4%
|
Rate of U.S. MD Seniors Matching to Family Medicine
|
8.4%
|
8.1%
|
8.3%
|
8.0%
|
7.7%
|
Fill Rate by U.S. DO Seniors
|
30.3%
|
29.6%
|
28.5%
|
27.6%
|
25.5%
|
Rate of U.S. DO Seniors Matching to Family Medicine
|
22.4%
|
22.2%
|
20.1%
|
19.1%
|
17.7%
|
Fill Rate by U.S. IMGs
|
15.8%
|
15.5%
|
14.3%
|
11.6%
|
|
Rate by U.S. IMGs Matching to Family Medicine
|
25.1%
|
23.6%
|
23.5%
|
20.1%
|
19.8%
|
Fill Rate by Non-U.S. IMGs
|
9.3%
|
11.0%
|
13.5%
|
14.9%
|
17.5%
|
Rate of Non-U.S. IMGs Matching to Family Medicine
|
10.0%
|
11.2%
|
12.0%
|
12.0%
|
14.3%
|
Fill Rate by U.S. MD Grads
|
1.8%
|
1.8%
|
1.3%
|
1.7%
|
1.7%
|
Rate of U.S. MD Grads Matching to Family Medicine
|
10.1%
|
11.5%
|
8.9%
|
11.2%
|
11.2%
|
Fill Rate by U.S. DO Grads
|
1.9%
|
1.4%
|
0.8%
|
1.0%
|
1.0%
|
Rate of U.S. DO Grads Matching to Family Medicine
|
24.5%
|
21.9%
|
15.0%
|
18.8%
|
17.0%
|
Fill Rate by Others
|
0.02%
|
0.02%
|
0.00%
|
0.00%
|
0.00%
|
Rate of Others Matching to Family Medicine
|
9.1%
|
7.1%
|
0.0%
|
0.0%
|
0.0%
|
Two significant procedural changes to the NRMP Match process affect historical data from the NRMP because they resulted in variances that do not represent the true change in physician workforce trends.
Single accreditation system: From 2014 to 2020, the U.S. graduate medical education system shifted to a single accreditation system under the Accreditation Council for Graduate Medical Education. The 2020 NRMP Match was the first year in which there was no AOA Intern/Resident Registration Program. This means that a portion of the family medicine growth in the NRMP Match does not reflect new training positions but rather the shift from one matching program to another.
The United States is the only country that trains osteopathic physicians; therefore, the AOA Match did not include IMGs.
The NRMP’s All In Policy: This policy, instituted in 2013, changed how programs offered their positions by requiring programs that had previously only offered a portion of their positions in the NRMP Match to offer all their positions in the Match. Again, some of the overall increases and family medicine increases in the years since 2013 have resulted from a shift in how positions are filled rather than from new training opportunities or an increasing workforce.
More on the family medicine and primary care 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, NRMP Match results are not comprehensive of all entry into GME in the United States. The NRMP Match is not the only mechanism through which medical students or graduates are matched with their required GME or residency programs in a specialized field that leads to board certification in a medical specialty (or multiple specialties). Other matching services (e.g., the annual Military Match) and private arrangements outside of the Match also fill residency openings. The results published on Match Day each year also exclude the SOAP.
The family medicine workforce must grow rapidly to meet the needs of a high-functioning, affordable U.S. health care system and to improve health outcomes nationwide. While increasing residency training positions in family medicine is essential, workforce shortages cannot be solved through training expansion alone. Recruitment into family medicine—and long-term retention of the workforce—depend on a practice environment that is sustainable, well-resourced, and aligned with the needs of patients and communities.
To address these challenges, the AAFP advocates for policies that strengthen the family medicine practice environment and make the specialty more attractive to future trainees. Central to this effort is a call to increase health care spending devoted to primary care from roughly 5% to at least 10%, ensuring that family medicine practices have the financial support they need to build teams, invest in infrastructure, and deliver high-quality care without being chronically overburdened and under-resourced. The AAFP is also advancing payment reforms that move away from fee-for-service and toward hybrid and population-based models that better support comprehensive, continuous care, alongside efforts to reduce administrative burden that detracts from patient care and professional satisfaction. Together, these policies are intended to improve both recruitment into family medicine and retention of the existing workforce.
Recruitment, retention and training
In parallel, the AAFP works with policymakers to expand and protect programs that directly address physician shortages and support training in high-need communities. This includes securing increased and multi-year funding for the Teaching Health Center Graduate Medical Education (THCGME) program, a proven workforce solution whose graduates are more than twice as likely to practice in medically underserved areas compared with those trained in traditional residency programs. The recent four-year extension of THCGME funding—the longest in the program’s history—provides critical stability for these community-based residencies, while continued advocacy for permanent funding remains a priority. The AAFP supports programs such as the Conrad 30 waiver, the National Health Service Corps, the Resident Education Deferred Interest Act and the Public Service Loan Forgiveness program, all of which reduce financial barriers and expand pathways into family medicine, particularly for physicians serving rural and underserved populations.
Improving health outcomes will also require aligning medical education pathways with workforce needs. Addressing shortages will depend on increasing residency training in family medicine, other primary care specialties, and select subspecialties, as well as transforming pathways to and through medical school. Greater societal and educational support is needed to recruit and sustain candidates who reflect the racial, cultural, geographic and linguistic diversity of the U.S. population.
A workforce that more closely mirrors the communities it serves is essential to improving access, quality and equity, particularly for populations with the greatest unmet health needs.
Investing in primary care solutions
Finally, the AAFP is leading efforts to modernize the residency selection and recruitment process itself through the Residency Selection Improvement Initiative, which aims to reduce inefficiencies, curb overapplication, and better connect applicants with family medicine programs that are aligned with their interests and commitments. By improving transparency, streamlining interviews and creating clearer pathways for applicants dedicated to family medicine, the initiative seeks to fill more family medicine residency positions and strengthen the pathway to family medicine. These changes will require coordinated action across teaching hospitals, medical schools, payers, policymakers, employers and communities.
Workforce shortages are already affecting patients in every state, underscoring the urgency of action. Family medicine is committed to leading this transformation and partnering across sectors to change the trajectory of the physician workforce and strengthen the foundation of care for all Americans.