• Posted August 24, 2026

Family Medicine Shortage: Why Future Doctors Look Elsewhere

Dr. Genaro DeLeon, a resident physician at the Cleveland Clinic, couldn’t decide between pursuing surgery or family medicine.

Surgery paid more and offered a more comfortable lifestyle, DeLeon said.

On the other hand, family medicine meant juggling an inbox full of questions, requests, referrals and test results for hundreds of patients, not to mention cramming in as many office visits as possible each day.

In the end, DeLeon chose family medicine based partly on the family doctor who served his small rural hometown of Kingsville, Texas.

“The primary care doc in my hometown is kind of the jack of all trades and community leader,” DeLeon said. “I would see him on the school board, he was a good family friend, and I think I was drawn to how everybody kind of gravitated towards him and looked for advice beyond even medical and healthcare concerns.”

Unfortunately, not enough medical students are following DeLeon to a career in family medicine.

The United States will need about 40,400 more primary care physicians by 2036 to meet the needs of a growing population, according to the Association of American Medical Colleges.

The federal Health Resources and Services Administration paints an even more dire picture, projecting a shortage of more than 70,600 primary care physicians by 2038. This includes around 39,000 family doctors, 20,600 internal medicine docs, 9,300 pediatricians and 1,500 geriatricians.

That means there needs to be a steady influx of medical students choosing family medicine, both to expand the workforce and replace many doctors of the baby-boom generation who are now reaching retirement age.

“A lot of medical students are choosing family medicine and general internal medicine, just not enough,” said Michael Dill, director of workforce studies for the American Association of Medical Colleges (AAMC).

Many potential family doctors hear of the specialty’s downsides — lower pay, longer hours, loads of red tape — and decide they’d rather pursue some other field, researchers said.

Even worse, some are told by instructors that family medicine is beneath them.

“There’s a stigma that’s getting passed around in med schools, and I heard it too as a medical student — ‘You’re too smart for family medicine,’ ” DeLeon said. “I think that line gets used a lot.”

Others simply can’t find the path to family medicine, because it’s not emphasized as an option by medical schools or there aren’t enough training positions available to them.

Many schools don’t offer a specific family medicine clerkship, and it can also be a struggle for a budding family doc to find a place to complete their residency.

Clerkships are structured rotations that occur during the final two years of medical school, to give students a taste of different fields and a chance to apply their classroom knowledge to real patients. Residencies are the postgraduate training programs that follow medical school.

So even if enough students want to enter family medicine to meet the nation's needs, not all will be able to find the training opportunities they need to become full-fledged professionals, Dill said.

“The real bottleneck here is not the number of people interested in becoming physicians, it’s our capacity to train new ones,” he said.

Pay And Headaches

Low pay is certainly a part of the equation in a student’s consideration of family medicine.

Family doctors, internal medicine docs and pediatricians are among the lowest-paid specialties in the U.S. Unfortunately, these doctors are as apt to graduate with as much school debt as those who choose more lucrative specialties, making monthly loan payments a lot harder to manage.

The AAMC estimates that 7 of 10 medical students graduated with some medical debt in 2023. The average amount of debt was more than $202,000, and half graduated with loan debt of more than $150,000.

And that number doesn’t count whatever debt they accrued in college prior to medical school.

“It depends on the institution, but some people are leaving medical school with half a million dollars in debt,” said Dr. Catherine Coe, chair of family medicine at the University of California, San Diego.

But experts said pay usually isn’t foremost on the minds of medical students choosing their specialty.

Instead, they’re more driven by how the specialty will fit their personality and their lifestyle, Dill said.

In an AAMC graduate questionnaire from 2024, 98% of medical school graduates said fit with personality, interests and skills was most important in a specialty. After that, just under 98% said the content of the specialty mattered a lot, followed by 81% citing work/life balance and 78% who said they followed the lead of an influential role model, as DeLeon did.

About 55% said income expectations influenced their specialty choice, and 25% cited their anticipated level of college debt, the questionnaire found. 

“It’s not as if income isn’t on the list, but it’s seventh or eighth,” Dill said. “First is fit with personality, interests and skills. Then you have work-life balance, where it’s geographically located, how it fits with your family plans, and so on. And then you get the income expectations, but it’s fairly far down the list.”

Sadly, family medicine often doesn’t appeal to some budding doctors on those metrics, either.

There is a load of paperwork, as well as pressure to see as many patients as possible in a day, often eating into a doctor’s personal time.

