The 2025 Specialties Matching Service results are out, and the numbers tell an interesting story about where pulmonary and critical care medicine stands in the fellowship landscape.
Overall, the fellowship match continues to grow. The SMS matched 12,390 applicants across 77 subspecialties—the largest year in its history. But when you zoom into our corner of medicine, the picture gets more nuanced. Let me break down what happened in PCCM, interventional pulmonology, and sleep medicine, and what it means for those of you considering fellowship or trying to understand the competitive landscape.
The Big Picture: Fellowship Demand Is Still Growing
Before we dive into the specialty-specific data, here's what stood out across the board:
The match offered 14,620 positions this year, up from 14,169 in 2024.
Nearly 15,000 physicians applied, and 83.5% matched—down slightly from 84.5% last year. That small dip matters. It suggests that while more positions are opening, applicant growth is outpacing spot availability in certain fields.
U.S. MD graduates continue to dominate the match, filling 46.6% of all fellowship positions.
Pulmonary and critical care subspecialties see much higher percentages of international medical graduates and U.S. DO graduates compared to fields like surgical subspecialties or competitive radiology fellowships.
Pulmonary Disease and Critical Care Medicine: The Workhorse Track
PCCM remains one of the largest fellowship matches in internal medicine. In 2025, 816 positions were offered across 229 programs. Of those, 794 filled—a 97.3% fill rate.
Here's what stands out:
1,131 applicants ranked PCCM programs, but only 794 matched. That's a 70.2% match rate for applicants, meaning nearly 30% of people who wanted PCCM didn't get it.
Let's put that in perspective. PCCM is not considered a hyper-competitive fellowship in the way that cardiology or GI are. But the numbers show something different. The applicant-to-position ratio sits at 1.4:1, which means there's real competition—especially for top programs in academic centers.
Source: Results and Data: Specialties Matching Service, 2025 Appointment Year, NMRP
U.S. MD graduates filled 40.3% of PCCM spots. The remaining positions went to U.S. DOs (16.9%), U.S. IMGs (16.8%), and non-U.S. IMGs (24.9%). That distribution reflects the reality of our field: we have workforce shortages, and we rely heavily on a diverse training pipeline to meet critical care demand.
What this means for applicants: PCCM is still very accessible, but it's not a safety net. If you're a U.S. MD grad applying to top-tier academic programs only, you could face more competition than you expect. Casting a wide net and understanding fit—not just prestige—matters here.
Interventional Pulmonology: Small, Competitive, and Growing
Interventional pulmonology is a different beast. Only 44 positions were offered across 38 programs in 2025. Of those, 43 filled—a 97.7% fill rate.
51 applicants ranked interventional pulm programs, and 43 matched.
That's an 84.3% match rate, which sounds good until you realize this is one of the most self-selected applicant pools in all of medicine. People don't casually apply to interventional pulmonology. If you're ranking it, you've already done a rotation, networked with faculty, and proven your interest.
The applicant-to-position ratio is 1.2:1, which is relatively favorable compared to PCCM's 1.4:1. But the small program numbers mean individual applicant profiles matter more. You're not blending into a pool of hundreds—you're competing directly against dozens of highly motivated peers.
Source: Results and Data: Specialties Matching Service, 2025 Appointment Year, NMRP
U.S. MD graduates filled 34.1% of interventional pulm spots. U.S. DOs took 14.0%, U.S. IMGs 20.9%, and non-U.S. IMGs 30.2%. This tells us that interventional pulmonology programs are open to diverse backgrounds, but the procedural nature of the field and limited spots mean competition is real.
What this means for applicants: If you want interventional pulm, you need to signal interest early. Do a rotation. Present at a conference. Get a letter from someone in the field. The small program size means every application gets scrutinized, and programs want to see commitment, not curiosity.
Sleep Medicine: The Underappreciated Opportunity
Sleep medicine is fascinating because it's both accessible and underutilized. In 2025, 218 positions were offered across 102 programs. But only 207 filled—a 95.0% fill rate. That's lower than both PCCM and interventional pulm.
249 applicants ranked sleep programs, and 207 matched. That's an 83.1% match rate.
So why didn't more spots fill? The answer is likely twofold.
Sleep medicine is still viewed as a "lifestyle" subspecialty, which means some applicants rank it as a backup or explore it without full commitment.
Not all programs are equally desirable—geographic location and program reputation matter a lot in sleep medicine.
Source: Results and Data: Specialties Matching Service, 2025 Appointment Year, NMRP
The applicant-to-position ratio is 1.1:1, which is the most favorable of the three subspecialties we're discussing. U.S. MD graduates filled 39.0% of positions, with U.S. DOs taking 21.3%, U.S. IMGs 15.0%, and non-U.S. IMGs 22.2%.
What this means for applicants: If you're interested in sleep medicine, your odds of matching are good—especially if you're open to geographic flexibility. The field is growing as we recognize the systemic health impacts of sleep disorders, but it's not yet saturated. That won't last forever.
Trends to Watch
Looking at the five-year data, a few patterns emerge:
PCCM is stable but competitive. The number of positions has grown steadily from 657 in 2021 to 816 in 2025. Applicant interest has grown in parallel, keeping match rates steady around 70%. The field isn't getting easier to break into.
Interventional pulmonology is slowly expanding. Positions have held steady between 40-47 over the past five years, with slight year-to-year variation. Match rates fluctuate more than PCCM because of the small applicant pool, but the overall trend is stable demand with limited supply.
Sleep medicine is growing—but not filling. Positions increased from 179 in 2021 to 218 in 2025, but fill rates remain in the 88-95% range. This suggests unmet demand from programs but incomplete interest from trainees. That gap represents opportunity.
What This Means for Our Field
We're training more pulmonary and critical care physicians than ever before, but we're not meeting the workforce demand. The ICU boarding crisis, ventilator shortages during COVID, and aging population all point to the same reality: we need more intensivists.
The match data reflects that need—but it also shows we're drawing heavily from international medical graduates and DOs to fill the gap. This is the reality of modern medical training. But it does raise questions about how we're recruiting U.S. MD graduates into the field and whether we're doing enough to make PCCM an attractive career path.
For those of you in training or considering fellowship, the numbers are clear: PCCM is accessible but not automatic. Interventional pulmonology is niche and competitive. Sleep medicine is the underappreciated opportunity with room to grow.
In summary, the 2025 match data tells us that our field is growing, diversifying, and still facing real workforce challenges. If you're interested in pulmonary and critical care, now is the time to lean in. The demand is there. The question is whether we're building the pipeline to meet it.