Last month, the National Residency Match Program released the data from the subspecialty fellowship match for physicians who will begin their fellowship training in July 2025. There is a wealth of information in the data and it tells us a lot about how young physicians see the future of medicine and a lot about what subspecialties will likely have physician shortages in the future.
Overall, there were 77 subspecialties with a total of 14,620 offered fellowship positions, of which 12,390 (84.7%) were filled. There were 14,833 applicants, of whom 12,390 (83.5%) matched to a subspecialty fellowship position. This represents a continued trend for more fellowship positions and more fellowship applicants each year. For example, in 2000, there were just 3,000 fellowship positions offered, only 20% of the number offered this year.
There are several categories of applicants including graduates from U.S. medical schools (MD), graduates from U.S. osteopathic schools (DO), Canadian medical graduates, U.S. international graduates (for example, U.S. citizens attending Caribbean medical schools), and non-U.S. citizen international graduates (e.g., foreign medical graduates). In general, U.S. MD applicants tend to be the most competitive for fellowship positions and U.S. international graduates tend to be the least competitive. I’ve grouped the data by all of the subspecialty fellowships within various specialties.
Internal Medicine
The internal medicine subspecialty fellowship match day was December 4, 2024. In all, there were 8,985 applicants for 7,169 fellowship positions. But for several subspecialties, there were fewer applicants than positions offered including adult congenital heart disease (3 fewer), advanced heart failure and heart transplant (63 fewer), geriatric medicine (178 fewer), palliative medicine (48 fewer), infectious disease (91 fewer), interventional cardiology (35 fewer), and nephrology (95 fewer). These subspecialties are considered non-competitive, since nearly all of the applicants should theoretically be able to match into a position (or at least those applicants who are reasonably competent and non-psychotic). The graph below shows the percent of available positions for each subspecialty that were filled by any applicant (blue bars) and by U.S. MD applicants (orange bars).
The most competitive subspecialties were cardiology, gastroenterology, and hematology/oncology – 100% of available fellowship positions in each of these subspecialties filled. The least competitive were heart failure/heart transplant and geriatric medicine with fewer than 50% of available positions filled. Notable subspecialties with a low percentage of positions that filled were palliative medicine (80%), infectious disease (70%), and nephrology (73%). Note that adult congenital heart disease, heart failure/transplant, cardiac electrophysiology, and interventional cardiology are sub-subspecialties since to be eligible to apply, one must first complete a cardiology subspecialty fellowship.
The popularity of a subspecialty can also be measured by the percentages of available positions that were filled by U.S. medical school (MD) graduates. By this measure, nephrology was the least popular subspecialty with only 18% of positions filled by U.S. MD graduates, followed by geriatrics with 20% filled by U.S. MD applicants, and heart failure/heart transplant with only 24% of positions filled by U.S. MD graduates.
Pediatrics
The pediatric subspecialty fellowship match day was also on December 4, 2024. In all, there were 1,667 applicants for 1,970 fellowship positions. Unlike internal medicine, in most pediatric subspecialties, there were fewer applicants than available positions. Only two subspecialties had more applicants than positions: pediatric critical care and pediatric hospital medicine. The implication is that most (reasonably competent) applicants who wanted a pediatric subspecialty position were able to get one somewhere.
The most competitive pediatric subspecialties were critical care (99% of positions filled), pediatric transplant hepatology (93% of positions filled), cardiology (92% of positions filled), and pediatric hospital medicine (92% of positions filled). The least competitive were child abuse and nephrology with fewer than 40% of available positions filled. As measured by the percentage of available positions filled by U.S. MD graduates, child abuse and nephrology were again the least competitive, with fewer than 24% of positions filled by U.S. MD graduates.
Not included in the above graph is the very small subspecialty of academic pediatrics with only 5 available positions and 6 total applicants nationwide.
Surgery
The surgical subspecialty matches were held on different days between May and October 2024. It is important to note that there are two pathways for thoracic surgery and vascular surgery with positions available both as a integrated residency pathway (5 years for vascular and 6 years for thoracic) or as a 2-3 year subspecialty fellowship after four years of general surgery. The data below is only for the thoracic and vascular surgery subspecialty fellowship pathway.
Three surgical subspecialties had fewer applicants than available positions: hand surgery (25), surgical critical care (47), and vascular surgery (2). Surgical subspecialties were considerably more competitive than either internal medicine or pediatric subspecialties. All surgical subspecialties filled more than 80% of available positions with four subspecialties filling 100% of positions (colo-rectal, pediatric, oncology, and thoracic). Similarly, when measured by the percentage of available positions filled by U.S. MD graduates, all surgical subspecialties were competitive and filled with more than 50% U.S. MD graduates.
Obstetrics and Gynecology
The OB/GYN subspecialty match day was September 25, 2024. There were 526 applicants for 464 available positions in seven subspecialties. Two subspecialties had fewer applicants than available positions: complex family planning and maternal-fetal medicine.
