On March 18, 2016, medical students across the country learned of their future ACGME residency from the National Resident Matching Program (NRMP). For 1,894 of them, that residency is emergency medicine (see Table 1; one slot was listed as “offered” in error, so only 1,894 EM slots were available in 2016). However, many others may have been disappointed with their results because EM filled every single one of its slots. (There were 2,476 applicants for those EM slots.) In addition, 302 of the 307 osteopathic EM slots were filled via the American Osteopathic Association match on February 8, 2016. This is the second time that EM has filled all of its slots in the NRMP match, with the last time being 2012. Back then, there were 1,668 slots offered in EM. So despite an increase of 227 slots in four years, EM was still able to fill all of them without going through the Supplemental Offer and Acceptance Program (SOAP), which has replaced the “scramble” that previously existed for those who did not match and for programs with unfilled slots.

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Table 1. PGY-1 Residency Positions Offered and Number Filled, 2012–2016

This is great news for EM residency programs, which are landing the best and brightest medical students—the future of the specialty is ensured by this enriched talent pool—but this is bad news for current medical students who have an interest in EM. It is getting tougher every year to match in EM. In 2015, the average USMLE Step 1 score of a student who matched to EM was 230, up from 219 in 2006.

EM does not have residency slots available for all those students who wish to pursue our specialty. Funding for new graduate medical education (GME) slots in general has become very scarce. The federal government has no interest in spending money for new slots. A few local and state governments have provided funds, especially focusing on specific needs in their state. Interestingly, most of the new growth in residency slots has come from private investment. Health systems, large contract management groups, and individual hospitals have determined that their best chance of recruiting physicians for employment is to create and fund their own residencies. This does slowly grow the supply side of residency training, but it also moderates the GME funding crises and makes government action less likely. With the recent strong growth in the number of medical schools and medical school class size, the demand side of the residency training equation is getting larger annually, with medical students caught in the middle and perhaps waiting in a long line of qualified, newly minted physicians awaiting an opportunity to train.

Dr. House is a professor in the department of emergency medicine at The University of Iowa in Iowa City.