Cracking the code on the emergency medicine match: It's about supply and demand, not interviews

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES
Alexis E. Pelletier-Bui MD, Laura R. Hopson MD, Jason I. Reminick MD, MBA, MS, Michael C. Bond MD, Alisa Hayes MD, Ephy Love PhD
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Potential factors fall into three areas: excess supply of positions, lack of student demand for EM and problems embedded in the recruitment process.</p><p>Key insights into EM's current challenges can be gleaned from publicly available data from the Electronic Residency Application Service (ERAS), the NRMP, and the Accreditation Council for Graduate Medical Education (ACGME) as well as data from Thalamus (a graduate medical education interview management platform representing approximately 25% of EM programs; “Thalamus”) and additional NRMP data as a result of a data sharing agreement with Thalamus (“NRMP/Thalamus”).</p><p>EM programs in The Match increased from 170 to 287 (69%) from 2014 to 2023,<span><sup>1</sup></span> which includes 50 American Osteopathic Association programs that transitioned to the ACGME.<span><sup>2</sup></span> EM positions increased from 1786 to 3010 (69%) over the same period through both contribution from new programs and expansion of existing programs.<span><sup>1, 2</sup></span></p><p>After a steady increase in applicants from 2019 to 2021, allopathic and osteopathic applicants decreased substantially in 2022 and 2023, with the steepest decline in allopathic applicants (Figure 1). Total applications from all applicant types declined by approximately 17% year-over-year for the last two Match cycles (email communication from ERAS Strategy &amp; Engagement Director, Michele Oesterheld, May 2023). In both 2022 and 2023, the number of applicants preferring EM who submitted a rank order list (ROL) in EM was lower than the number of positions available (NRMP/Thalamus; Figure 1).</p><p>In sum, almost every 2023 EM applicant in ERAS would have needed to match in EM to fill the available positions, which was unrealistic. For the past 2 years, approximately 30% of applicants to EM also applied to at least one other specialty (email from ERAS Pilot Administration Director, Jayme Bograd, October 2022), with some preferring that other specialty (NRMP/Thalamus). Other applicants may have had academic challenges, visa, licensing, or credentialing issues that hindered their consideration at many institutions. 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From the late 1980s to early 1990s, anesthesiology residency positions exploded. A 1994 workforce assessment predicted a future oversupply. Extensive publicity drove a precipitous decline of U.S. applicants.<span><sup>9</sup></span> By 2000, IMGs comprised more than half of the graduating anesthesiologists in the United States.<span><sup>9</sup></span> Total applicants to anesthesiology did not begin to recover until 2001 data forecasted a significant workforce shortage. 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引用次数: 0

Abstract

Emergency medicine (EM), a historically highly competitive specialty, experienced an abrupt change in the National Resident Matching Program (NRMP)'s Main Residency Match (hereafter referred to as “The Match”) results in 2022 and 2023. Unfilled residency positions increased from an average of 0.48% (2012–2021) to 7.4% (2022) and 18.4% (2023), leaving 46% of EM residency programs facing vacancies in 2023.1

This drastic shift produced keen scrutiny to the cause. Potential factors fall into three areas: excess supply of positions, lack of student demand for EM and problems embedded in the recruitment process.

Key insights into EM's current challenges can be gleaned from publicly available data from the Electronic Residency Application Service (ERAS), the NRMP, and the Accreditation Council for Graduate Medical Education (ACGME) as well as data from Thalamus (a graduate medical education interview management platform representing approximately 25% of EM programs; “Thalamus”) and additional NRMP data as a result of a data sharing agreement with Thalamus (“NRMP/Thalamus”).

