Once again, a record was set for both the number of slots available for residency programs and the number of positions filled during the 2017 Main Residency Match.

This is the fifth straight year the National Resident Matching Program (NRMP) has reported growth, with 35,969 applicants submitting their program choices, up 1.4% from the previous year, and 27,688 positions matched to postgraduate year 1 (PGY-1) applicants, up 3.2% from 2016.

One factor driving the increase is the “all-in” policy that required programs registering for the Match to offer all their available positions in the Match or another national matching program. The policy, which began with the 2013 Match, has resulted in significant increases for internal medicine, family medicine, and pediatrics.

Internal medicine residency programs offered 7,233 programs, accounting for about 25% of all PGY-1 positions. This was up from 7,024 programs offered last year. U.S. seniors accounted for 44.9% of the 7,101 slots filled, a rate that was slightly lower than the 46.9% of slots filled by U.S. medical school graduates in 2016.

The year-over-year increase in internal medicine was tracking similar to the increase in overall positions, something seen as a good thing by the American College of Physicians (ACP).

“Internal medicine provides a lot of the primary care physicians and also the subspecialty internal medicine positions and that helps address, and may help improve, the concern with physician shortages, particularly in both primary care and subspecialty medicine,” Philip Masters, MD, ACP’s vice president of membership and international programs, said in an interview. “What you don’t want to see is increases in the total number but decreases in the people who tend to take care of older people. It’s good that it is at least tracking in the same direction of each other.”

Family medicine, the next largest offering, accounted for 11.6% of all positions. In 2017, there 3,356 residency slots offered, up from 3,238 in 2016. U.S. graduates accounted for 45.1% of the 3,215 positions filled this year, roughly the same rate as last year.

“While the increase in medical students matching to family medicine is encouraging, the uptick is woefully inadequate to meet the primary health care needs of the American people,” John Meigs Jr., MD, president of the American Academy of Family Physicians, said in a statement. “Research shows increased availability of primary care and especially family medicine leads to increased quality and lower costs for patients and the health care system.”

Pediatrics ranked third in programs offered (2,738, or 9.5% of all positions offered) and had 98.4% of those slots fill this year. Of the 2,693 spots that were filled, 67.5% were filled by U.S. medical school graduates, about the same rate as in 2016.

Other specialties that made up a smaller percentage of the overall Match positions but boasted high total fill rates for PGY-1 positions in 2017 were emergency medicine (99.7%), neurology (97.4%), ob.gyn. (100%), psychiatry (99.7%), and surgery (99.6%).

A record-high 18,539 allopathic medical school seniors submitted program choices and 17,480 (94.3%) were matched to first-year resident programs, a rate that has been consistent for a number of years according to NRMP data.

Of the 1,279 unfilled slots, 1,177 were offered in the Match Week Supplemental Offer and Acceptance Program, the results of which will be available in May.

One trend that stood out for NRMP President and CEO Mona Signer was the decline in both U.S.- and non-U.S.-citizen international medical school graduates (IMGs) who submitted program choices.

“I was surprised that the number of U.S.-citizen and non-U.S.-citizen IMGs declined this year, but on the other hand, the good news is their match rates went up,” Ms. Signer said in an interview.

U.S.-citizen IMGs declined by 254 to 5,069, but 54.8% were matched to first-year residency positions, the highest match rate since 2004. The number of non-U.S.-citizen IMGs declined by 176 to 7,284, but 52.4% were matched to first-year positions, the highest match rate since 2005.

Ms. Signer declined to speculate what caused the decline, noting that NRMP does not collect demographic data.

Dr. Masters of the ACP noted that IMGs are filling a significant portion of internal medicine positions, now at around 45%.

“As the number of internal medicine slots increases, the percentage that are filled by U.S. medical seniors is decreasing and what that means is the number of international medical graduates is increasing in terms of their participation in training programs both in internal medicine and also across all the other subspecialties of medicine,” he said.

Dr. Masters noted that this trend is important in light of the White House’s continued attempts to curb immigration from certain parts of the world.

“That really accentuates the concerns that ACP has with the executive orders that could potentially disrupt the movement of international medical graduates here for training,” he said.