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The headlines can be frightening: The physician shortage is big and getting bigger.

According to the Association of American Medical Colleges (AAMC), by 2036, the shortage will be as high as 86,000 doctors. When you slice and dice the numbers to drill down on primary care physicians (PCPs), the potential shortage looks even more grim. The AAMC reported that, in 2024, 252 of the nation’s 3139 pediatric residency slots went unfilled, and family medicine programs experienced 636 vacant residencies.

There are many theories surrounding the why, the greatest being that med students are increasingly focused on higher-paying specialty fields. There’s also an issue with how many medical schools include family medicine as an option. Some of the more prestigious programs such as Johns Hopkins and Harvard, for instance, don’t have full-fledged family medicine tracks.

The American Academy of Family Physicians (AAFP), however, thinks some of the problem can be found in a mismatch between residency applicants and the available number of family medicine residencies. With this theory, the AAFP recently announced a new initiative geared toward helping applicants find the right programs.

Whatever the case may be, everyone agrees that the looming PCP shortage is real, and it’s time to address it.

The Issues

From where she sits, Allison Macerollo, MD, associate professor of clinical family medicine at The Ohio State University College of Medicine, Columbus, Ohio, the PCP issue is multifaceted, as are the fixes. “The issues begin prior to medical school and continue during and after,” she said. “There’s not one specific reason for the shortage; it’s nuanced.”

Whether, or how, medical schools are addressing these issues varies widely, but Ohio State is putting a push to recruit potential students with the goal of becoming PCPs in the local community. To accomplish that, the school is offering more scholarships to students who want to advance in family medicine. The school is also offering an accelerated medical school model for those students who want to become PCPs, a big incentive as these students face 1 less year of student debt.

During med school, Ohio State offers programming that supports family medicine, said Macerollo. “We make sure they’re having positive interactions with family medicine docs in the clinical care setting,” she said. “Seeing someone who is burned out isn’t helpful, so we use strong role models in community preceptors and faculty to avoid that.”

Martina Ambardjieva, MD, a urologist with Dr Telx in Kennewick, Washington, sees family medicine as underrepresented in medical school curriculum, as well as underappreciated in the academic culture.

“Solutions must start early,” she said. “We need stronger mentorship, earlier exposure to primary care in the curriculum, and more loan repayment incentives. Community-based preceptorships, rural tracks, and integrating family physicians into leadership roles within medical schools can also shift the culture.”

Ambardjieva also sees value in addressing the match process ahead of the actual day. “Many students decide against family medicine long before the match,” she said. “While the match itself is fair structurally, students’ rank order lists often reflect a lack of meaningful exposure to primary care role models or community-based clinical experiences. Academic medical centers tend to emphasize hospital-based, subspecialist care.”

The Mismatch

Attacking the PCP shortage from multiple angles is important, but the AAFP is directing its efforts at the matching process. Overall, the 2025 NRMP Match Day saw a decline of 21 people entering family medicine residency programs out of about 5000 matches. While that’s not a big gap, the need for filling PCP jobs is growing.

“We’ve been seeing success in growing our family medicine programs throughout the country, including rural communities,” said Karen Mitchell, vice president of Student & Resident Initiatives at AAFP. “There are currently more than 800 residency programs in the country, so that’s a big success.”

But along with that success, there’s a challenge, Mitchell said. Family medicine residency applicants find it difficult to find the right program for their personal needs and wants. The AAFP’s new, multiyear initiative will assess whether the processes and systems associated with family medicine residency recruitment are meeting the needs of the growing primary care workforce.

The initiative will involve a stakeholder group of organizations and individuals to examine residency recruitment systems, the application and interview process, and the performance of the match program for both applicants and the programs it fills. The AAFP hopes to compile its findings this fall and then determine next steps, according to Mitchell.

During the first round of this year’s match process, there was a higher number of unmatched students and family medicine programs than in other specialties, said Mitchell. “The process went on for 3 days,” she explains. “Most went on to get filled, but that’s a stressful 3 days, and we’d like applicants and programs to find each other more efficiently.”

In comparison, other specialties had fewer mismatches, said Mitchell.

“We know that a few years ago emergency medicine had a similar issue, and they also took steps to address the issue and fix it,” she said. “They looked at the specifics of the application and interview offer process.”

For family medicine, the AAFP is taking a broader approach.

“There’s some uniqueness going on in family medicine that we hope to address,” said Mitchell. “We want solutions that make the match and selection process more efficient from both sides so that we fill more spots and meet the needs of the healthcare system.”

One continuing challenge in family medicine is meeting the needs of underserved communities.

“Rural communities and some inner-city areas are particularly vulnerable,” said Ambardjieva. “These regions are already struggling with access to care, and a shortfall of family physicians could worsen health disparities.”

Rural communities pose match problems because their programs are so small, said Mitchell, making them harder to find.

“That means applicants must explore multiple programs to find a fit,” she said. “We’re looking for solutions that would help before they even apply. It’s hard for students to understand a community unless they experience it, so they can’t know if it would be a good fit before applying.”

Even after match day, some focus should go to retention, according to Ambardjieva. She recommends improving working conditions, reducing administrative burdens, and ensuring PCPs feel valued and empowered within the broader healthcare system.

The AAFP is currently pulling together the appropriate thought leaders and influencers from a cross section of residency programs, advisors, and learners, with a target date in August for its first gathering.

“We hope to identify two to five work streams of items that we might be able to change and close the gap,” said Mitchell. “We hope to have a good plan in place by next spring, in time for match day.”

No matter what the outcome or the plan, closing the widening gap between family healthcare physician needs and the number of residents selecting that direction won’t happen overnight. “It may take 2-3 years to implement,” said Mitchell. “We want a plan that has impact.”