Mar 20, 2023 - Health

More medical school grads are bypassing ERs

Share of 2023 residency programs filled by U.S. fourth-year M.D. students, by specialty
Data: National Residency Matching Program; Chart: Simran Parwani/Axios

More medical school graduates are steering away from emergency medicine and opting for specialties like orthopedics and plastic surgery, raising concern about a field that bore the brunt of COVID-19 and remains beset by the overdose epidemic and other health crises.

Driving the news: More than 550 slots for emergency medicine residents were left unfilled this year, according to the National Resident Matching Program, which pairs newly minted doctors with post-graduate opportunities in medical centers.

  • That's up from 335 a year ago and a major jump from 2018, when only 13 ER openings were unfilled.
  • The field not long ago was one of the most desired for young doctors: ER residency slots rose by 44.6% between 2000 and 2010, more than any other specialty.
  • The current dropoff comes as the number of medical school graduates hits new highs and Congress is weighing an expansion of residency positions. A total of 42,952 medical school graduates applied for 40,375 available positions during this year's Match Day.

Between the lines: Experts attribute the trend to the pandemic experience, along with health system consolidation, cost-cutting and the corporatization of medicine.

  • "This is a challenging time for EM," the American Academy of Emergency Medicine and other professional groups said in a joint statement. "As we focus on solutions, we continue to work hard to support trainees, residency programs, and faculty."
  • A field once celebrated on TV and lauded during the early days of COVID has since become come to embody professional burnout — with attendant risks like patient violence, to hear practitioners tell it.
  • "People talk about death by a thousand cuts," Elizabeth Datner, chair of the department of emergency medicine at Einstein Healthcare Network, told the Philadelphia Inquirer.
  • "When students see us super burned out and dealing with a health care system that treats the emergency department like a release valve, they see the toll it takes on us," Jessica Adkins Murphy, president of the Emergency Medicine Residents Association, told the Washington Post.
  • This drop in interest in emergency medicine could also be part of a correction following a 2021 report predicting an oversupply of doctors in that specialty, the Post reports.

Yes, but: Even as emergency departments struggled to find enough residents, disciplines like orthopedic surgery, plastic surgery, diagnostic radiology and thoracic surgery filled completely.

  • In the aftermath of the Supreme Court decision striking down Roe v. Wade, the number of obstetrics and gynecology residency slots remained stable, even as some future residents described having to factor which state a residency program is in.
  • "I’m in my interview season, tracking governor races in states where I don’t live," a medical student told The Cut about his peers. "I had a vested interest in how people in Pennsylvania were voting because it determined whether having the foundation of my career there made any sense."

What we're watching: There's been a freeze on residency positions dating to 1997, and with a dearth of positions, it's left thousands of young doctors without jobs, the New York Times reported.

  • It's a problem the American Association of Medical Colleges has railed against as the U.S. faces a shortage of up to 124,000 physicians by 2034.
  • Congress finally added 1,000 new slots to be phased in over five years starting this year. But critics have slammed the addition, saying the rules attached to those new positions are "overly prescriptive."
  • Emergency care could become even more important as millions fall off Medicaid rolls with the end of the COVID-19 public health emergency and could lose access to key preventive services.
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