I recently did a research project on the progression of emergency medicine residency programs in the past 20 years. There are now 200 residency programs broken down as follows: 114 three-year and 35 four-year Allopathic (total 149), 28 three-year and 18 four-year Osteopathic (total 46) and five military-based residency programs.

The yield from these residency programs is approximately 2,057 graduates, 1,727 Allopathic and 320 Osteopathic. With more than 1,500 new jobs being created each year and many leftovers still unfilled from the year before, the numbers just don’t add up. One of the major issues is also the location of these residencies with only 40 in the Western half of the US and the rest in the East. Many states tend to retain a large portion of their residents, but in states like North and South Dakota, the need is high and the supply low.

I recently had the pleasure of lecturing at the Regions Hospital Emergency Medicine Residency in St. Paul, Minn. Not one of their residents wanted to leave the state! In residency-rife cities like Philadelphia, Boston and New York, there is more of a migration from the program site (especially New York with their dismal income-to-cost ratios). But one-program states like Maine, Wisconsin and Oregon will retain more than 90% of their grads. Another factor is growth ratio … Allopathic program growth in the past five years is less than 7% while Osteopathic programs have increased by 20. All this means that there are not enough emergency physicians to fill the emergency departments and not enough emergency departments to handle the ever increasing census coming through their doors. So the market will be highly competitive again this year with fewer jobs in the highly-desirable lifestyle locations, and more in the rural and less popular lifestyle regions.

As for job requirements, we saw the availability of emergency medicine jobs open to primary care trained physicians hit a high of 35% last year. This year it is at 40%. These numbers have a direct correlation to permeation of large, national contract groups.

In the Northeast, where primary care boards are accepted at only 15% of jobs, only 22% of jobs are with NCGs.