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After the Match

The Unchecked Growth of EM Programs (and No Sign of Stopping)

Cook, Thomas MD

doi: 10.1097/01.EEM.0000581488.93825.92
After the Match

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Should emergency medicine graduates be concerned about a future with too much competition for high-paying jobs? The number of first-year EM positions has increased by almost 37 percent since 2015, according to the 2019 report by the National Resident Matching Program. (http://bit.ly/2XHyheb.) Even if the number of residency positions doesn't increase in the future, there will be more than 7400 EM residents in 2022, and a third of them will graduate that year. This creates a lot of anxiety for EM residents banking on the ability to receive annual incomes typically in excess of $300,000.

Is there any organization not directly providing emergency clinical services that is monitoring this? Is someone asking the right questions and developing a strategy to avoid the overproduction of EPs? After a little investigation, I am pretty sure the answer is no.

The Accreditation Council for Graduate Medical Education (ACGME) has been the umbrella organization that oversees graduate medical education in the United States since 1980. Their mission is summarized in this statement on their website: “The ACGME is a private, 501(c)(3), not-for-profit organization that sets standards for US graduate medical education (residency and fellowship) programs and the institutions that sponsor them, and renders accreditation decisions based on compliance with these standards.” (http://bit.ly/2LWjhlo.)

What they don't do is determine how many programs there should be based on the employment marketplace for any given specialty. I called the residency review committee for emergency medicine to confirm this, and was informed that any attempt by the ACGME to limit the number of programs could be interpreted as restriction of trade. Even if they wanted to, the ACGME could not limit the overall number of residents or programs available to medical school graduates.

The ACGME website has a very, very long list of all accredited emergency medicine programs. There are now 239 programs, an incredibly high number.

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The ACGME-AOA Merger

I entered each program into a spreadsheet along with the year the program was first accredited. Most of the older programs are listed on the ACGME site as beginning in 1982 because the ACGME only came into existence in 1980. My program started in 1978, according to the ACGME, but it was not accredited until 1982. There were 49 emergency medicine accredited programs that year. After 1982, the annual rate of program accreditation was pretty consistent until 2015. Then something incredible happened.

At least 20 new programs were accredited each year from 2016 to 2018. The data for 2019 are not complete yet, but program accreditation seems to be at a similar pace. A total of 75 programs were accredited by the ACGME for the first time from January 2016 to June 2019. Of course, this information generates a lot of questions. What is driving this? Will it continue, or is this a short-lived phenomenon? Will the rate of new program accreditations stabilize?

A closer look at the data revealed that the biggest contributor to the rapid increase in the number of programs since 2015 is the merger between the ACGME and American Osteopathic Association, which will establish a single residency accreditation organization in the United States by 2020. The AOA will no longer accredit osteopathic residency programs for training, and all previously AOA-accredited residencies and new osteopathic programs are required to apply for accreditation from the ACGME.

Forty-one of the 75 programs accredited by the ACGME since 2016 were either established osteopathic programs applying for first-time ACGME accreditation or new osteopathic programs. Fifty-five percent of the increase in newly accredited programs since 2016 can be attributed to this merger. But if we factor out the osteopath surge created by the merger, there were more new allopathic programs accredited by the ACGME compared with similar periods over the past 37 years.

The ACGME-AOA merger is not the sole reason for the dramatic increase in residency positions, nor does it answer the pivotal question of whether there are too many graduates for too few jobs. There are other factors at play, and this is where we will pick up the conversation next month by looking at the influence of contract management groups on the increased production of emergency physicians.

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Dr. Cookis the program director of the emergency medicine residency at Palmetto Health Richland in Columbia, SC. He is also the founder of 3rd Rock Ultrasound (http://emergencyultrasound.com). Friend him atwww.facebook.com/3rdRockUltrasound, follow him on Twitter @3rdRockUS, and read his past columns athttp://bit.ly/EMN-Match.

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