Ten years ago, academics in the NEJM disagreed about a looming shortage of residency positions. After 10 years of data, we now have the answer.

Abstract: The United States is not facing an overall shortage of residency positions for U.S. MD and DO graduates. From 2010 to 2025, PGY-1 positions grew faster than the number of U.S. seniors, maintaining an annual surplus of 4,700 to 11,000 slots. While some specialties remain highly competitive, total training capacity continues to exceed the number of U.S. medical school graduates.

In the early 2010s, U.S. medical education leaders publicly debated a crucial question for the physician workforce: Would the United States face a shortage of residency positions for its growing number of medical school graduates?

Two New England Journal of Medicine perspectives framed that debate. In 2013, John Iglehart warned in The Residency Mismatch¹ that increasing MD and DO enrollment, combined with the 1997 Medicare cap on GME funding, could push graduates past available PGY-1 positions. In 2015, Fitzhugh Mullan, Edward Salsberg, and Katie Weider argued in Why a GME Squeeze Is Unlikely² that the system would expand slots through state and hospital funding and through new programs, keeping pace with graduates.

Ten years on, we have enough data to test those predictions.

The growth story: 2010 to 2025

In 2010, the NRMP Main Match offered 22,809 PGY-1 positions¹⁷. By 2025, that number reached 40,041²¹. Over the same period, combined U.S. MD and DO seniors rose from about 18,100 to 28,760^17,21. Total positions grew faster than U.S. seniors, which widened the slot surplus. In 2010 the surplus over U.S. seniors was roughly 4,700. In 2025 it was about 11,300. International Medical Graduates (IMGs) filled many of these positions⁴.

The mismatch that remains

Total positions are sufficient, yet the distribution across specialties does not match graduate preferences. Fields like dermatology, orthopedic surgery, and plastic surgery remain far more competitive than training capacity. Much of the net growth has been in primary care and hospital-based specialties⁹. Hayek and colleagues projected this pattern years ago: enough total PGY-1 positions, with persistent bottlenecks in select specialties³.

Who was right

The data favor Mullan, Salsberg, and Weider’s core claim²: the system expanded PGY-1 positions fast enough to accommodate U.S. MD and DO seniors. Iglehart’s broader caution stands¹: specialty-specific bottlenecks persist, and some applicants will not match into their first-choice fields even when total positions are adequate.

The outlook to 2035

If current trends continue, the United States should retain a PGY-1 surplus into the 2030s, even as medical school enrollment rises^5,8,10. The main swing factor is how technology and hospital incentives affect training capacity. Advances that raise physician productivity could slow slot growth. For now, the data support continued overall adequacy.

Take-home for future physicians

For U.S. MD and DO students, matching somewhere remains very likely. Matching into the most competitive specialties will remain difficult¹⁶. For IMGs, the continued availability of surplus positions provides opportunity, while U.S. seniors retain Match priority.

PGY-1 Positions vs U.S. MD and DO Seniors (2010 to 2025)

Note: For 2010 to 2017, the DO column reflects “DO students + graduates” as reported by NRMP. From 2018 onward, it reflects “DO seniors.” These are administrative counts, not samples, and reflect active applicants.

Download CSV: PGY-1 vs U.S. seniors 2010–2025

Endnotes

1. Iglehart JK. The Residency Mismatch. New England Journal of Medicine. 2013;369(4):297–299. doi:10.1056/NEJMp1306445.
2. Mullan F, Salsberg E, Weider K. Why a GME squeeze is unlikely. New England Journal of Medicine. 2015;373(25):2397–2399. doi:10.1056/NEJMp1511707.
3. Hayek SA, Lane SM, Fluck MB, Hunsinger MA, Blansfield J, Shabahang M. Ten-year projections for U.S. residency positions. Journal of Surgical Education. 2017;75(3):546–551. doi:10.1016/j.jsurg.2017.08.021.
4. Traverso G, McMahon GT. Residency training and international medical graduates. JAMA. 2012;308(21):2193. doi:10.1001/jama.2012.14681.
5. Jolly P, Lischka T, Sondheimer H. Numbers of MD and DO graduates in GME programs accredited by ACGME and AOA. Academic Medicine. 2015;90(7):970–974. doi:10.1097/ACM.0000000000000649.
6. Haas MRC, Hopson LR, Zink BJ. Too big too fast? Implications of the rapid increase in EM residency positions. AEM Education and Training. 2019;4(S1). doi:10.1002/aet2.10400.
7. Cummings M, Sefcik DJ. The impact of osteopathic physicians’ participation in ACGME-accredited postdoctoral programs, 1985 to 2006. Academic Medicine. 2009;84(6):733–736. doi:10.1097/ACM.0b013e3181a3de21.
8. Kirch DG, Salsberg E. The physician workforce challenge. Annals of Surgery. 2007;246(4):535–540. doi:10.1097/SLA.0b013e3181571a39.
9. Holt KD, Miller RS, Philibert I, Nasca TJ. Patterns of change in ACGME-accredited residency programs and positions. Journal of Graduate Medical Education. 2014;6(2):399–403. doi:10.4300/JGME-D-14-00140.1.
10. Mallon WT. Medical school expansion: Déjà vu all over again? Academic Medicine. 2007;82(12):1121–1125. doi:10.1097/ACM.0b013e318159cca6.
11. Kindig DA. How will GME reform affect specialties and geographic areas? JAMA. 1994;272(1):37. doi:10.1001/jama.1994.03520010049031.
12. Shannon S. The problem with graduate medical education. The Journal of the American Osteopathic Association. 2012;112(4):166. doi:10.7556/JAOA.2012.112.4.166.
13. Cooper RA. Perceptions of medical school deans and state medical society executives about physician supply. JAMA. 2003;290(22):2992. doi:10.1001/jama.290.22.2992.
14. Iglehart JK. Grassroots activism and the pursuit of an expanded physician supply. New England Journal of Medicine. 2008;358(16):1741–1749. doi:10.1056/NEJMHPR0800058.
15. Salsberg E, Grover A. Physician workforce shortages. Academic Medicine. 2006;81(9):782–787. doi:10.1097/00001888-200609000-00003.
16. Jolly P, Erikson C, Garrison G. U.S. graduate medical education and physician specialty choice. Academic Medicine. 2013;88(4):468–474. doi:10.1097/ACM.0b013e318285199d.
17. National Resident Matching Program. Results and Data: 2010 Main Residency Match. Washington, DC: NRMP.
18. National Resident Matching Program. Results and Data: 2015 Main Residency Match. Washington, DC: NRMP.
19. National Resident Matching Program. Results and Data: 2021 Main Residency Match. Washington, DC: NRMP.
20. National Resident Matching Program. Results and Data: 2024 Main Residency Match and Advance Data Tables: 2024. Washington, DC: NRMP.
21. National Resident Matching Program. Results and Data: 2025 Main Residency Match. Washington, DC: NRMP.
22. National Resident Matching Program. Results and Data: 2016 Main Residency Match. Washington, DC: NRMP.

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