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The U.S. faces a range of health care flashpoints — unaffordable drugs, opioids, vaping — as we debate whether to adopt universal care. For now, the Affordable Care Act is the law of the land, but Republicans want to issue it a final death blow.

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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.

More medical school grads are bypassing ERs

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Report: People happier during pandemic due to kindness

Happiness has risen slightly since the pandemic began amid acts of kindness, global report finds.

Ice hockey fans and revellers crowd the Kauppatori square in Helsinki on May 29.

Revellers in Helsinki last May celebrate Finland winning the 2022 Ice Hockey World Championship. Finland was ranked the world's happiest country for the sixth consecutive year following a World Happiness report survey. Photo: Alessandro Rampazzo/AFP via Getty Images

World Happiness Report

Coronavirus

China is becoming the most formidable rival America has faced, and the risk of confrontation with Russia, North Korea or Iran still looms. Authoritarians are rising, the chaotic Afghanistan exit revealed the limits of U.S. power, and the pandemic, climate change and other critical challenges continue to pose grave threats.

World

President Biden has made the COVID-19 crisis and a post-Trump return to national unity and traditional democratic ideals his top priorities. From vaccinations to stimulus to schools, Biden is seeking bipartisan compromise while showing a willingness to use executive authority and bare Democratic majorities in the U.S. House and Senate to implement his policies. Republican leaders are navigating deep party divisions over if and how to move beyond former President Trump.

Politics & Policy

The "Ted Lasso" cast will team up with President Biden and first lady Jill Biden to "discuss the importance of mental health" and well-being during a visit to the White House on Monday, the administration announced.

The big picture: President Biden tweeted a reference to the visit in a Sunday post featuring a photo of a sign stating "BELIEVE" above a door leading into the Oval Office — a nod to a poster above the office of coach Ted Lasso, played by Jason Sudeikis, in the hit Apple TV+ show about fictional soccer team AFC Richmond.

A screenshot of a tweet by President Biden a photo featuring a yellow poster bearing the word “BELIEVE” above a door leading to the Oval Office — alluding to a poster in the TV show "Ted Lasso" ahead of the cast's visit.

The issue of mental health has been a key storyline in the Emmy Award-winning show, with Lasso getting therapy following panic attacks.

Cast members Hannah Waddingham, Brendan Hunt, Phil Dunster, Brett Goldstein, Jeremy Swift, Toheeb Jimoh, Kola Bokinni, Cristo Fernandez, Billy Harris and James Lance are expected to join Sudeikis for the White House meeting, per an emailed statement from Apple TV+ announcing the news.

What they're saying: Apple TV+ noted in its statement that "Ted Lasso" has "inspired the world through its universal themes around optimism, kindness, and determination and the Lasso philosophy to 'believe.'"

Editor's note: This article has been updated with additional comment from the White House and Apple TV+.

"Ted Lasso" cast to join Bidens at White House to promote mental health

President Biden tweeted a hint to the event  in a post featuring a photo of a poster stating "BELIEVE" above a door in the White House.

 Jason Sudeikis attends the Apple original series 'Ted Lasso' Season 3 red carpet premiere event at Westwood Village Theater on March 07, 2023 in Los Angeles, California

Jason Sudeikis attends the Apple original series "Ted Lasso" Season 3 red carpet premiere event  in Los Angeles, California, earlier this month. Photo: Emma McIntyre/WireImage

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After a record economic expansion, the coronavirus pandemic sent the U.S. economy into a recession as unemployment soared to staggering heights. The country now faces urgent questions about how much stimulus is needed for reeling consumers and businesses, and what a recovery might look like.

Economy & Business

The Centers for Disease Control and Prevention last month warned about an increase in cases of the drug-resistant bacterial infection Shigella. 

Driving the news: There are an estimated 450,000 infections in the U.S. each year. The percentage of shigellosis that were resistant to antibiotic treatments increased from 0% in 2015 to 5% in 2022, per the CDC.

The CDC called the diarrhea-causing bacteria Shigella a "serious public health threat," noting that it can spread easily.

"Clinicians treating patients infected with XDR strains have limited antimicrobial treatment options," the CDC said. 

The first case of extensively drug-resistant Shigella was discovered in the U.S. in 2016. 

People with Shigella infection may experience diarrhea, which can be bloody, fever, stomach pain and the feeling of needing to pass stool even when the bowels are empty, per the CDC.

Symptoms typically begin 1-2 days after infection and can last for a week. The infection can affect bowel habits for several months after infection. 

For children, the American Academy of Pediatrics says that parents should call a doctor if there is blood in a child's stool, there’s no improvement or the child is showing symptoms of dehydration.

Shigella can spread easily, per the CDC, as it takes just a small number of bacteria to make somebody sick. Plus, a person can spread the infection for "several weeks" after their symptoms end. 

An individual can get infected by accidentally ingesting the bacteria, such as through contaminated food or water, or touching your mouth with the bacteria on your hand. 

To reduce your chances of getting sick, the CDC recommends washing your hands with soap and water, especially before eating and after changing a diaper. 

Additionally, the CDC says to avoid swallowing water from ponds, lakes or untreated pools and to drink filtered or bottled water when traveling internationally. 

Who is most at risk for Shigella infection? 

Children under 5 are most likely to get infected and many outbreaks occur in schools and early care settings, per the CDC.

The CDC said that other groups at risk for shigellosis include men who have sex with men, travelers who eat contaminated food or water and people who have weakened immune systems. 

What are the treatments for Shigella infection?

Most people with shigellosis get better without any treatment in 5 to 7 days, typically with fluids and rest. 

In cases of severe illness, doctors can order lab tests to determine if antibiotics would be effective in treating the illness. 

The CDC says to notify your doctor if your sickness does not get better after a couple of days of starting the antibiotics.

To prevent antimicrobial resistance, the CDC recommends "using antibiotics only when needed and exactly as prescribed."

Go deeper... The bad business of developing new antibiotics

The bad business of developing new antibiotics

What to know about the antibiotic-resistant Shigella bacteria

The CDC called the diarrhea-causing bacteria Shigella a "serious public health threat."

: Dr. Kate Williamson examines a child during a yearly routine exam at Southern Orange County Pediatric Associates in Ladera Ranch, CA on Tuesday, July 28, 2020

Kate Williamson examines a child during a yearly routine exam at Southern Orange County Pediatric Associates in Ladera Ranch, Calif., on July 28, 2020. Photo: Paul Bersebach/MediaNews Group/Orange County Register via Getty Images

Monday's health stories

More medical school grads are bypassing ERs

Report: People happier during pandemic due to kindness

"Ted Lasso" cast to join Bidens at White House to promote mental health

What to know about the antibiotic-resistant Shigella bacteria