ACEP President: Drop in Emergency Medicine Training Applicants ‘Concerning’

By Christopher Cheney

The number of emergency medicine training program applicants dropped 26% this year, falling from a high of 3,734 in 2021 to 2,765 in 2023, according to the National Resident Matching Program.

The steep decline in applicants to emergency medicine training programs comes as emergency departments nationwide emerge from a harrowing experience of chaotic emergency rooms during the coronavirus pandemic. Prior to this year’s plunge in applicants, there was an expectation that there would be an oversupply of emergency physicians, with 8,000 more than needed by 2030, according to a 2021 report.

The plunge in applicants is disturbing, says Christopher Kang, MD, president of the American College of Emergency Physicians and a practicing emergency medicine physician. “It is concerning but it is not necessarily surprising. No specialty likes to see a drop in trainees, but if you look at both the short-term and long-term factors involved, we were anticipating that this would likely happen, although not at this degree.”

Multiple factors likely contributed to the sharp decrease in emergency medicine training program applicants, he says:

• “One factor is we knew there was a decline in applicants last year; however, when you look back at the past five or 10 years, emergency medicine was one of the more popular specialties and the number of training applicants increased. However, as many specialties have experienced, somewhere along the way when you try to meet training demand, you have to start more training programs. At this point, a mismatch has occurred.”
• “Second, when people want to go into this specialty, they have certain perceptions. Then when they experience the specialty, they start to see whether it is for them. In this regard, there are two factors at play. One is some of their expectations of what they were looking for in a career changed after they experienced it. Second is when young doctors see what emergency physicians have done over the past three years of the coronavirus pandemic, it has been challenging for those in the profession. When young doctors see that, despite the noble mission, emergency medicine is not what they want for a career.”
• “Third, young doctors have seen outwardly—not just in the emergency department itself but also in the media—rising frustrations among patients and a rise in workplace violence. They know it is difficult to see patients in a timely fashion, and they all probably have family members or friends who have experienced delays in care that have not met their immediate acute healthcare needs.”
• “Fourth, there are always specialties that become more popular; and somewhere along the way, those who are helping young doctors look for a career to match their expectations and skillsets may say, ‘Emergency medicine is going to be a challenging environment, is this really what you want to do?’ For those who may be on the fence, they may have another specialty they were interested in, and they decide to try that instead.”

Given the impact of the pandemic and the decline in emergency medicine training applicants, the predicted oversupply of emergency medicine physicians in the 2021 report needs to be revised downward, Kang said. “Largely due to the pandemic, the attrition rate has increased. So, we have tried to review the numbers, and our best estimate now is that if the attrition rate increased by 2% or 3%, if the number of training applicants decreased, and if the number of residency slots changed, the number of excess emergency medicine physicians is going to be half of what was forecasted.”

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.