EM Had a Bad Match – Let’s Talk About That

September 11, 2023

Written by Mitchell Cross

Spoon Feed
An unprecedented 555 unfilled positions in the 2023 emergency medicine (EM) match were less likely a result of wavering interest in our specialty and more due to surging interest after the COVID pandemic (in 2021) and financial pressures within healthcare, resulting in a proliferation of training positions.

Has EM lost its allure?
EM has been an attractive specialty for decades, drawing diverse individuals from all walks of life. While the high number of unmatched spots over the past two years has caused concern about the future of EM, this outcome was predictable.

The 26% drop in applicants from 2021 to 2023 is not a true marker of waning interest in our specialty. COVID resulted in a surge of applicants in 2021, which was an outlier when compared to baseline. In fact, applicants remain stable to pre-pandemic levels. The make-up, however, has shifted to a larger proportion of international applicants.

The rapid growth of training programs within the last 5-10 years, along with expansion of established programs, has outstripped the stable demand for positions. One of the largest driving factors for these changes is direct financial pressure. Between 2001 and 2021, the number of EM residencies increased from 117 to 276, which corresponds to a 136% increase. The proportion of for-profit affiliated EM residencies during that time increased by 1129%.

How will this change my practice?
The house of emergency medicine is at a crossroads. We must police ourselves and demand both high quality training and responsible growth. Market forces will likely produce self-correction, causing some programs to downsize or close. Also, delivery of healthcare is changing, shifting from inpatient to outpatient. Just as anesthesia expanded their scope of practice (i.e. pain management, ambulatory surgery), EM must also evolve with the times to continue to provide high quality acute care for anyone, anywhere, anytime.

Another Spoonful
You’ll want to read this excellent recap and action plan by ALiEM, written by some of the authors of the original Annals of EM article that sparked the editorial we are covering today.

Source
The Emergency Medicine Match: Is the Sky Falling or Is This Just Growing Pains? Ann Emerg Med. 2023 Aug 4:S0196-0644(23)00576-0. doi: 10.1016/j.annemergmed.2023.07.004. Epub ahead of print.

Peer reviewed by Ketan Patel

Editor’s note: In the Annals of EM article, six variables were associated with unfilled positions: 1) unfilled positions in the 2022 Match; 2) smaller program size; 3) location in the Mid Atlantic, 4) prior AOA accreditation; 5) location in the East North Central; 6) and corporate ownership structure (OR 3.21, 95%CI 1.06 to 9.72). ~Clay Smith