BACKGROUND: Pain medicine fellowship training has evolved significantly since the Accreditation Council for Graduate Medical Education accreditation in 1993. Recent years have seen substantial changes in applicant demographics and match outcomes, particularly a dramatic decline in the number of anesthesiology applicants. OBJECTIVE: To analyze trends in the Pain Medicine Fellowship Match from 2019-2025, examining applicant demographics, match outcomes, and implications for workforce development and training standardization. METHODS: Retrospective analysis of National Resident Matching Program and Electronic Residency Application Service data from 2019-2025 pain medicine fellowship cycles, including applicant specialty backgrounds, positions offered, fill rates, and program-level outcomes. RESULTS: Total applicants declined from 520 (2019) to 442 (2025), with anesthesiology applicants decreasing by 70%, from 351 to 106, over this period. During that time, physical medicine and rehabilitation applicants increased from 101 in 2019 to 170 in 2025, representing a 68% increase and making it the largest single specialty group in 2025. Emergency medicine applicants increased from 10 to 61 while neurology and psychiatry applicants remained stable. From 2024 to 2025, total positions stabilized (389 to 390) with trending improvement in the fill rate (82.3% to 85.4%). The applicant pool shifted from anesthesiology-dominant to multidisciplinary, with significant regional disparities in program fill rates. CONCLUSIONS: The pain medicine fellowship match reflects a fundamental transformation in specialty composition, driven by anesthesiology workforce dynamics and reimbursement concerns. This evolution presents both challenges in training standardization and opportunities for enhanced multidisciplinary care. Strategic interventions, including early specialty exposure, enhanced mentorship, and curriculum adaptation, are essential to sustain workforce capacity and address access disparities.
Wright et al. (Thu,) studied this question.