Three subspecialties filled 100% of available positions: pelvic medicine & reconstructive surgery, gynecologic oncology, and minimally invasive gynecologic surgery. Overall, the OB/GYN subspecialties were all very competitive with all of them filling 90% or more of their available positions and all of them filling 74% or more with U.S. MD graduates. Maternal-fetal medicine was the least competitive of the OB/GYN subspecialties.
Radiology
There are 5 radiology subspecialties and their match day was held on June 12, 2024. In all five, there were fewer applicants than available positions, implying that just about any (reasonably competent) radiology resident was able to find a subspecialty fellowship position somewhere.
Emergency radiology was the least competitive subspecialty with only 37% of available positions filled in total and only 11% filled with U.S. MD graduates. However emergency radiology is a relatively small subspecialty with only 37 fellowship positions offered this year. Interventional radiology was the next least competitive with only 62% of available positions filled in total and only 30% filled with U.S. MD graduates.
Neurology
There are 4 subspecialties in neurology that held their match days between May and August 2024. In two subspecialties, there were fewer applicants than available positions: epilepsy and vascular neurology.
Emergency Medicine
The four emergency medicine subspecialties held their match day on October 30, 2025. In both the subspecialties of clinical ultrasound and emergency medical services, there were fewer applicants than available positions. These two subspecialties also filled with the lowest percentage of U.S. MD graduates (41% and 43% respectively).
Physical Medicine & Rehabilitation
There are 4 subspecialties in PM&R that held their match days in either October or December 2024. In all four subspecialties, there were fewer applicants than available positions implying that nearly all applicants would theoretically be able to find a position somewhere in the country. The least competitive subspecialties were pediatric rehabilitation medicine with 46% of available positions filled (25% by U.S. MD graduates) and spinal cord injury rehabilitation with only 38% of available positions filled (21% by U.S. MD graduates). Overall, the demand for subspecialty training in physical medicine & rehabilitation appears to be considerably less than in other specialties.
All of the Rest
There were several specialties with only one or two subspecialties that participated in the subspecialty match. Their match days ranged from May 2024 to January 2025, depending on each subspecialty and their results are shown in the graph below.
In two of the miscellaneous subspecialties, there were more applicants than available positions (allergy & immunology and sports medicine). These two subspecialties were also the most competitive with 99% of available positions filled in the match. In all of the others, there were fewer applicants than available positions. The least competitive was medical genetics with only 51% of positions filled in total and only 16% filled by U.S. MD graduates. Laryngology is a relatively small subspecialty of otolaryngology with only 12 available positions nationwide – of these, 6 (50%) were filled in total.
Implications of the Subspecialty Match
There are several conclusions we can draw from this years subspecialty match:
- If you are a resident in pediatrics, radiology, physical medicine, or psychiatry and you want a fellowship, you can usually get one. In these specialties, most or all of the subspecialties had fewer applicants than available positions. Numerous subspecialties of other specialties also had fewer applicants than positions. However, applicants must have already completed 3 to 4 years of residency after 4 years of medical school making all subspecialty applicants in their late 20’s or early 30’s. Physicians in this age range tend to be less mobile because of spouses with jobs or children in school. Thus in theory, any reasonably competent resident in one of these specialties should be able to match to a subspecialty fellowship somewhere, but in reality, they may not be able to match to a program that is geographically feasible for them.
- Foreign medical graduates are increasing. Non-U.S. citizen international medical graduates (foreign medical graduates) must normally first complete a residency in the United States before being eligible to apply to a U.S. subspecialty fellowship. The COVID pandemic caused a significant reduction in the number of foreign medical graduates applying to the residency match. This resulted in fewer foreign medical graduates in U.S. residencies and thus fewer foreign medical graduates in those U.S residencies to apply to subspecialty fellowships. This year, the total number of foreign medical graduates significantly increased, reflecting the rebound in foreign medical graduates in U.S. residencies over the past 3 years. Overall, 75% of foreign medical graduates were able to match into a subspecialty fellowship, making them more competitive than U.S. citizens who attend international medical schools (69% of whom matched) but less competitive than U.S. DO graduates (82% of whom matched), or U.S. MD graduates (91% of whom matched). The subspecialties with the highest percentage of available positions filled by foreign medical graduates were medical genetics (55%), endocrinology (39%), nephrology (36%), interventional cardiology (34%), and rheumatology (34%).
- Nephrology is unpopular. This year’s subspecialty match has continued an alarming trend for nephrology in both pediatrics and internal medicine. As in recent previous years, a large number of nephrology positions went unfilled. Of those positions that did fill, the majority of them were filled by applicants trained in medical schools outside of the United States as either U.S. citizens or citizens of foreign countries. There are several reasons why nephrology is an unpopular subspecialty as I have discussed in previous blog posts. But the implication is that the demand for nephrologists will significantly exceed the supply of nephrologists in the future. Hospitals would be well-advised to make efforts to recruit and retain nephrologists now in order to ensure that they have adequate nephrology expertise in the upcoming years. This may mean paying more competitive salaries or training advanced practice providers to oversee some nephrology services amenable to algorithm-based management, such as dialysis and management of patients with chronic kidney disease.
