Emergency medicine had a historic match last year with a record number of residency positions not filling during the initial round. We're also expecting to see dramatic results this spring gauging by the early data released by the Electronic Residency Application Service (ERAS) for the 2023 match. (Association of American Medical Colleges. https://bit.ly/3WjykHa.)
The data in Table 1 are from the annual reports of the National Residency Matching Program (NRMP) from 2015 through 2022 and preliminary data for the 2023 match supplied by ERAS. There was a steady increase in EM programs and residency positions from 2015 to 2022 and an annual increase in the number of applicants. There was also an excess number of applicants from 531 in 2015 to 894 in 2021.
This changed dramatically in 2022. The excess number of applicants decreased from 894 in 2021 to 160 in 2022, an astounding 82 percent change. And preliminary 2023 match data show this will remain the same or get worse.
Table 2 displays the average number of applications per program from 2018 through 2023 based on ERAS's annual preliminary match data from November. The most striking item is the 21 percent drop in applications from 2022 to 2023 and the 34 percent drop from 2021 to 2023.
The composition of EM applicants has changed over the past year as well. The number of osteopathic graduates hovered around 30 percent of all applicants and the number of international medical graduates stayed at around 18 percent from 2018 through this year. Preliminary ERAS data for the 2023 match show DOs holding steady at 32 percent of all applicants per program but a drop of nine percent for allopathic applicants from 2021 and an increase of IMGs by eight percent. Comparing these with the data from 2018, the percentage of MD applicants per program dropped 17 percent in only five years.
What should we make of all this?
Even Tighter Competition
This is good news if you are an applicant to emergency medicine. As the old saying goes, “One man's crisis is another man's opportunity.” With at least five new programs taking residents in 2023, demand continues to increase in the face of dwindling supply.
The average EM applicant sent out 56 applications for this year's match, and this is similar to the data we have from the previous five years. With the number of applicants and available positions nearly equal, however, even average applicants received more invitations to interview this year than ever. During my interviews, I had to keep in mind that each applicant I spoke with would have up to 40 choices, and above-average ones would more likely get their first choice. This makes the competition among programs extremely tight.
How should programs interpret this information? Program leaders quickly took to the internet to comment after ERAS released the data in November. The listserv for the Council of Residency Directors in Emergency Medicine advised programs to interview more applicants and strongly consider interviewing DO and IMG applicants if they had not in the past. The net effect of this advice in next month's match, however, will likely be small. Like it or not, math is math.
There are nearly equal numbers of applicants and available positions. Within the applicant pool, there are 600 IMGs, as well as an unknown number of less accomplished medical students. There is also an unknown number of applicants using emergency medicine as a backup plan while pursuing other highly competitive specialties. We will have a chaotic week in March if many programs do not consider IMGs or less accomplished medical students or they lose out on great applicants who match in more competitive specialties.
It's unlikely that emergency medicine will rebound next month from last year's wake-up call. Instead, the likely scenario is a higher number of unfilled programs during the initial round, followed by intense activity in the Supplemental Offer and Acceptance Program (SOAP). EM program directors have paid little attention to SOAP for decades because unmatched positions were annually in the single digits. This changed suddenly in 2022, and now most programs need to plan for the strong possibility they will be involved.
Will EM reverse course? That remains to be seen. As incredible as it sounds, more health care institutions are planning to open new programs, particularly in smaller hospitals where emergency medicine may be one of a few residencies on campus or even be unopposed. Given the declining supply of applicants, these programs will be forced to consider less accomplished medical school graduates, the effect of which will be worth considering in the future. At the very least, academic emergency medicine can expect similar match challenges in the years to come.
Dr. Cookis the program director of the emergency medicine residency at Prisma Health 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.