“There is in primary care a very high administrative burden,” said Dr. Tracy Kedian, associate dean of admissions at UMass Chan Medical School in Worcester, Massachusetts. “There’s a lot of paperwork, authorizations, communications, things that we need to do that are not direct care of our patients. It takes a lot of time and it adds a lot of hours to your day.”

On top of that, patients these days often come to their doctor in worse condition and needing more comprehensive care for multiple conditions, Kedian said.

"Our patients are much sicker than they were before the pandemic, because no one went to the doctor for two years," she said. "The amount of heart disease and cancer and dementia that happened and wasn't treated during the pandemic is all falling back on the primary care physician."

Worse, it doesn’t seem that the burden is going to ease anytime soon, Dill said.

“It seems like every time a new thing comes along that we want done to improve the delivery of healthcare, more often than not it’s something we ask primary care physicians to do,” he said.

Dill pointed to a new concept called social determinants of health, “which are things that drive people’s health status that happen outside of healthcare.” Examples include access to good food, the ability to get around your town by walking, or the income necessary to make healthier choices.

“In order to provide healthcare, you need to be aware of those things, and so we ask primary care physicians to know more about them,” he said. “And that’s one more thing to do. It’s a thing they want to do, and they understand the importance of, but if you keep piling on enough of those things it becomes more of a pressure cooker to be a primary care physician, right?”

Medical School Obstacles

In 2026, family medicine represented about 1 out of 10 (11%) of all residencies matched to medical school students, according to the American Academy of Family Physicians (AAFP).

Family medicine had about 12,000 applicants for approximately 5,000 residency positions open in 2026, the AAFP said. There were about 900 unfilled positions left following the first round of matching, but all but 76 were filled by the end.

But in some ways, medical school is structured to steer many good students away from family medicine, experts say.

For example, students who choose to take on a primary care residency often wind up floating away to some other field, such as cardiology, neurology, nephrology or gastroenterology, said Dr. Caroline Richardson, chair of family medicine at Brown University Warren Alpert Medical School in Providence, Rhode Island.

“People say things like, why don’t people who go into primary care residencies end up doing primary care, and the answer is because they’re not primary care residencies,” Richardson said. “They’re hospital training grounds and subspecialty preparation. That’s what they’re designed to do. That’s how they’re sold, that’s how their curriculum is developed, and that’s what residents are exposed to during their training, because they’re not exposed to primary care, really.”

Likewise, said UC San Diego’s Coe, many medical students looking for a clerkship prior to graduation might be hard-pressed to find one devoted to family medicine.

These clerkships are a key driver of students choosing family medicine as their specialty, according to a November 2025 study in the Journal of The American Board of Family Medicine.

About 37% of MD (Doctor of Medicine) residents and 43% of DO (Doctor of Osteopathic Medicine) residents said that they chose to pursue family medicine during their clerkship rotation in that field, the study found.

By comparison, only 16% of MDs and 19% of DOs decided to pursue family medicine before entering medical school, and only 10% of MDs and 11% of DOs chose the track during the first two years of medical school — before exposure to a family medicine clerkship.

“Some medical schools don’t have a family medicine clerkship,” she said. “They have a surgery clerkship. They have a pediatrics clerkship. They have an internal medicine clerkship. It’s like, what’s in a name? Sometimes calling out that there’s a family medicine rotation is really important.”

To test this theory, UC San Diego recently renamed its primary care clerkship. It’s now called a family medicine clerkship, Coe said.

“We’ve actually seen interest increasing in family medicine, just based on the name and people knowing that exists as a specialty,” she said.

Perhaps most pernicious is what Coe refers to as the "hidden curriculum." That’s the quiet advice that teachers and administrators pass along to students, “where people don’t know about or are actively dissuaded from family medicine,” she said.

“Things like, you’re too smart to be a family doctor,” said Coe, echoing what DeLeon himself heard as a student.

Myths Of Family Medicine

Another part of the hidden curriculum that might dissaude others is the thought that by becoming a family doctor, you may be limiting yourself in one way or another, Coe said.

In fact, she argued, the field offers a wide field of opportunities.

“What I typically say to students is: The nice part about family medicine is it’s a continuous choose-your-own-adventure,” Coe said. “You are well-trained in everything, so you can reinvent yourself throughout the course of your career based on where your interests lie and what your community needs. 

“Some people want to deliver babies. They don’t think they can do that in family medicine. They absolutely can do that,” Coe said. “In fact, there are fellowships that allow you to do obstetrical care.”

