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A few weeks ago, medical students across the country waited as Match Day approached. It was and always is fun to watch the Match Day celebrations in person and through social media as we welcome the next cohort of physicians into the profession of medicine. Every March, medical students across the United States experience one of the most pivotal moments in their careers: Match Day. This event, organized by the National Resident Matching Program (NRMP), determines where these future doctors will complete their residency training. It’s a culmination of years of hard work, dedication, and perseverance. Every school does it a little differently, but in general, students open envelopes revealing their residency placements, often surrounded by family, friends, and faculty, marking the transition from medical school to residency and specialty clinical training.

Match Day is not just a celebration; it’s also a reflection of the healthcare system’s needs and priorities. The specialties students match into provide insight into the types of physicians being trained and how well the system aligns with the nation’s healthcare demands. I still feel a bit left out because I had an untraditional path into medicine and was in the medical student/resident workroom when I opened my e-mail to find out where I had matched for my family medicine residency. Although it was exciting, and I was happy to have my wife at my side for this pivotal moment of my career, it still did not feel as exciting or climactic as some celebrations we are all used to seeing.

This feels like a good moment to reflect on and examine the new positions entering our workforce and the types of positions we are creating to care for the US population both now and for the next 30 to 40 years.

A Record Day

Match Day 2025 was the largest in history, with 47,208 applicants—a 4.2% increase. While the US trains a diverse range of physicians, the distribution does not always align with community needs and locations. For example, despite the well-identified need for more primary care physicians, fewer medical students choose primary care specialties due to many factors. Subspecialties like dermatology and orthopedic surgery remain popular, often because of higher earning potential and perceived prestige. Furthermore, many residency programs are concentrated in urban or suburban areas, and more than 60% of residents end up in practice near where they trained, leading to a lack of physicians in rural regions.

In the NRMP 2025 Match, primary care specialties grew, offering 20,300 positions with a 93.5% fill rate. Internal medicine filled 11,379 positions, achieving a 96.8% fill rate, while pediatrics rebounded to 95.3%. Family medicine experienced a slight decline, filling 85% of its positions. However, the US faces a growing demand for primary care physicians, driven by an aging population, particularly the baby boomer generation, and increasing chronic health conditions. According to projections, the country will face a shortage of 17,800 and 48,000 primary care physicians by 2034. We know that the continuous, comprehensive, and whole-person care provided by family medicine, internal medicine, and pediatric physicians is critical to preventing and treating disease early, improving the quality of care, and reducing the exorbitant and rising cost of healthcare in the US.  We save $13 in downstream healthcare expenses for every dollar spent on primary care. Strengthening primary care infrastructure is essential to addressing rising healthcare costs while ensuring a healthier population. It’s an investment in a more sustainable and equitable healthcare system.

This is not to say that the physician shortage is unique to primary care. By 2034, there is a projected shortage of 21,000 to 77,100 specialists, such as surgeons and other nonprimary care physicians. Addressing this gap will require significant medical education, residency training, and healthcare infrastructure investments. The baby boomer generation is particularly in need of more psychiatrists, geriatricians, and cardiologists, reflecting the aging population’s mental health and cardiovascular needs.

The supply of physicians does not meet the demand. The US healthcare system is grappling with a mismatch between the supply of physicians and the demand for their services. The aging baby boomer population, which requires more complex and frequent medical care, is a significant factor. In addition, physician burnout, exacerbated by the COVID-19 pandemic, has led to early retirements and reduced working hours, further straining the system.

Areas to Address

Addressing the physician shortage and ensuring the right mix of specialties is a complex problem, and there is no single or easy solution. However, some areas can be addressed, and we can work to create policy incentives to address this challenge.

1. Expand Residency Programs: Increasing the number of residency slots, especially in high-demand specialties and locations where the need is greatest, such as rural communities, can provide more opportunities for training and improve access to care. Federal funding for graduate medical education is long overdue for revision and must be increased to support this expansion.
2. Incentivize Underserved Areas or Specialties: Offering loan forgiveness, scholarships, tax incentives, and competitive salaries to physicians who practice in rural or underserved communities or who practice in specialties with a greater need or demand can help address regional and physician specialty disparities.
3. Team-Based Care Models: Allowing advanced practice professionals, such as nurse practitioners and physician assistants, to work as part of a physician-led healthcare team can help to distribute responsibilities, alleviate the burden on physicians, and improve access to care.
4. Promote Telemedicine, Broadband Access, and Interstate Licensure: Expanding telehealth services, along with a broadband network and flexibility for increasing practice across state lines, can improve access to care, especially in remote areas or for highly specialized care.
5. Enhance Medical School Enrollment: Increasing the number of medical school seats and supporting students from diverse backgrounds can help build a workforce that reflects the population’s needs. This needs to begin in high school to ensure students have the training and background to consider a career in medicine.
6. Invest in Prevention and Primary Care: Strengthening primary care infrastructure and focusing on preventive care will improve the health and longevity of our communities, reduce the demand for specialized services, and lower healthcare costs.
7. Address the Systemic Drivers of Physician Burnout: Our current healthcare system is dysfunctional; it doesn’t work for patients, it doesn’t work for physicians, and it doesn’t help make our communities healthier. Until we address the toxic nature of our system, we will not be able to ensure personal and professional fulfillment or longevity for those who choose a career in medicine. Fragmented care delivery, burdensome administrative demands, soaring costs, and uneven access to essential services must be addressed. We need comprehensive reforms that prioritize people over profits, restore the focus on patient-centered care, and support physicians in delivering high-quality care without excessive barriers. By addressing the toxicity within the system, we can rebuild a framework that supports the health of communities and the personal and professional fulfillment of those choosing a career in medicine.

Combined with innovative healthcare delivery models, these measures can ensure a sustainable and equitable healthcare system. Let me know if you’d like to explore any of these strategies further!

Match Day is a moment of triumph for medical students, but it also highlights the challenges within the US healthcare system. Addressing physician shortages and aligning training with the needs of specific populations require a multifaceted approach, including policy changes, increased funding, and innovative training models. By investing in the future of medical education, the US can ensure a robust and equitable healthcare system for generations to come.

Alex McDonald, MD, has disclosed no relevant financial relationships.