This article is a continuation in a series of national studies conducted by the American Academy of Family Physicians that reports the performance of family medicine and other primary care specialties in the National Residency Matching Program® (NRMP) Main Residency Match, hereafter called the Match. Match data from 1986-2016 were analyzed to compare the numbers of positions offered and filled in family medicine, other primary care specialties, emergency medicine, diagnostic radiology, ophthalmology, anesthesiology, and dermatology (E-ROAD), and other select specialties. Of the 10 largest specialties defined by the greatest number of positions offered in the 2016 Match, all but one (general surgery) have experienced growth since 1986.Overall, the total number of positions offered in the Match grew by an average of 226 positions per year. At the same time, primary care specialties grew 19 positions per year, and E-ROAD specialties grew by 72 positions per year. The disproportionate growth of subspecialties overall, notably the E-ROAD subspecialties, relative to the modest growth of primary care specialties, makes the goal of better health care harder to achieve. The GME portion of physician workforce pipeline is mismatched to the health needs of the nation, and this mismatch is worsening.