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In this year's Match, went unfilled -- more than double the 219 unfilled positions last year and only 14 unfilled spots in the 2021 Match, according to preliminary data.

This year's data were shared across social media but not officially by the National Resident Matching Program (NRMP), and most of the spots will likely be filled in the Supplemental Offer and Acceptance Program (SOAP). Nonetheless, emergency medicine physicians are concerned about the recent trend.

"It's a radical change," said Robert McNamara, MD, chair of emergency medicine at Temple University in Philadelphia and chief medical officer of the American Academy of Emergency Medicine (AAEM). "If you go back 3 or 4 years, emergency medicine was one of the most competitive specialties."

The reasons for the jump in unfilled positions -- the exact spots and programs were -- are multifactorial, according to a from several emergency medicine groups published on the American College of Emergency Physicians (ACEP) website. Reasons include workforce projections, increased clinical demands, emergency department boarding, economic challenges, the COVID-19 pandemic, the corporatization of medicine, and others.

"It's still a great profession, we just don't have the narrative we did 15 to 20 years ago," said Ryan Stanton, MD, an emergency medicine physician in Lexington, Kentucky, and an ACEP board member. "It's a negative narrative. We hear about struggles with payers, and threats of continued cuts. Students listen to that."

McNamara placed special emphasis on workforce issues -- in particular, that warned of future challenges with emergency physician oversupply -- and on the increasing involvement of corporate entities.

"Emergency medicine residents always have among the highest debt of any specialty," McNamara said. "They have a strong sense of social justice and often don't come from privileged backgrounds ... so they're likely to accumulate debt."

Residents carrying a lot of debt who suspect they won't be able to get a job when they graduate may be deterred from entering the specialty, he noted.

Additionally, fewer graduates are finding placement with physician-owned groups, and instead more are working for corporate entities, which can impact physician autonomy, he added.

"Doctors who work for these companies don't like it," McNamara said. "They're burning out. They get treated like a money-making machine, like a cog in the wheel. ... Emergency medicine is a 24/7/365 specialty, and with the nature of the things we see, you can't do a difficult specialty long-term if you feel someone is taking advantage of you."

Facilities have created more emergency medicine residency spots in recent years, he pointed out, noting that, in a way, the specialty is a victim of its own success. "Once you attract talented doctors, you want more," he said. "Some hospitals say, wow, they have an emergency medicine residency, I want one too. We just created too many."

He said it's not just corporations pushing to create new positions, but academic centers as well.

Stanton was particularly concerned about the creation of new residency positions. "There are no guardrails on the number of programs, whether they're produced by HCA or the expansion of academic programs," he said. "You can open up a residency program as long as you meet ACGME [Accreditation Council for Graduate Medical Education] criteria."

"A residency program is not a cost-effective staffing strategy. It is an educational opportunity," he added. "Any program expanding simply to find a cheap workforce is doing it for the wrong reasons."

Bryan Carmody, MD, of Eastern Virginia Medical School in Norfolk, who posts frequently about Match data, noted in that even while emergency medicine residency positions are up -- they more than doubled in the past 15 years -- the number of applicants took a significant dip last year, and fell again in this year's Match cycle.

"Regardless of why, the what is clear," Carmody wrote. "There are unquestionably fewer emergency medicine applicants. So the next question is, if you care about emergency medicine, what -- if anything -- should you do about it?"

In the joint statement, ACEP, AAEM, and others noted that they convened a Match Task Force to identify the factors that have led to the increase in unfilled positions, and to develop a strategy to mitigate the crisis.

"Although these are challenging results, emergency medicine remains a vibrant and appealing specialty for many, with almost 2,500 new trainees already joining the emergency medicine family," the group wrote.

McNamara said there are no easy solutions. "We have to restore emergency medicine to a practice where physicians can enjoy the job," he said. "It's not going to be good for a while."

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