They warn of post-COVID burnout and patients’ growing distrust of doctors. The pay isn’t as good, they say, especially as hospitals rely more on nurses and physician assistants for emergency departments. And job prospects could be bleak, they warn, as emergency medicine residency programs have aggressively expanded in recent years.
Traylor, 51, was surprised to learn that more than 550 emergency medicine openings went unfilled in Match Week, when medical students are assigned to the hospitals that will train them. That was more than double the 219 unfilled spots at the same time last year.
Applicants for emergency medicine training programs dropped 35%, from a high of 3,734 in 2021 to 2,765 this year, according to data from the National Resident Matching Program.
Doctors and industry associations say the drop in interest is a symptom of a struggling medical field as the United States emerges from the worst of the pandemic. Emergency departments are overwhelmed as they become congested with patients waiting for beds, veteran providers give up and violence against the rest of the staff escalates. These factors are damaging the emergency room’s reputation as an ideal place to learn while caring for a steady stream of patients with a wide range of conditions.
“When students see us super burnt out and dealing with a healthcare system that treats the emergency department like an escape valve, they see the toll it takes on us,” he said Jessica Adkins Murphy, president of the Association of Emergency Medicine Residents, who is in her final year of residency at the University of Kentucky Hospital in Lexington. “And in that environment we don’t always have the emotional bandwidth to teach students as much as we should.”
But she said the learning experiences are still valuable. Most open residency slots are eventually taken following a supplemental process that matches programs that were unable to fill all slots with students who originally did not receive offers. This process filled 501 of openings for emergency residency this week.
But the growing number of openings in the first round signals an abrupt shift to a specialty once considered one of the most coveted in medicine, allowing program leaders to be selective in their search for the best and brightest. The medical drama “ER” was America’s most watched TV show in the mid-1990s. ER doctors were hailed as the pandemic’s early heroes, risking their lives caring for a deluge of covid patients that overwhelmed hospitals.
Now students like Traylor — who were drawn to the unpredictability and challenges of emergency medicine and the opportunity to care for society’s most vulnerable — are having second thoughts.
“Nothing really excites me as much as emergency medicine,” said Traylor, who studies at the University of the Incarnate Word School of Osteopathic Medicine in San Antonio. “But I have to keep an open mind because maybe I’ll find something that resonates more.”
Emergency departments that used to pick the best medical students now have to cast a wider net. Even well-known hospitals in big cities – Duke University School of Medicine in Durham, NC, Einstein Medical Center in Philadelphia and Baylor University Medical Center in Dallas – had vacancies open for emergency residents after the first shift, according to a list distributed to students who did not match the first shift. The three hospitals said all their positions were eventually filled.
The decline in interest in emergency medicine does not mean that the United States is facing an immediate shortage of emergency room physicians. Applications for emergency residencies are back to pre-pandemic levels after peaking in 2021. But the number of emergency residency programs has also increased from 171 in 2015 to 287 this year, allowing them to offer more than 3,000 places for the first time, according to corresponding program data.
Indeed, one of the factors that appears to be deterring medical students is a 2021 report that predicts an oversupply of emergency physicians with 8,000 more than needed by 2030.
But industry groups worry that overcorrecting could leave emergency departments understaffed if the next generation of physicians turns to other specialties and burnout continues.
“With the current state of health care, more and more people are dropping out of medicine, and that could lead us to review the oversupply,” said Chris Kang, president of the American College of Emergency Physicians.
Charlie, a third-year med student in New England who spoke on the condition that his last name not be published to protect his job prospects, said his time as an emergency medical technician in Colorado during the height of the pandemic made him reconsider. your objective. to work as an emergency doctor.
Instead of receiving additional help, the ER doctors told Charlie they were forced to work with fewer resources as the burnt out nurses left for better paying jobs. The emergency department bears the brunt of America’s public health failures, from uninsured people admitted with preventable conditions to homeless people who don’t receive basic care, he said.
Charlie said he still considers working in the emergency department a “noble profession”. But as he nears the end of his medical school career, he said he is also considering residencies in psychiatry, internal medicine and family medicine.
“It’s just frustrating to see some of these brilliant minds being crushed just by the pressures of the system over which they have very little influence and control,” said Charlie. “I really need to think about whether this is something sustainable that I can make a career out of.”
Directors of emergency residency programs have urged each other to consider students graduating from osteopathic and international medical schools if they have not done so in the past.
Thomas Cook, who leads Prisma Health’s emergency room residency program in Columbia, SC, said he interviewed 30 more applicants than usual this year as he hoped more students would see emergency medicine as a backup option.
Cook, who has analyzed and written about emergency residency trends, said the rise in hospitals launch of ER programs even when declining enrollments would result in programs considering more students with average grades. But students who graduate at the top of their class aren’t necessarily the best for the emergency room. doctors, he said.
“This is a blue collar job. We are the medical police,” Cook said, noting how the emergency room ensures treatment for everyone, including the uninsured, as well as people with mental health and substance abuse crises. “We’ve always been that safety net, and I think the biggest skill you need to have is a strong work ethic and an enormous amount of compassion.”
Bayhealth in southern Delaware is among the health care systems that It is throwing an emergency medicine residency program this year. But it failed to fill any of its six slots in the first round of residency applications, prompting it to turn to international students as it struggled this week to fill spots.
Dean Johnson, who leads the program, said projections of an oversupply of emergency physicians and the pandemic highlighting the difficult nature of emergency room work had made recruitment more difficult.
“They are voting with their feet,” Johnson said.
To overcome the challenges, he says he needs to highlight the prospects for work in underserved communities, the opportunities created by the unexpected high attrition rate and the value of ER training to any clinician.
The decline in interest in emergency medicine residencies could also be a boon for students who are more dedicated to the field.
Drew Hopper, a first-year medical student in central Washington, has yearned to be an emergency room physician since pursuing one as a high school student in the Portland area. As the father of two young children, he also saw emergency medicine as an opportunity to have a better work-life balance and land a high-paying job without the extensive training required in other jobs.
On the one hand, he’s glad he has less competition to land his dream job. But he also worries about the corporatization of American medicine and the pressure on administrators to work faster with fewer resources, compromising the mission of providing quality care to society’s most vulnerable.
“It’s really sad to see a once-competitive field have so many extraordinary problems,” said Hopper, 32. “I’ve been told over and over again, ‘If you can see yourself doing anything other than medicine, do this.’ It’s the same with emergency medicine: if you can see yourself doing anything other than an emergency, do it.”