EM programs in The Match increased from 170 to 287 (69%) from 2014 to 2023,1 which includes 50 American Osteopathic Association programs that transitioned to the ACGME.2 EM positions increased from 1786 to 3010 (69%) over the same period through both contribution from new programs and expansion of existing programs.1, 2

After a steady increase in applicants from 2019 to 2021, allopathic and osteopathic applicants decreased substantially in 2022 and 2023, with the steepest decline in allopathic applicants (Figure 1). Total applications from all applicant types declined by approximately 17% year-over-year for the last two Match cycles (email communication from ERAS Strategy & Engagement Director, Michele Oesterheld, May 2023). In both 2022 and 2023, the number of applicants preferring EM who submitted a rank order list (ROL) in EM was lower than the number of positions available (NRMP/Thalamus; Figure 1).

In sum, almost every 2023 EM applicant in ERAS would have needed to match in EM to fill the available positions, which was unrealistic. For the past 2 years, approximately 30% of applicants to EM also applied to at least one other specialty (email from ERAS Pilot Administration Director, Jayme Bograd, October 2022), with some preferring that other specialty (NRMP/Thalamus). Other applicants may have had academic challenges, visa, licensing, or credentialing issues that hindered their consideration at many institutions. These data clearly illustrate that a supply-and-demand mismatch exists between EM applicants and currently available positions.

Some propose that potentially modifiable program and applicant interview behaviors contribute to Match results.3, 4 These are likely limited in their impact.

We need to understand why the pipeline to EM is decreasing. One major concern is the projected surplus of 7845 EM physicians by 2030 limiting future job prospects.7 While there will still be EM job shortages in many areas,8 geography drives most individuals' decisions when choosing where to train and practice.1 Whether or not the assumptions around the initial workforce study are sustained,8 the impact of the initial report will likely not rapidly abate.

Anesthesiology previously experienced similar workforce challenges. From the late 1980s to early 1990s, anesthesiology residency positions exploded. A 1994 workforce assessment predicted a future oversupply. Extensive publicity drove a precipitous decline of U.S. applicants.9 By 2000, IMGs comprised more than half of the graduating anesthesiologists in the United States.9 Total applicants to anesthesiology did not begin to recover until 2001 data forecasted a significant workforce shortage. Reassessment of the anesthesiology workforce in 2011 showed that entry rates into anesthesiology still remained below 1993 levels and projected continued workforce shortages due to further contraction of training positions.9 Extrapolating from anesthesiology, it is unlikely that student interest in EM will increase until they are confident of future job availability.

The excess supply of emergency medicine positions and lack of student demand are the primary drivers for the 2022 and 2023 emergency medicine Match experiences. Modifying interview behaviors will not resolve the situation. Improvement in future Match cycles will require a change in student interest. Emergency medicine must address its detractions including workforce projections and the work environment. We must educate applicants on the numerous benefits of selecting a career in emergency medicine. We will need to support our training programs through difficult decisions regarding program size and tackle institutional and national policy changes.

Alexis E. Pelletier-Bui: Study concept and design, drafting of the manuscript, critical revision of the manuscript for important intellectual content, analysis and interpretation of the data. Laura R. Hopson: Study concept and design, drafting of the manuscript, critical revision of the manuscript for important intellectual content, analysis and interpretation of the data. Michael C. Bond: Study concept and design, drafting of the manuscript, critical revision of the manuscript for important intellectual content, analysis and interpretation of the data. Alisa Hayes: Study concept and design, drafting of the manuscript, critical revision of the manuscript for important intellectual content, analysis and interpretation of the data. Jason I. Reminick: Study concept and design, drafting of the manuscript, critical revision of the manuscript for important intellectual content, acquisition of the data, analysis and interpretation of the data. Ephy Love: Study concept and design, drafting of the manuscript, critical revision of the manuscript for important intellectual content, acquisition of the data, analysis and interpretation of the data, statistical expertise.

LRH reports the following conflicts of interest: Research support from Toyota Motor Co. for unrelated work (PI-Brent, University of Michigan, ended August 2022), Member of CORD BoD and this work does not reflect organizational opinions. JIR and ERL report the following conflicts of interest: JIR and ERL are both shareholders and employees in Thalamus. The other authors declare no conflicts of interest.

