Physician Residency Specialties: How Competitiveness Shapes the Match
By Muntasir Minhaz • Published Aug 04, 2026 • Graduate & Professional School
The 2026 NRMP Main Residency Match filled 41,482 of 44,344 positions, a 93.5% overall fill rate. Fill rates vary sharply by specialty: psychiatry filled 97.4% of its slots while family medicine filled only 83.6%, leaving 899 positions open.
44,344 total residency positions were offered across specialties in 2026.
Internal medicine filled 95.2% of 11,632 positions, the largest single specialty by position count.
Family medicine filled 83.6%, down from 85.0% the year before.
Dermatology, radiation oncology, ophthalmology, and the integrated surgical subspecialties filled at or near 100%.
What the Match measures
Every March, the National Resident Matching Program (NRMP) releases results of the Main Residency Match, pairing graduating medical students with residency programs across the country. The 2026 Match registered 53,373 applicants, of whom 48,050 submitted certified rank order lists.
Programs offered 44,344 positions and filled 41,482 of them, a 93.5% overall fill rate.
Fill rate is the clearest public measure of how competitive a specialty is. A specialty that fills nearly every position, often with US MD seniors near the top of the applicant pool, signals high demand from students. A specialty with a lower fill rate signals either fewer total applicants or applicants choosing other fields first, leaving programs to fill remaining spots through the Supplemental Offer and Acceptance Program (SOAP) after Match Day.
2026 fill rates by specialty
| Specialty | Positions offered | Positions filled | Fill rate |
|---|---|---|---|
| Psychiatry | 2,516 | 2,451 | 97.4% |
| Emergency Medicine | 3,198 | 3,058 | 95.6% |
| Internal Medicine | 11,632 | 11,078 | 95.2% |
| Pediatrics | 3,185 | 3,006 | 94.4% |
| Family Medicine | 5,491 | 4,592 | 83.6% |
NRMP also reports that dermatology, radiation oncology, ophthalmology, and the integrated surgical subspecialties, including orthopedic surgery, plastic surgery, neurosurgery, otolaryngology, vascular surgery, and thoracic surgery, filled at or near 100% in 2026. NRMP's public summary does not break out exact position counts for these fields, so treat near-100% fill as a directional signal rather than an exact figure.
Why family medicine fill rates dropped
Family medicine filled 83.6% of its 5,491 offered positions in 2026, down from 85.0% the year before, leaving 899 positions unfilled going into SOAP.
NRMP said it plans to convene a panel to study student interest and recruitment for the specialty. Family medicine and other primary care fields have filled below 90% for several Match cycles, driven partly by pay differences between primary care and specialty medicine and partly by students prioritizing fields with more predictable hours.
What drives high fill rates in competitive specialties
Specialties that fill at or near 100% typically combine three factors: high pay relative to training length, a controllable lifestyle with predictable hours, and limited seats relative to applicant demand. Dermatology, ophthalmology, and the integrated surgical subspecialties fit this pattern, and they also tend to demand stronger board scores, research output, and away rotations from applicants who want to match successfully.
Primary care specialties like family medicine, internal medicine, and pediatrics offer far more total positions and typically require fewer years of additional fellowship training to reach full scope of practice. That makes them more accessible on paper, but these specialties also depend more heavily on international medical graduates and DO applicants to fill open seats compared to fields like dermatology.
What happens to unfilled positions
Programs with unfilled positions after Match Day enter SOAP, a process that lets eligible unmatched applicants apply to open spots over several days in March. Family medicine, along with other primary care and some surgical specialties in a given year, typically supplies a large share of SOAP positions because of its higher offered-position count relative to the number of applicants ranking it first.
How US MD seniors compare to other applicant types
US MD seniors historically match at higher rates than international medical graduates, US DO seniors, and US MD graduates from prior years, since programs rank familiar, in-cycle candidates from accredited US medical schools favorably. The NRMP's Match Data reports break down results by applicant type each year, letting you see how your specific applicant category performed in a given specialty before you build your rank list.
What this means for your specialty choice
If you're choosing a specialty during medical school, look at more than fill rate alone. A near-100% fill rate tells you the field is hard to match into, not whether it fits your interests or your intended lifestyle. Talk to residents and attendings in fields you're considering, and use rotations to test your fit before you commit to a specialty with a demanding application, like the surgical subspecialties or dermatology.