Pediatrics Is Filling Its Residency Spots. So Why Am I Alarmed?

Beyond the Fill Rate Series: When a “94.4% fill rate” hides a workforce crisis hiding in plain sight

"Beyond the Fill Rate" is an ongoing series examining what the pediatrics workforce data is actually telling us. This is Part 1.

This year’s NRMP Match has come and gone, and on its face, the numbers might suggest a well-known crisis is improving.

The statistic most commonly cited in medical education circles, is the residency fill rate and right now for pediatrics, it looks reassuring enough to silence alarm bells.

The fill rate functions as a report card metric across specialties: a shorthand signal that graduates are choosing a field, that seats are being filled, that things are okay.

In the 2026 Main Residency Match, pediatrics filled 94.4% of its categorical positions down slightly from 95.3% in 2025, but well above the troubling low of 91.8% in 2024.

To those drawn to headline statistics, this reads like an underdog bounce back story.

And to anyone outside of medicine, a 94.4% fill rate probably doesn’t sound like a crisis.

That’s an A minus on a report card, not too shabby.

But to those who look past this vanity metric, the picture is far more troubling and in our current political climate, it is one that will not improve on its own.

In fact, it may get significantly worse.

The fill rate, at best, is an incomplete picture. At worst, it is actively misleading us about a workforce crisis that has been quietly building for over a decade.

The Statistic We Should Actually Be Talking About

While many viewed the 2024 NRMP categorical pediatrics statistics as a failure, I saw them as the first canary in the coal mine.

While others focused on the fill rate underperforming, my attention shifted to something more revealing: a fundamental change in who was filling those categorical positions.

That shift has not reversed. It has only widened.

The fill rate tells you how many seats got filled.

It doesn’t tell you who filled them.

That’s where the story deepens.

The story of US MD seniors, those who graduate from American allopathic medical schools tell us everything we need to know.

1,889 US MD seniors in 2015. 1,464 in 2024. A 22% decline in a single decade. Family medicine went up 8%. Internal medicine went up 8%. Pediatrics went the other way.

The 2026 Match makes this trend impossible to ignore.

US MD seniors filled just 45% of categorical pediatrics positions this cycle, the lowest percentage in the last five match cycles.

To put that in context: in 2022, US MD seniors filled 58% of those same positions.

That is a 13-percentage-point collapse in four years.

One fluctuating fill rate headline does not reverse a structural trend of this magnitude, and the forces pushing US MD students away from pediatrics remain firmly in place.

So who is filling those seats?

Here is where the numbers become sticky and concerning.

While US MD seniors have steadily retreated from pediatrics, interest among other domestic applicant groups has remained remarkably stable.

Over the past five match cycles, US DO seniors have consistently filled roughly 20% of categorical pediatrics positions, and US citizen IMGs approximately 7%.

The desire to enter pediatrics among those graduates has not wavered.

What has changed significantly is the share of positions being filled by non-US citizen international medical graduates (non-US IMGs).

The numbers tell a striking story.

In 2022, non-US IMGs filled 350 categorical pediatrics positions. In 2026, that figure had risen to 684, a near doubling in just five years.

In 2024, non-US IMGs crossed the 15% threshold for the first time, while US MD seniors had fallen to filling just 48% of positions.

By 2025, non-US IMGs accounted for approximately 19% of filled positions while US MD seniors fell to 47%. In 2026, that figure climbed again to 22% and 45% respectively.

From my assessment, if this trajectory continues (little reason to believe it won’t) we are approaching a threshold where 1 in 4 categorical pediatrics positions is filled by a non-US IMG.

That is not a prediction meant to alarm. It is a straightforward extrapolation of a five-year trend with no signs of reversal.

Why this matters right now, in 2026

It does not matter to me who fills these categorical pediatric positions.

I am happy to welcome anyone who wants to provide quality healthcare to our next generation of Americans

But I would be naive to believe we are living in a normal times, where this distinction does not matter.

With the political climate as it is, I am genuinely concerned for my non-US IMG colleagues.

To be training in an environment ripe with anti-immigrant sentiment, I am concerned about their safety and whether the pediatric profession is equipped with the resources to help them thrive, not merely survive.

As they match into these US based residency programs they deal with many challenges from visa sponsorship, work authorization, and in many cases figuring out a pathway to remain in the US to practice after training.

Broader anti-immigration policy shifts have already begun to affect international medical graduates at every stage of training.

In my view, the situation in which this trend reverses, where immigrant-born physicians stop filing pediatric positions, is one where the environment becomes so inhospitable they simply stop coming.

That outcome would not only close the door on these amazing majority overqualified physicians, but will gut an already stretched pediatric workforce.

The future of the American pediatrics workforce is a house of cards, yet we celebrate that the roof is not leaking.

An Indictment of Apathy, Not of Physicians

To be plain: this article is not written to condemn non-US IMG physicians.

It is a call out to the American pediatric profession to reckon with its collective apathy towards aggressively solving its domestic recruitment crisis, while congratulating itself on a vanity metric year after year.

We are now dealing with the consequences. The data poses the uncomfortable question that fill rate never brought accountability in us to ask.

What would happen to American pediatrics if the international pipeline dried up overnight?

In this political climate, that question deserves an immediate and direct answer.

That answer can only come from us starting much earlier than match day.

It starts at the level of K-12 education, college, medical school, and the pediatric clerkship.

In the next article, we will look at what’s actually driving US MS seniors away from pediatrics and more importantly whether any of it is reversible.

"Beyond the Fill Rate" Series Part 1: Pediatrics Is Filling Its Residency Spots. So Why Am I Alarmed? (You are here) Part 2: What Is Quietly Pushing America's Best Medical Students Away From Treating Children? (Coming soon)