As tens of thousands of medical students basked in the big reveal this Match Day of where they will start their residency training on July 1, family medicine isn’t necessarily celebrating. 

A large number of available family medicine slots initially have gone unfilled, even as the overall number of residency positions in that specialty and in other specialties hit new highs, according to data released by the National Resident Matching Program (NRMP). 

Overall, there were 41,126 applicants for 44,344 positions. Ninety-three percent of all first-year positions were filled. That’s in keeping with past years but a slight decline from the 94.3% match rate in 2025.

As in the past few years, allopathic and osteopathic seniors seem to be gravitating toward specialties offering either higher pay or what they perceive to be a better work-life balance. Anesthesiology, dermatology, and many surgical specialties had large numbers of applicants and high match rates. 

Primary care specialties — internal medicine, internal medicine-pediatrics, pediatrics, and family medicine — still make up the largest number of available positions, but collectively, 92% were filled, a 1.4% decline from 2025.

For family medicine, the total number of applicants increased, but only about 84% of the 5491 positions were filled, with just under a third taken by US MD seniors. 

Still, the American Academy of Family Physicians (AAFP) applauded what it described as swelling interest. “An unprecedented number of medical students and graduates chose this path, a decision that commits physicians to showing up for patients at every stage of life,” said Sarah C. Nosal, MD, AAFP president, in a statement. 

Stats Muddied – For Now 

Bryan Carmody, MD, MPH, a pediatric nephrologist who gives detailed analyses of medical education on his blog, said that early Match Day numbers for family medicine might be muddied by the fact that many students apply to the specialty as a back-up choice. 

“You've got stable, or, relatively declining, interest in family medicine in the context of continued expansion of program positions,” Carmody told Medscape Medical News.

The NRMP is concerned. It said in a statement that family medicine “has faced growing challenges in attracting medical students, raising questions about how training pathways, professional expectations, and workforce needs are aligning.” 

The program is convening a panel to examine the challenges in family medicine. 

“The AAFP is planning to participate in the Blue Ribbon Panel and we are interested to see where it leads,” said Karen Mitchell, MD, vice president for National Residency and Academic Partnerships at AAFP, in a statement provided to Medscape Medical News.

Interest in emergency medicine has also flagged, with fewer applicants and matches, even as the number of positions have doubled in the past 15 years, said Carmody. In 2026, there were 3198 positions, 140 of which were not taken. 

“There's less interest in emergency medicine than there was several years ago,” Carmody said. 

Apparently, the popularity of the television medical drama The Pitt has not inspired medical students yet. Carmody said he’d expect any bump from the show — which would be marginal anyway — to not occur until 2027 or 2028. 

Psychiatry Fills Up

Another specialty that has seen big bumps in available positions, due to a push by the field, and applicants: psychiatry. In 2026, 97% of 2516 positions were filled, almost two thirds by US MD seniors. A year ago, only eight of 2388 positions were not filled. 

Carmody noted rising interest in physical medicine and rehabilitation (PM&R) for the second year in a row. He said it was driven in part by the field’s popularity among osteopathic students, who also continue to grow in number. 

Overall, 808 applicants vied for 253 PM&R positions, all of which were filled — 134 by US MD seniors, 103 by DO seniors, and the remaining eight evenly split by MD and DO graduates. 

Laws restricting or outlawing abortion — making for a difficult training environment — have not had a negative impact on obstetrics and gynecology. The specialty was competitive again in 2026, with only two of 1638 residency slots not being filled. More than two thirds were filled by US MD seniors. Ob/gyn positions were almost entirely filled in the previous 2 years. 

But federal immigration policies might be dampening the prospects of international medical school graduates (IMGs) who are not US citizens. While the number of those applicants was up in 2026, their match rates declined — by 1.6%, compared to a 2.2% increase in match rate for US citizen IMGs.

The match rate was even lower for foreign-born IMGs who required visa sponsorship: 54.4%, a 5-year low, said the NRMP. For foreign-born IMGs who were US permanent citizens, the match rate was 67.9%. 

Carmody said the lower match rate for IMGs who require a visa reflects the concern among program directors that a bureaucratic hold-up could mean not having someone to start right away on July 1. Then, “you're just down a person,” he said.

The NRMP data suggest that residency programs have “downranked the noncitizen IMG,” said Carmody.

Some physician organizations are concerned.

“We will need to carefully explore factors that may have contributed to the decline in number of matched IMGs this year," said Davoren Chick, MD, chief learning officer for the American College of Physicians, in a statement.

“IMGs provide essential frontline care within the US healthcare system and are mission critical to the provision of healthcare in the US, not only during training through their service to teaching hospitals but also following training through their disproportionately large role in meeting the needs of medically underserved populations,” she said.

Alicia Ault is a Saint Petersburg, Florida-based freelance journalist whose work has appeared in many health and science publications, including Smithsonian.com. You can find her on X @aliciaault and on Bluesky @aliciaault.bsky.social.