As emergency physicians, we are all too familiar with the fast-paced and unpredictable nature of our specialty. However, in recent years, another challenge has emerged that demands our attention: declining trends in some categories of emergency medicine residency applications and the resulting match rates. Changes in application numbers and match rates pose important questions about the future of our field. In this blog, we will explore the factors contributing to these changes and ideas for ways to address them.
Trends in emergency medicine residency applications
According to Emergency Medicine News, the number of emergency medicine residency applications rose to 4,391 in 2021—over 20% higher than 2020. This peak was followed by the first decline ever in EM applications in 2022, after which the decrease continued to 3,151 in 2023.
Interestingly, this decrease was followed by a significant increase in 2024 to 4,248 which is in line with 2020 pre-pandemic numbers. Separating these statistics by applicant type shows important trends driving the 2024 increase. Of MD, DO, and international resident applications, MD applications showed the sharpest decline in 2023 with a small increase in 2024. DO and international resident applications, however, increased significantly, driving the bulk of growth in 2024.
Emergency medicine application decline
Jessica Adkins Murphy, MD, 2023 President of the Emergency Medicine Residents Association, cited a number of important reasons for the decline in applications and interest in the specialty. Some emergency medicine applicants expressed concerns about the job market including forecasts of an emergency medicine physician surplus by 2030 and a resulting decline in compensation. High burnout rates were also cited as a major concern, along with violence in the ED. Other issues raised include the increasing role of both corporate hospital administration and the growing influence of nurse practitioners and physicians assistants.
Decrease in emergency medicine match rates
At the same time, the number of emergency medicine residency positions offered increased as did the number of unfilled positions. In the Cureus article “The 2022 and 2023 Emergency Medicine Residency Match: A Cautionary Tale,” the authors report that 219 out of 2,921 emergency medicine positions remained unfilled after the initial match in 2022–a fill rate of 92.5%–which, at that time, was the highest number of unfilled positions the specialty had ever seen. In 2023, emergency medicine offered 3,010 residency positions with 554 unclaimed on Match Day. This equates with a fill rate of 81.6% compared with the overall match rate of 93.3%.
Factors driving the decreasing emergency medicine match rates in 2022 and 2023
In addition to lower application numbers, residency programs have increased significantly due to a combination of existing residency program expansion and the proliferation of for-profit emergency medicine centers. Fueled by market forces rather than identified workforce needs, standalone for-profit emergency departments represent the largest increase in available residency positions vs. applicants.
In addition to this increase in volume of residency opportunities, more recent accreditation of programs at for-profit hospitals, and their for-profit status are associated with a higher rate of unfilled slots as compared to traditional programs. In fact, an article presented at the 2023 American College of Emergency Physician Scientific Assembly—Unfilled in emergency medicine: An analysis of the 2022 and 2023 Match by program accreditation, ownership, and geography—states that 50% of for-profit residency positions go unfilled.
Potential Solutions
Firstly, conducting a thorough review of the automatic approval process for new programs and implementing more stringent accreditation criteria can enhance the quality and sustainability of residency training. This step is crucial in making these programs more appealing to potential residents.
Addressing physician burnout is equally vital. Implementing policies that prioritize patient care over profit can lead to improved working conditions and a reduction in burnout among emergency physicians. Financial incentives also hold significant potential in attracting residents to emergency medicine, especially in underserved rural areas. Offering loan forgiveness and higher compensation can make the specialty more enticing to prospective residents.
Conclusion
Addressing the challenges of emergency medicine residency program recruitment demands a comprehensive strategy. Regulatory reforms, improved working conditions, and financial incentives are essential steps in tackling these issues. Through these efforts, we can uphold the standards of emergency medicine education and practice, ensuring the delivery of top-notch care to patients.
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