Why aren't these specialties popular? A look at 5 unfilled medical fields

The 2023 Main Residency Match data are out and contain some mixed news. Overall, total available positions are up 3% year-over-year, and the total number of PGY-1 positions increased 3.2%.^[] As the US population ages, a growing physician workforce is welcome news.

But the match data also contain some cause for concern. This year, 93.3% of all positions were filled, and 93.0% of PGY-1 positions. This begs the questions: Which specialties had the most vacancies? And what factors might be contributing to them?

Family Medicine

577 unfilled positions^[]

In some ways, it was a banner year for Family Medicine resident matching. In other ways, the specialty needs to gain ground.

The American Academy of Family Physicians noted the following in their analysis of the Match data.^[]

First, the good news: There were more Family Medicine match positions available in 2023 than ever before. Openings have increased for 14 consecutive years, with 12 of the last 14 years setting new records.

Now, the not-so-good news:

“The composition of residency training positions must reflect the composition needed in the workforce, and as such, needs to increase steeply in family medicine, other primary care specialties, and a few other specialties,” the AAFP wrote.

Money could be contributing to the shortage. According to Doximity’s 2023 Physician Compensation Report, the average FM earns $273,040, ranking near the middle of the 20 lowest-earning specialties.^[] Compare that with Radiology, which is mid-pack among the highest-earning specialties, with an average salary of $503,564.

Emergency Medicine

554 unfilled positions

Year-over-year, Emergency Medicine saw declines in its match data. In 2022, there were 219 unmatched positions. Vacancies more than doubled a year later, as reported by the American College of Emergency Physicians (ACEP).^[]

In a March news release, the ACEP assured EMs that the organization is working on the problem, and recognized that there are “multiple factors” driving applicants to other specialties.

The ACEP said that those factors may include: 

• Escalating clinical demands

• Fluctuating workforce projections

• Emergency department boarding

• Economic struggles among healthcare organizations

• Corporate trends in medicine

• COVID-19 and its impact

Workload, isolation, anxiety, and general emotional strain contributed to the experience.^[]

Surgery-Preliminary

551 unfilled positions

“Non-designated preliminary, general surgery interns have no job security after year 1,” wrote the authors of a 2020 study published in Surgery, spelling out a convincing reason why medical students may only turn to surgery-preliminary out of necessity.^[]

But the same study, which retrospectively analyzed non-designated preliminary, general surgery residents at the Mayo Clinic over 25 years, reached an interesting conclusion.

“Most non-designated, preliminary residents at our institution secured categorical spots for continuing graduate medical education,” the authors wrote.

Over that time period, of the 232 international medical students and 83 US medical students, 75% went on to match for categorical residencies in general surgery (49%), orthopedic surgery (8%), and anesthesiology (8%). Among the remaining trainees, 18% did a second preliminary year, and 7% ended their graduate training.

“A preliminary internship year seems a useful endeavor for most trainees and even a second prelim year produces a categorical position for most of these driven and hard-working individuals,” the authors concluded. 

Internal Medicine

380 unfilled positions

Overall, IMs’ match rate stood at 96%.^[] That’s good news, in light of the pending PCP shortage described in the Family Medicine section of this article. But despite the “banner match year,” the American Board of Internal Medicine (ABIM) sees some trouble ahead in some of its subspecialties, which had the following match rates:

• Geriatrics: 45%

• Advanced heart failure and transplant cardiology: 56%

• Adult congenital heart disease: 64%

• Nephrology: 73%

• Infectious disease: 74%

The remaining subspecialties filled between 95% and 100% of vacancies.

The ABIM said it is “monitoring these match rates carefully and looking for ways to enhance these disciplines.”

Once again, compensation could be a factor here. 

Pediatrics (Categorical)

86 unfilled positions

Pediatrics’ 86 unfilled positions represent a 97% match rate.^[] Internal Medicine-Pediatrics filled 99% of its positions. Year-over-year, the total number of available positions increased by 4,098, including an additional 571 primary care positions. The specialty also saw a record-breaking number of applicants (42,952). 

Pediatrics and pediatric subspecialties occupied 11 of the 20 lowest-paid subspecialties. In 2023, the average pediatrician earns $242,832. Compare that with similarly ranked oral & maxillofacial surgeons, who earn an average of $556,642. 

Of course, money isn’t everything–especially in pediatrics. A 2021 article published in Pediatrics highlights how the profession continues to attract people based on the intrinsic rewards that come from working with children.^[] But as training continues, other considerations come into account in selecting a residency program, such as location (often foremost), lifestyle, family, and student loan debt, the latter of which is no doubt influenced by salary.

“The impact of debt burden must also be elucidated in this dialogue as we consider solutions such as loan repayment programs and salary subsidies,” the article author wrote.