The results of the 2009 National Resident Matching Program (NRMP) reflect a persistently low level of student interest in family medicine residency training in the United States. Compared with the 2008 Match, 70 fewer positions (with 89 fewer US seniors) were filled in family medicine residency programs through the NRMP in 2009, at the same time that 18 fewer positions were filled in primary care internal medicine (11 fewer US seniors), one more position was filled in pediatrics-primary care (three more US seniors), and 13 more positions were filled in internal medicine-pediatrics programs (but with seven fewer US seniors). Multiple forces, including student perspectives of the demands, rewards and prestige of the specialty, the turbulence and uncertainty of the health care and economic environments, lifestyle issues, the advice of deans, and the impact of faculty role models, continue to influence medical student career choices. A total of 152 more positions (28 fewer US seniors) were filled in categorical internal medicine. Thirty-one more positions (72 more US seniors) were filled in categorical pediatrics programs. The 2009 NRMP results suggest that while interest in family medicine experienced a slight increase in the number of students choosing the specialty last year, overall interest in primary care careers continues to decline. With the nation continuing to call for the roles and services of family physicians, family medicine still matched too few graduates through the 2009 NRMP to effectively address the nation's needs for primary care physicians.