[kxyvr]

That's not true. You can look at the residency match for 2025 here:

https://www.nrmp.org/match-data/2025/05/results-and-data-202...

While many specialties are fully filled, we need pediatricians, family medicine, and internal medicine docs. They're generalists and where the largest shortage is. There were 147 unfilled slots for pediatricians, 805 for family medicine, and 357 for internal medicine. They don't have the applicants; it's not the slots.

[metaphor]

> There were 147 unfilled slots for pediatricians, 805 for family medicine, and 357 for internal medicine. They don't have the applicants; it's not the slots.

You lost me...from your cite[1]:

  | Specialty         | Positions | Applicants | Matches | App/Pos | Deficit |
  |-------------------|-----------|------------|---------|---------|---------|
  | Pediatrics        |     3,135 |      3,998 |   2,988 |    128% |    4.7% |
  | Family Medicine   |     5,357 |      7,337 |   4,552 |    137% |   15.0% |
  | Internal Medicine |    10,941 |     17,131 |  10,584 |    157% |    3.3% |

I'm curious what conditions merit a "match".

Aren't a lot of these shortages scattered around rural areas where young doctors really don't want to move to? I understand from a buddy who is currently in med school that there are all sorts of incentive carrots being deployed to attract doctors to these underserved communities.

[1] https://www.nrmp.org/wp-content/uploads/2025/05/Main_Match_R...

[kxyvr]

There's a video as to how the match works here:

https://www.nrmp.org/intro-to-the-match/how-matching-algorit...

Basically, you interview at a bunch of programs and then rank them. The programs (hospitals) rank applicants and then the algorithm does its magic to "match" applicants to programs. Now, if one doesn't match with any of them, there's something called the scramble where a med student works with their program to match into a program somewhere in some specialty that has room. This is non-ideal, but can work out.

Generally speaking, the match algorithm is setup to guarantee all U.S. medical school graduates a match somewhere in something. In may not be what you want, but you will have a job. Then, preference is given to things like the island schools (affiliated medical schools in the Carribean, which are very expensive, but somewhat easier to get into), and then to other international medical schools. Somewhere in there are also foreign physicians who want to work in the U.S., but are forced to redo residency.

I don't know everything about how it works, but that's the general idea. To that end, I don't fully understand the stats you pulled from the reference. That doesn't mean they're not valid, but I don't know.

And, yes, often times, there are open slots at some program in the middle of nowhere. As much as there can be incentives such some debt relief by working in rural hospitals, the jobs are not a good fit for a lot (most) people. I mean, someone just worked extremely hard for 10 years or more and you want them to go live in a town of 10k people. It's not that it's not important, but you can't force people to do it and it takes a particular personality to be happy there. A lot of highly educated people want to live in urban centers with amenities. Not all, but probably most.

Places like Canada use their foreign docs to fill this rural gap. A not small number of the rural docs are foreign born and trained and they essentially work this crappy jobs until they have permanent residency and then they move to more desirable markets. It's a trade, I guess, but there's not a small amount of resentment about it.

[metaphor]

Appreciate the perspective.

> A not small number of the rural docs are foreign born and trained and they essentially work this crappy jobs until they have permanent residency and then they move to more desirable markets.

Not sure that I follow how "rural" necessarily begets "crappy" though. Is the working quality of life somehow that much worse, or is it the relative social isolation and/or lack of recreational options while off duty, or is it really just a case of urbanite out of their accustomed habitat?

[kxyvr]

It's a combination of factors. Rural hospitals and clinics tend to be under-resourced with lack of equipment in buildings that aren't particularly nice. As far as small town, if you like it, great. However, people who are highly educated tend to like to be around others who are similarly educated and that's difficult to find in a rural town unless it's also a university town. There tends to be a lack of school options for their children and given how much they spent on their own education, they tend to prioritize this highly. There tends to be a lack of town infrastructure like good grocery stores, or theater, or museums, or other amenities. Docs also have their own medical needs and understand that those can't be met at small clinics, so they like to have access to good hospitals. Imagine intimately knowing all the ways something like childbirth can kill you and also knowing that there's not an appropriately trained surgeon in town. By the time one finishes their training, they're probably in their 30s and may want to find a partner. Options tend to be limited in small towns. On the darker side of things, foreign people are often not particularly welcomed in rural towns and this can be a particularly bitter experience for the foreign docs that are essentially forced to work there.

So, no, it's not just an urbanite out of their comfort zone. There's a whole host of issues. And, to be clear, we need people to work these jobs, but it's not particularly pleasant for a lot of them.

[metaphor]

Ahh, grokked. Thanks for helping me better empathize with such a nuanced situation.

[nradov]

That's largely a separate problem. Most teaching hospitals aren't located in rural areas.

[nradov]

My statement above was correct. There are students who graduate from accredited medical schools with MD/DO degrees but don't get matched. Part of that is because some of them simply don't apply to programs that have extra openings. Medicare / Medicaid pay primary care physicians below market rates so students are naturally reluctant to pursue those specialties.

[kxyvr]

If they don't match, they're allowed to scramble and move into one of those programs with open positions. If they don't choose to, that's on them, but it's still not a problem with number of residency slots.

I very much agree that pay is a barrier to entering specialties like family medicine. Though it depends on the market, I normally see family medicine at around $200k/year and that's not great if one needs to take something like $750k debt to get there along with eight years of training after a bachelors. If we want to fix that, then we need to make the value proposition better and reduce the medical school debt, improve working conditions, and/or increase pay.

So, yes, if one wants to maximize their earning potential, then they need to enter one of the specialty residencies and fellowships. Those are currently filled. However, that's not where the biggest need is and I contend that's not why there's a physician shortage.

[rileymat2]

But aren’t the specialities where the highest salaries are? So to reduce costs, shouldn’t those have more slots?