A changing pain training landscape: Match trends in NASS-recognized interventional spine and musculoskeletal medicine fellowships versus ACGME/NRMP-accredited pain medicine fellowships (2020–2025)

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Background: In 2023, there was a sudden decline in the popularity of Accreditation Council for Graduate Medical Education (ACGME) Pain Medicine fellowship programs, as demonstrated by National Resident Matching Program (NRMP) application and match data. In comparison, little is known about the application rates and match performance of the North American Spine Society (NASS)-recognized Interventional Spine and Musculoskeletal Medicine (ISMM) fellowships established in 2020. Objective: We aimed to compare the characteristics of NASS-recognized ISMM applicants and their match results with those of NRMP-sponsored Pain Medicine applicants to determine whether both pathways faced similar challenges in recruiting and successfully matching trainees in recent years. Methods: This longitudinal observational study examines and describes the total number of applicants, match rate, and position fill percentage results of the ACGME NRMP and NASS ISMM from 2020 to 2025, stratified by gender and primary specialty. Results: Over the study period, match rates did not markedly change for ISMM, but for ACGME they increased suddenly in 2023 and remained at this level. For ISMM and ACGME, the percentage of positions filled through the match trended downward. For both, the number of female applicants remained low and stable despite fluctuations in the total number of applicants. The distribution of applicants by primary specialties changed for the ACGME; notably, Anesthesiology applicants decreased by 65% from 2021 to 2025, while applications from all other specialties increased, including an increase in Emergency Medicine applicants by 221%. Since its inception, the NASS ISMM match has been primarily composed of Physical Medicine and Rehabilitation (PM&R) physicians, who accounted for 88% of applicants and 90% of successful matches. Conclusion: ACGME and NASS ISMM pain fellowships have been at the forefront of evolving trends in program fill rates from 2020 to 2025. Match rates for applicants remained high, reflecting a less competitive and more accessible process for those pursuing careers in pain and spine care.In 2025, male PM&R physicians were the largest group of applicants across both fellowship pathways, highlighting continued strong engagement from this specialty. Although overall applicant numbers have shifted, these trends present an opportunity to broaden outreach, strengthen early mentorship programs, and expand the pipeline of future pain and spine specialists.

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