The results of the 2003 National Resident Matching Program (NRMP) reflect a persistent decline of student interest in family practice residency training in the United States. Compared with the 2002 Match, 118 fewer positions (179 fewer US seniors) were filled in family practice residency programs through the NRMP in 2003, as well as 23 fewer (12 fewer US seniors) in primary care internal medicine, 20 fewer in pediatrics-primary care (11 fewer US seniors), and 23 fewer (34 fewer US seniors) in internal medicine-pediatric programs. In comparison, 40 more positions (14 more US seniors) were filled in anesthesiology and 8 more (8 more US seniors) in diagnostic radiology, two "marker" disciplines that have shown increases over the past 3 years. Sixty-seven more positions (but 148 fewer US seniors) were also filled in categorical internal medicine, while 107 more positions (33 more US seniors) were filled in categorical pediatrics programs, where trainees perceive options for either practicing as generalists or entering subspecialty fellowships, depending on the market. While the needs of the nation, especially rural and underserved populations, continue to offer opportunities for family physicians, family practice experienced continued decline though the 2003 NRMP. Many different forces, including student perspectives of the demands, rewards, and prestige of the specialty; the turbulence and uncertainty of the health care environment; liability protection issues; and the impact of faculty and resident role models, are impacting medical student career choices. The 2003 NRMP again confirms the trend away from family practice and primary care careers.