The same goes for dermatology, or infectious disease care, or women’s health, or reproductive medicine, or any of the other areas of medicine that a family doctor must be aware of to serve as a point person for patients’ healthcare, she said.

“You can become anything based on where your interests lie and what your community needs,” Coe said. “It’s cool to be able to flex like that."

DeLeon agrees.

“I’ll be honest, some of the sharpest individuals that I’ve met are family medicine docs or primary care providers, because you have to learn all the specialties,” DeLeon said. “You have to learn all the diagnoses and when to send them to those specialists in the first place.”

In fact, DeLeon said his experience as a quarterback for his Texas high school team guided his decision to pursue family medicine.

“That relationship that you get with the patients, that responsibility, we call it being the quarterback: You’re overseeing everything,” DeLeon said.

“Everything a family medicine doc is responsible for, literally from the beginning of life to the end, the happy times, the difficult conversations, and the responsibility that you have in the relationship you can form with patients that you don’t get in surgery,” he said. “I really like that relationship, talking through patient concerns on a daily basis, and that definitely set me down the path.”

Mentorship like that offered by Coe can be essential when a student is weighing their career options, said Dr. Mary Bailey, a second-year resident at the Center for Family Medicine at Akron General Hospital in Ohio.

Bailey recalled another student who came to Akron General fired up to pursue ER medicine.

“I’m not going to say we coerced or convinced him, but he got to see some of the really incredible things about family medicine and is now considering it as a future career,” Bailey said. “I think allowing students to have high-quality experiences with family medicine and providers who are passionate about it as a specialty could draw more people in."

The 'Click'

In his role with the AAMC, Dill regularly talks to medical students about why they chose to pursue any given specialty.

“It comes down to at some point along the line, they found something that clicked with them,” he said. “And it’s really remarkable. Every single medical student I’ve talked to who’s had to make that choice has a specific story about, I was doing my clinical rotation in this and, my God, it hit me — that’s what I want to do.”

For Bailey, that "click" came with one of the patients she saw on the first day of her residency at Akron General.

“Our visit was so long because it was my first day as a resident and I didn't know how to do anything,” she recalled. “She ended up having like all of these very concerning signs and symptoms and we ended up getting this whole workup.

“She came back to follow up with me and just was so grateful. She said 'I had no clue that what I was doing was causing all of these symptoms and I feel better now and I am just so grateful for you and for how you took the time and followed up with my family,' ” Bailey said.

She has since followed this patient through a diagnosis of dementia.

“This dementia and memory loss and the loss of who she is has been just so meaningful and heartbreaking at the same time, and to be able to carry just a little bit of that burden on behalf of the family is just such an honor, and I'm just so honored that they've entrusted me with her care,” Bailey said.

DeLeon said his "click" came while doing his family medicine rotation at a free clinic for patients in downtown Indianapolis.

“You go from a prenatal visit, checking on Mom to see if you need to send her to the hospital, is she in labor, we’re getting fetal heart tones,” DeLeon recalled, ”And then ride over to the next visit and you’re checking in on a cyst that you removed in a patient last week.”

One patient that stayed in DeLeon’s mind was a child who’d just immigrated from Burma.

“Come to find out they had some genetic syndrome that needed a little bit of tying into the healthcare system with some specialists,” DeLeon said. “So we got that situated for them, got follow-ups scheduled with specialty clinics — and then cleaned out their ears just because their ears had been full of earwax.

“There’s the serious side of things where we need to get you in with the specialist and get you in with the long-term management of very complex things,” DeLeon said. “But we’ll also make you comfortable by cleaning out your ears. You get very humbled and you remember why you entered medicine in the first place.”

Both DeLeon and Bailey now carry a roster of 250 to 300 patients. Neither is sure where they’ll end up in family medicine, but both are enthusiastic about their prospects.

“I’m really, really hoping that I get to do full-spectrum family medicine, from itty-bitty babies to my sweet little 90-year-olds,” Bailey said. “Time will tell. I’ve got a little time to figure it out.”

SOURCES: Dr. Genaro DeLeon, resident physician, Cleveland Clinic; Michael Dill, director of workforce studies, American Association of Medical Colleges; Dr. Catherine Coe, chair of family medicine, University of California-San Diego; Dr. Tracy Kedian, associate dean of admissions, UMass Chan Medical School; Dr. Caroline Richardson, chair of family medicine, Brown University Warren Alpert Medical School; Dr. Mary Bailey, second-year resident, Center for Family Medicine at Akron General Hospital; Association of American Medical Colleges; Health Resources and Services Administration; American Academy of Family Physicians