After a surprisingly low number of applicants and a shockingly high unfilled rate last year, emergency medicine (EM) appears to be leveling off as it regains its status as one of the medical profession’s most sought-after specialties. There was a collective exhale from the emergency medicine community after the emergency medicine results of the 2024 Match, but relief remains elusive as concerns about the specialty’s program growth linger.

This year, 135 emergency medicine positions went unfilled across 54 programs—considerably down from the 554 unfilled positions across 132 programs last year. This decrease—from 18 percent to just 4 percent—in unfilled positions is encouraging news for the specialty.

For years, emergency medicine enjoyed tremendous success in the Match with nearly every spot filled. In 2021, when emergency physicians were hailed as health care heroes in the wake of the COVID-19 pandemic, EM applicants reached a peak of more than 4,300. But in 2022, the number of EM-bound students sharply dropped. With more than 700 fewer applicants, the 2022 Match saw 219 unfilled spots across 69 programs. The 2023 cycle continued the downward trend with a continued but smaller drop in EM-bound applicants, and an even larger rise in unfilled spots, which shocked the EM community; some even questioned its future.¹

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The 2024 cycle marked the greatest number of students applying to emergency medicine, according to preliminary data from ERAS. More than 4,400 applicants signed up for emergency medicine this year—nearly 1,200 more EM applicants than the previous year and with nearly double the amount of international medical graduate (IMG) applicants. While emergency medicine’s Match rates have not returned to pre-COVID numbers, it certainly is a sign of renewed interest in the field.

“We are very encouraged that the interest in EM has seen a rebound over the last year,” said Chinmay Patel, DO, the emergency medicine clerkship director at the Burnett School of Medicine at Texas Christian University. “The increase in EM interest mirrors what anecdotally many residency programs around the country experienced this interview season with increased applications.”

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The increase in number of applicants and subsequent Match has been mostly driven by an increase in osteopathic and IMG applicants. The results of the 2024 Match showed that 35 percent of EM positions were filled by osteopathic students and 15 percent by international medical students and graduates. Natalie Zink, a graduating medical student at the Medical College of Georgia, said she anticipated the increased competition in emergency medicine this year, but it did not deter her decision. Although applicants from allopathic U.S. schools like Ms. Zink remained relatively flat, competition from osteopathic students and international graduates contributed to the rebound.

“After such a tough year last year, I assumed there would be a large rebound. EM is a very welcoming specialty where many types of people fit – our strength is in our motley crew,” Zink said. “EM is the only specialty that allows me the depth and breadth of pathophysiology, plus the added flexibility of fellowship training. There is no recipe for a perfect career; you have to follow your passions.”

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Many applicants, like Nsikak Daniel who graduated medical school in St. Lucia, felt like they would never have a chance at matching in EM were excited at the opportunity to be given a chance. At ACEP’s Scientific Assembly in Philadelphia last October, Dr. Daniel had no plans to participate in the 2024 Match. She doubted she could earn a spot in an emergency medicine residency program in the United States.

There were financial limitations. She wasn’t personally impressed with her U.S. Medical Licensing Exam test scores. And she thought there would be steep competition from U.S.-based students. But a sponsor she found at ACEP’s annual meeting encouraged her to continue her dream of practicing emergency medicine.

Following ACEP24, “I bought my ERAS token, prepared my entire application in less than two weeks, including my personal statement and letters of recommendation, and submitted to 47 programs,” she said. “The next few weeks, I received eight interview offers and now, so help me God, I matched into EM! It has been a rollercoaster ride but personally, I think it makes this latest achievement all the more worth it.”

Dr. Daniel, who graduated medical school in 2022, is just one of 2,891 applicants who matched into emergency medicine in the 2024 Match program this spring.

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“Our residency program leadership was very deliberate with recruitment, interviewing, and ranking as were many other programs,” said Annahieta Kalantari, DO, vice chair of education at the Penn State Health Milton S Hershey Medical Center. “They spent hundreds of hours finding the right candidates for our rank list.”

Many experts have noted that top grades and board scores do not always predict who will become the best emergency physicians. There are a number of emergency medicine leaders who have said that they themselves were just average students. Identifying future residents who fit the mission and values of a program and have genuine interest in serving that specific patient population is also an important part of a successful Match.

The concept of “program signaling” was introduced by ERAS two years ago to further this aim and is a way for applicants to show interest in programs before applying. Signals serve as a way for an applicant to indicate to a select few programs that they are highly interested. This year, applicants to EM could signal up to seven residency programs when submitting applications. On average, 13 percent of a program’s applicants used a signal when applying to the program. Preliminary 2024 ERAS data showed applicants to EM who used a signal received an interview offer roughly 55 percent of the time compared to 28 percent for those who did not signal the program.² Program directors can use applicant signals in various ways in order to focus their efforts on those most interested in their programs and, hopefully, this leads to a successful match.

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Benjamin Aiwonodagbon, MD, MPH, knew EM would be competitive this year, but for him, “it was EM or nothing.” He feels that the increase in IMG residents will positively impact the future of EM in meaningful ways. “Data has shown that the more diversity in a team or organization, the better the outcome,” he said. “When a managing team mirrors the patient population, the better the health outcomes for such patients.”

Dr. Aiwonodagbon added that the influx of IMG applicants to U.S. residency programs might be beneficial to workforce distribution challenges, noting that some visa sponsorships require board-certified physicians to practice in rural, under-served communities. Additionally, the impact could transcend the United States and have a global influence.

“The more IMG EM physicians we have in the future, the better for global EM and EM health systems in developing countries,” he said. “EM is the missing piece of health care in most sub-Saharan African countries, for example. I, for one, would love to contribute to building EM in my home country Nigeria in the future.”

While the 2024 Match numbers paint an optimistic picture, many of the factors that led to the 2023 drop off have not changed. Hospital boarding, workforce concerns, economic challenges, ED violence, corporatization of the practice of medicine, and payer and governmental administrative burdens still continue to plague emergency physicians. These systemic challenges require continued efforts to improve conditions for emergency physicians and their patients.

“I don’t think a few setbacks are going to deter what an ED represents at its core—humanity,” said Sreenidhi Vanyaa Manian, another student who successfully matched. “Only time will tell how everything works out but as long as people who are passionate about EM comprise it, I am not worried about the future of the specialty.”

This article updates a previous online post on March 15, 2024. Nsikak Daniel, was incorrectly identified as a medical student in the prior version. She has already graduated medical school.

Dr. Fisher is an emergency physician and serves as Senior Director, Workforce and EM Practice for ACEP.

Dr. Kiemeny is program director at Loma Linda University Medical Center.

Mrs. Calaway is the managing director of content and communication integration at ACEP.

Dr. Dark is medical editor in chief of ACEP Now and associate professor of emergency medicine at Baylor College of Medicine.

References

1. Adelman L, Fisher J, Dark C. A profession in peril. ACEP Now. 2023;42(3). Available at: https://www.acepnow.com/article/a-profession-in-peril/
2. ERAS statistics. Association of American Medical Colleges. Available at: https://www.aamc.org/data-reports/data/eras-statistics-data. Accessed March 19, 2024.