Emergency medicine residencies more prone to go unfilled at for-profit and newly accredited programs

The variety of unfilled positions in emergency medicine residency programs surged in 2022 and 2023, with the trend most pronounced at programs that were recently accredited or under for-profit ownership. That’s the important thing finding of my team’s recent study of the past two match cycles.

A match cycle is when medical students select a specialty and learn where they’ll train. It starts when fourth-year medical students interview at residency programs at hospitals across the country. Then, the scholars rank their preferred training programs, and the programs rank the scholars. An algorithm makes matches.

The proportion of medical students applying for emergency medicine residencies dropped by 16.8% from 2021 to 2022 and declined one other 18.1% from 2022 to 2023. This abrupt decline may degrade the three-to-four-year clinical training experience of emergency medicine residents and affect how the health care system provides emergency care in the longer term.

But this waning in demand is simply half of the story. Deepening the issue is the proven fact that the variety of emergency medicine residency programs has grown at the identical time.

No checks on the for-profit sector

Over the past five to eight years, more for-profit and personal capital-backed firms have bought emergency medicine facilities, taken over staffing contracts in existing hospitals and created emergency residency programs.

Since they’re for-profit entities, these firms have a responsibility to return money to investors. They have been shown to attain this by paying residents less and charging higher prices on services like imaging and hospitalization.

Currently, there are not any limits on the variety of residency programs or positions in emergency medicine. The Review Committee for Emergency Medicine routinely approves all proposals for brand spanking new residency programs that meet requirements. Despite the proven fact that positions are already going unfilled, eight latest emergency medicine residency programs were accredited throughout the 2022-23 academic yr. This accreditation system is currently under review, but any changes will take years to enter effect.

More positions, lower demand

I’m a physician who studies the state of emergency care. In our recent paper, my team and I calculated the variety of emergency medicine residency programs that filled all positions previously two match cycles.

Our study shows that in 2022, 277 emergency medicine residency programs offered 2,921 positions and had 219 unfilled positions. In 2023, 287 emergency medicine programs offered 3,010 positions and 554 went unfilled. In each of those years, about 30 programs had primary clinical training sites under for-profit ownership.

The drop in interest in emergency medicine could also be driven by well-circulated forecasts predicting a surplus within the emergency physician workforce by 2030 and escalating levels of burnout amongst emergency physicians.

By examining where residents selected to go when there have been good enough programs to select from, we learned three things.

First, more established programs did higher. Emergency medicine residency programs accredited throughout the past five years had greater than double the likelihood of not filling all positions compared with those accredited for greater than five years.

Second, in 2023, more opportunities were offered in several metropolitan areas, including Detroit, Miami and Philadelphia, but these programs ended up with many unfilled positions.

Third, emergency medicine residency programs with for-profit clinical sites were less prone to fill all residency positions. These programs had a 50% greater likelihood of not filling all positions when put next with nonprofit or government-run sites.

Possible solutions

It’s not clear whether these trends will proceed. In 1996, the anesthesiology specialty saw the proportion of filled residency positions drop to 45%, an all-time low. Yet the specialty rebounded to fill nearly 100% of accessible positions by 2002.

While it is feasible the past two years for emergency medicine are a part of the natural ebb and flow of specialty interest amongst medical students, our findings, the historical literature and the recent bankruptcy filing of Envision – a big, for-profit emergency medicine group that staffs several clinical sites and residency programs – all suggest medical students could also be recognizing the disadvantages of for-profit emergency medicine residency programs.

There is little data on the standard of those programs. No research yet has evaluated board exam pass rates of emergency medicine residents graduating from newly accredited or for-profit clinic sites. However, residents in pediatric programs with a company affiliation had lower board exam pass rates.

In addition to reconsidering the persistent opening of recent programs, now stands out as the time for organizations just like the Emergency Medicine Residents’ Association and the American College of Emergency Physicians to deal with issues that affect recruitment of emergency medicine residents.

Physician burnout might be addressed by reviewing hospital policies designed to maximise profits. For example, many patients are admitted to the hospital, yet “board” within the hallway of an emergency department for hours. These patients have routinely been shown to have worse outcomesyet hospital leadership incessantly attempts to prioritize revenue-generating surgeries and procedures in lieu of assigning beds for admitted patients from the emergency department.

Loan forgiveness and increased salaries could draw more residents to emergency medicine, especially in rural areas where distinct physician shortages exist. And more female residents can be drawn into emergency medicine if disparities in pay and concerns over violence in emergency rooms were systematically resolved.