Abstract Image

破解急诊医学匹配密码:关键在于供需,而非面试
急诊医学(EM)历来是一个竞争激烈的专业,但在 2022 年和 2023 年,国家住院医师匹配计划(NRMP)的主要住院医师匹配(以下简称 "匹配")结果却发生了突变。未填补的住院医师职位从平均0.48%(2012-2021年)增加到7.4%(2022年)和18.4%(2023年),使得46%的急诊科住院医师项目在2023年面临职位空缺。潜在因素可分为三个方面:职位供应过剩、学生对 EM 需求不足以及招聘过程中存在的问题。我们可以从住院医师电子申请服务(ERAS)、NRMP和毕业后医学教育认证委员会(ACGME)的公开数据,以及Thalamus(一个毕业后医学教育面试管理平台,代表了约25%的EM项目;"Thalamus")的数据和NRMP与Thalamus达成的数据共享协议("NRMP/Thalamus")中获得有关EM当前挑战的关键信息。从 2014 年到 2023 年,The Match 中的 EM 项目从 170 个增加到 287 个(69%),1 其中包括 50 个过渡到 ACGME 的美国骨科协会项目。同期,通过新项目的贡献和现有项目的扩展,EM职位从1786个增加到3010个(69%)。1, 2A 在2019年至2021年申请者稳步增加之后,2022年和2023年,全科和骨科申请者大幅减少,其中全科申请者的降幅最大(图1)。在过去两个Match周期中,所有类型申请人的申请总数同比下降了约17%(ERAS战略与amp的电子邮件通信;参与总监Michele Oesterheld,2023年5月)。总之,ERAS中几乎所有2023年的EM申请人都需要通过EM匹配来填补现有职位,这是不现实的。在过去两年中,约有30%的电磁学申请人还申请了至少一个其他专业(ERAS试点管理主任Jayme Bograd的电子邮件,2022年10月),其中一些人更喜欢其他专业(NRMP/Thalamus)。其他申请人可能在学术上遇到困难、签证、执照或证书问题,阻碍了许多机构对他们的考虑。这些数据清楚地表明,电磁学申请者与现有职位之间存在供需不匹配的情况。一个主要的问题是,到 2030 年,预计将有 7845 名急诊科医生过剩,这将限制未来的就业前景。7 虽然在许多地区仍将存在急诊科工作岗位短缺的问题,8 但在选择培训和执业地点时,地理因素会促使大多数人做出决定。1 无论最初的劳动力研究的假设是否成立,8 最初报告的影响可能不会迅速减弱。从 20 世纪 80 年代末到 90 年代初,麻醉科住院医师职位激增。1994 年的一项劳动力评估预测未来将供过于求。到 2000 年,IMGs 已占美国麻醉医师毕业人数的一半以上。9 直到 2001 年的数据预测麻醉医师队伍将出现严重短缺时,麻醉医师的申请总人数才开始恢复。2011 年对麻醉科劳动力的重新评估显示,麻醉科的入职率仍低于 1993 年的水平,并预计由于培训职位的进一步收缩,劳动力短缺将持续存在。9 从麻醉科推断,在学生对未来工作机会充满信心之前,他们对急诊医学的兴趣不太可能增加。改变面试行为并不能解决这一问题。未来 Match 周期的改善需要学生兴趣的改变。急诊医学必须解决其不利因素,包括劳动力预测和工作环境。我们必须让申请者了解选择急诊医学职业的诸多好处。我们需要支持我们的培训计划,在计划规模方面做出艰难的决定,并应对机构和国家政策的变化:研究概念和设计、手稿起草、对手稿中重要的知识性内容进行批判性修改、分析和解释数据。Laura R.
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
AEM Education and Training
AEM Education and Training Nursing-Emergency Nursing
CiteScore
2.60
自引率
22.20%
发文量
89
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