- Geriatrics is unpopular. It is no surprise that geriatrics is an unpopular subspecialty. It is listed in the graph above as a subspecialty of internal medicine but applicants are eligible by completing a residency in either internal medicine or family medicine. The unpopularity of geriatrics is primarily financial. Geriatric specialists have incomes equal to or lower than either general internists or family physicians. Thus, there is no financial incentive for internists or family medicine physicians to spend an extra one or two years of fellowship training to become a geriatrician. Moreover, general internists and family physicians are normally credentialed to care for geriatric patients, without needing to have subspecialty geriatric training.
- Endocrinology is unpopular with U.S. medical graduates. In the past, endocrinology has had a high percentages of unfilled positions. This year, 98% of positions filled but the majority were by international medical graduates – either U.S. citizens or citizens of other countries who attended medical school outside of the United States. Endocrinology continues to be unpopular with U.S. MD graduates with only 30% of available positions filled by U.S. MD graduates.
- Infectious Disease is unpopular. In both internal medicine and pediatrics, infectious disease also remains an unpopular subspecialty. Similar to geriatrics, infectious disease specialists often have incomes less than the incomes of general internists or general pediatricians. This results in a strong financial disincentive to spend an additional 2 years of subspecialty fellowship training just to make less than one could have if they went into clinical practice straight out of residency. The current anti-vaccine rhetoric among many political leaders has left many infectious disease specialists feeling maligned and frustrated.
- Surgical subspecialties are highly competitive. The surgical subspecialties filled all or nearly all of available positions. Furthermore, more than half of all of these positions were filled by U.S. MD graduates. Critical care surgery was the least competitive with fewer total applicants than available positions and with just 83% of positions filled. There is no separate trauma surgery fellowship and most trauma surgeons complete a critical care surgery fellowship instead. This implies that there could be a shortage of trauma surgeons in the future.
- Maternal-fetal medicine and complex family planning are becoming unpopular. Two OB/GYN subspecialties that are affected by abortion laws warrant discussion: complex family planning and maternal-fetal medicine. Physicians specializing in complex family planning often perform abortions for women with high-risk medical conditions. Physicians specializing in maternal-fetal medicine perform deliveries for women with high risk medical conditions and often advise these women to have abortions because of the risk of maternal death during delivery. Many physicians in these two specialties have been leaving states that passed laws restricting abortion. Complex family planning as a OB/GYN subspecialty was notable because prior to 2024, all of its subspecialty fellowship positions filled each year. Last year, there were 3 unfilled positions and this year, there were 2 unfilled positions. Maternal-fetal medicine was also notable because among OB/GYN subspecialties, it had the fewest positions filled with U.S. MD graduates at 74%. This year, there were 16 unfilled positions in maternal-fetal medicine whereas last year, there were no unfilled positions and there was only 1 unfilled position in each of the 2022 and 2023 matches. The number of applicants to maternal-fetal medicine fellowships has dropped from 170 in 2022 to 151 this year. This suggests that OB/GYN residents perceive these two subspecialties as being vulnerable to restrictions and/or sanctions, making them less desirable than in the past. It also implies that there will be fewer obstetricians trained in managing high-risk deliveries than in the past, particularly in those states that have laws banning abortion.
- We are training fewer interventional radiologists. For the past 5 years, the number of fellowship positions and fellowship programs in interventional radiology has been falling. In 2022, there were 83 programs offering 166 positions; today, there are only 73 programs offering 159 positions. In 2022, 154 applicants matched in interventional radiology, this year, only 93 applicants matched. This indicates that we are training fewer interventional radiologists than in the past. However, the need for interventional radiologists is still quite high and consequently, we will likely see worsening shortages of them in the near future.
- Allergy & immunology continues to be competitive. Applicants can either complete a pediatric or an internal medicine residency to be eligible for an allergy & immunology subspecialty. Overall, 99% of available positions filled and most were by U.S. MD graduates.
- Sports medicine is competitive. To be eligible to apply to sports medicine, an applicant can have completed a residency in either family medicine, internal medicine, pediatrics, emergency medicine, or physical medicine & rehabilitation. Overall, 99% of available positions filled. Sports medicine is particularly popular for U.S. DO graduates who accounted for 41% of filled positions.
The demand for a particular subspecialty fellowship depends primarily on how residents perceive the lifestyle and income of that subspecialty. For example, allergy & immunology has a highly desirable lifestyle with most allergists working weekdays and little weekend or night call duties. On the other hand, geriatrics is unpopular because geriatric physicians generally have a lower income than general internists while incurring the cost of an additional 1-2 years of training.
The results of the match tell us a lot about which subspecialties are popular or unpopular with residents. These results also tell us about which subspecialties are likely to have physician shortages in the future. Successful hospitals will anticipate these shortage subspecialties and make efforts now to secure adequate staffing in these subspecialties with younger physicians who will be able to provide these needed subspecialty services for years to come.
March 10, 2025
