For those of us who work in the “trenches,” results of the 2023 Emergency Medicine (EM) Residency Match may not come as any surprise. Amid staffing shortages, increased pressure to meet productivity metrics, the innumerable challenges coinciding with the COVID-19 pandemic and many articles pinpointing the skyrocketing levels of physician burnout and attrition in emergency medicine, it is no wonder medical students are paying attention. In 2022, it was clear there was a trend beginning to emerge with the first major decrease in applicants into EM, resulting in 219 unfilled residency spots. And then 2023 happened and news was made that unfilled EM residency positions (prior to the Supplemental Offer and Acceptance Program, or SOAP) reached an unprecedented 555. For many years, EM maintained its status as a competitive specialty, typified with more students applying to EM than number of residency positions available. In 2021 the number of applicants into EM peaked. The following year, the number of applicants began to decrease, however the number of residency positions continued to increase.
EDUCATION
New York American College of Emergency Physicians
Devjani Das, MD FACEP
Director, Emergency Medicine Clerkship Director, Emergency Ultrasound Division Associate Professor of Emergency Medicine Columbia University Vagelos College of Physicians and Surgeons
EM Residency Match 2023: What happened?
So what happened and do we need to be concerned?
This phenomenon may partially be explained by a shift in the supply-demand curve of available EM residency positions. For the past decade, the number of residency positions have grown significantly. Many programs have expanded the number of spots available in the match as they have developed their programs, hired additional academic leaders and grown their clinical acuity and procedural training. On the same token, several for-profit hospital corporations have opened a number of programs, which some point to as a financial move for hospitals since residents earn lower salaries than attendings and are partially funded by the government. Due to concern of the corporatization and growth of these programs, ACEP successfully advocated against the opening of one new EM program in a large urban center – the first step in advocating for responsible growth of programs. Organizations like the Emergency Medicine Residents’ Association (EMRA), have also advocated for responsible growth of programs by submitting recommendations to the ACGME to increase certain EM residency procedure requirements, thereby limiting the growth of programs where procedures may not be as common in daily practice.
On a separate note, the COVID-19 pandemic initially had a booming effect on the medical field where medical providers, specifically “frontline” workers, were viewed as the true heroes during an otherwise catastrophic time. Soon after, attention was quickly directed to the mental health concerns surrounding the pandemic, which included handling overcrowded Emergency Departments (EDs), inadequate personal protective equipment and the emotional burden of making many life-altering decisions with sparse medical resources and knowledge. Measures have recently been instituted to increase attention in both the medical field and the general public about the unique mental health challenges in healthcare, like the Lorna Breen Act and National Physician Suicide Awareness Day. The mere existence of these actions, however, has highlighted the increasing rates of physician burnout and attrition within the medical field in general, and emergency medicine specifically. Medical student are not immune to these stories and are understandably anxious about how this may affect their future career options.
Compounding these challenges to EM is the general fear of poor job prospects, both in quantity and quality, for new residency graduates in the near future. An article published in the Annals of Emergency Medicine in 2021 conjectured that there may, in fact, be an oversupply of emergency physicians by 2030. Recent research has also highlighted the realities of workplace violence, both verbal and physical, and a study published in the American Journal of Emergency Medicine reported that 100% of ED nursing staff had experienced such violence during their careers. The prospect of a limited EM job market, in addition to the very real possibility of facing workplace violence in the ED, are powerful factors when medical students are considering their future residency choices.
Given all of this, what is our response as a specialty? The cat is most certainly out of the bag – the romanticization of what it means to be a physician, particularly in many crowded, understaffed and underresourced emergency departments across the country, has clearly made its way into the news headlines. Medical students are listening and are hearing the messages loud and clear. A Match Task Force, made up of a broad array of EM organizations—including EMRA, ACEP, SAEM, CORD, ACOEP and AAEM, among others—have convened to identify factors leading to the current workplace, as well as to develop strategies to improve it for future matches.
On a more local and personal level, it is our job to remind ourselves and our students that emergency departments are by far the most critical aspect of the safety net for so many people across the country. Having a dearth of EM physicians in the future will not only affect our specialty but will have direct consequences for our patients. We need to be mindful of supporting our fellow physicians, residents and students with the resources needed to provide the care our patients deserve. In addition, we should consider a decrease of the daily demands placed on us in order to remain productive with fewer resources. As well, we should support the mental and physical well-being of all who work in the emergency department. There will be no overnight solution and there is the very real possibility it may get worse before it becomes better. But if we care to foster future generations, we need to take these necessary steps today.
References
- Rose C, Landry A, Bowers KM. Will there be any emergency doctors to see you in the future? Stat. 20 Mar 2023. https://www.statnews.com/2023/03/20/emergency-medicine-residency-positions-unfilled-the-match/
- AMA Update: 2023 Match Trends: Emergency Medicine with Holly Caretta-Weyer MD
- EMRA’s Response to the 2023 Match EM Match: Strengthening the Specialty from all sides. 24 Mar 2023.
- Joint statement on the Emergency Medicine 2023 Match Results. AAEM, RSA, ACEP, CDEM, CORD, EMRA, SAEM, RAMS, ACOEP, AACEM, RSO.