If the US needs more primary care physicians, does it make sense to consider reducing training opportunities for some would-be family medicine physicians? 

A recent column in the Journal of the American Board of Family Medicine (JABFM) explored possible downsides to the expansion of family medicine residency programs and positions in recent years. 

“We have not fully ascertained the unintended consequences of the rapid escalation of Family Medicine residency positions on the existing Family Medicine residency programs, especially the most vulnerable ‘nonmetropolitan’ areas,” the authors wrote.

But some graduate medical education experts, including family medicine program directors, suggest that reducing family medicine residency opportunities is not the way to go. Some changes might help, but they balk at the idea of cutting slots. 

The healthcare system needs to continue investing in family medicine, according to Tricia Elliott, MD, senior vice president for academic and research affairs and the chief academic officer for the JPS Health Network in Fort Worth, Texas, which has one of the largest family medicine residency programs in the US.

“I just think we need to be strategic about it,” said Elliott, who is also a family medicine physician. 

Assessing the Need 

The US continues to experience an ongoing shortage of physicians, including primary care physicians. A 2024 report from the Association of American Medical Colleges projected a total shortage of between 13,500 and 86,000 physicians by 2036.

In response, more residency spots have opened up to train physicians to meet the growing demand for primary care. In fact, at the end of 2025, the Centers for Medicare & Medicaid Services awarded 32 new family medicine graduate medical education Medicare residency slots to 18 programs.

But with more than 800 family medicine programs now in existence, could there possibly be too many family medicine residency positions now? 

In 2025, the fill rate for family medicine was down. Family medicine filled 85.0% of their 5357 positions, down from 87.8% in 2024, which the National Resident Matching Program (NRMP) attributed mostly to the increase of 144 positions added in the Match. 

But the idea of reducing the total number of family medicine residency slots alarms some family medicine program directors. 

“You’re already going to have a shortage, and if you cut slots, it’s going to make it even worse,” said Philip Dooley, MD, the program director for the University of Kansas School of Medicine-Wichita Family Medicine Residency at Via Christi Hospitals in Kansas.

Raj Woolever, MD, doesn’t think there are too many family medicine openings, either. 

“It’s probably more a distribution problem than a problem of numbers,” said Woolever, program director of the family medicine residency program at Portsmouth Regional Hospital, New Hampshire, and the immediate past president of the Association of Family Medicine Residency Directors. 

Is There Stigma? 

The authors of the JABFM commentary pointed to 2012, when the NRMP expanded the number of positions. The “nearly 2-fold increases in positions nationwide since 2012 has resulted in 4.5-fold increases in programs participating in the supplemental match and a 5.7-fold increase in open residency positions,” they wrote. 

They proposed that family medicine residency programs might suffer a hit to their reputations if they don’t fill all their slots in the main match and have to fill their empty spots through the Supplemental Offer and Acceptance Program (SOAP). 

Dooley said he could understand that some may be concerned about stigma associated with having slots go unmatched. “We worry about everything,” he said. “It’s very fair to say that people are worried about it.”

But Reid Blackwelder, MD, associate dean for graduate medical education for the East Tennessee State University Quillen College of Medicine in Johnson City, Tennessee, wasn’t convinced. 

“Within the family medicine community, a program that doesn’t fill isn’t seen as a red flag or [take] a reputational hit,” Blackwelder said. “I don’t really see that as a significant issue.” 

Many unfilled spots do get filled during SOAP, and there are worse outcomes for a program than filling a residency spot via the supplemental match, according to Dooley, noting that many family medicine programs have had to fill slots via the supplemental match at various times. 

According to the American Medical Association, 2318 post-graduate year 1 (PGY-1) positions were filled through SOAP in 2025. Family medicine, with 753, was the specialty with the largest number of slots filled through SOAP. Surgery-preliminary (PGY-1 only) was second with 534.

“You want to match with somebody who’s aligned to your mission, vision and values,” Dooley said. “You don’t want to just take anybody. If you don’t have the right people in your application pool on the front end, don’t rank somebody just to rank them. Because you may be able to find a good person in SOAP who didn’t know about your program and didn’t cast a wide enough net.”

Plus, it takes time for newer programs to get established, he noted. 

However, Jeffrey Harrison, MD, suggested that programs may run the risk of accepting candidates who don’t want to be there or aren’t as well prepared as other candidates if they have to rely on the supplemental match. He said he wouldn’t worry as much about the first group as the second group. They may require additional support, and programs have to be prepared to provide that. 

“It needs to be in the consideration,” said Harrison, the family medicine department chair at the University of Nebraska Medical Center in Omaha. 

He also suggested that program leaders ask themselves whether they are confident they can continue to provide a high-quality educational experience before they consider expanding in the future. The UNMC Family Medicine Residency program is a larger program, with 16 family medicine residents in each of the three classes of its main program, plus additional residents in a specialized rural training program.

“We have not really grown either of those programs in numbers in the last 25 years,” said Harrison. “If we added more people, could we maintain the same quality of program that we’ve done?”

Sell Family Medicine as a Good Choice 

The authors of the commentary suggested it’s time to ask, “How can we reimagine Family Medicine in a way that attracts and expects the best and the brightest to come to our specialty?”

So, it may be some time to delve into the reasons that family medicine slots go unfilled in the main match, Blackwelder said. “The worst thing you can do is to cut programs,” he said. “Instead, ask why they’re not filling.” 

Consider some of the reasons that fourth-years choose a particular specialty — or choose a particular program. 

For some, it’s geography. They may want to work and live near family, or they may prefer a more urban environment. Research suggests that residency programs in rural areas have lower match rates than programs in so-called more “desirable areas.” 

For others, their choice stems from fulfilling a childhood dream. For many, their looming student loan debt is a stressor that influences their choice, and family medicine is one of the lowest-paid specialties. 

Family medicine programs might not be able to change those factors, but they may be able to highlight the advantages that they can offer. That is, programs might want to revisit their mission and how they market themselves toward medical students and medical school advisors. 

As Elliott put it, “You’ve got to make sure you have that clarity around your mission and clarity around your value proposition.”

Family medicine physicians and family medicine residency leaders can describe the advantages of a career in family medicine, including the chance to see a wide variety of cases and develop relationships with patients that can span years, even decades. They can emphasize their mission of service to their community. They can highlight any special programs or offerings they have, such as JPS Health Network’s optional fourth year for family medicine residents interested in pursuing additional experience in certain areas, such as sports medicine or geriatrics. 

“It’s our job, as educators, to show those upsides,” Harrison said. 

Programs can tap into their alumni network to reach prospective students and spread the word. Another way to market a family medicine program is to focus on training the best possible residents. 

“The best sellers are happy residents,” Woolever said. 

Thus, the goal should be improving efforts to help students easily find a program that’s the right fit and aligns with their own mission and goals, rather than cutting openings for family medicine residents, Woolever said. 

“The bigger picture is we’re grateful to have more family medicine slots to train more family doctors,” he said. 

Some changes that could have a positive impact are already on the horizon. 

In 2025, the American Academy of Family Physicians (AAFP) launched a Residency Selection Improvement Initiative to improve the family medicine match. The AAFP expects to put some changes in place by June of this year, with changes to the main residency Match to occur in 2027.