Who Filled First-Year Family Medicine Residency Positions from 1991 to 2004?

One Pagers | Aug 01, 2005
Lawrence Klein, MD; Ginger Ruddy, MD; Robert Phillips, MD, MSPH; Jessica McCann, MS; Martey Dodoo, PhD; Larry Green, MD

Graduates of U.S. allopathic schools have filled less than one half of the family medicine positions offered in the National Resident Matching Program (NRMP) Match since 2001. Overall fill rates in July have been relatively stable at approximately 94 percent. Family medicine has become reliant on international medical graduates (IMGs), who in 2004 made up 38 percent of first-year residents.

During the early 1990s, family medicine training positions increased by more than one third, adding about 900 positions, and the specialty enjoyed a revival of medical student interest.¹ Allopathic graduates' interest in family medicine has fallen precipitously since its height in 1996, when allopathic graduates filled almost three out of four training positions. Despite a poor fill rate in the NRMP Match each March (Table 1),² by the start of the internship year in July, around 94 to 97 percent of positions are filled (Table 2).³

Table 1. Family Medicine Positions Filled in the March NRMP Match

Positions	1998	1999	2000	2001	2002	2003	2004
Positions available	3,293	3,244	3,183	3,074	2,962	2,920	2,864
Percentage filled by U.S. seniors	66	62	57	49	47	42	41
Percentage filled by IMGs	10	13	15	16	20	24	26
Percentage filled	85	83	82	76	79	76	79
NRMP = National Resident Matching Program; IMG = international medical graduate.

Table 2. First-Year Family Medicine Positions Filled by July

Positions	1998	1999	2000	2001	2002	2003	2004
Positions available	3,723	3,644	3,623	3,528	3,523	3,480	3,501
Percentage filled by IMGs	15	15	19	30	32	38	38
Percentage filled	96	97	96	96	95	96	94
IMG = international medical graduate.

The absolute number of allopathic students currently choosing family medicine has declined only slightly compared with the period before the 1990s; but in the context of the larger number of medical residency positions available, the decline has been steep. The combination of a substantial increase in family medicine training positions and a drop in U.S. medical graduates' interest has yielded an almost threefold rise in the number of IMGs who fill first-year family medicine positions. In 2004, IMGs composed 38 percent of first-year family medicine residents, up from 15 percent in 1998. Currently, IMGs make up about 16 percent of the family medicine physician workforce. It remains to be seen how this internationalization of family medicine will affect the specialty in the United States, and medicine as a whole worldwide.

References

Green LA, Dodoo MS, Ruddy G, et al. The physician workforce of the United States: a family medicine perspective. Washington, D.C.: Robert Graham Center, 2004.
NRMP results and data 2004 match. Washington, D.C.: Association of American Medical Colleges, 2004. Accessed online May 24, 2005, at: http://www.nrmp.org/res_match/data_tables.html.
Pugno PA, McPherson DS, Schmittling GT, et al. Results of the 2004 National Resident Matching Program: family medicine. Fam Med 2004;36:562-70.

The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP.

Published in American Family Physician, Aug 1, 2005. Am Fam Physician. 2005;72(3):392. This series is coordinated by Sumi Sexton, MD, AFP Associate Medical Editor.