Thread by @ErinKarl_MD

Now that the #Match2023 dust has settled, we have celebrated our newly matched M4s, and as @CORD_EM's #CORDAA23 gets started, I wanted to put together some thoughts on the #EM #Match2023, highlight some facts, and answer some questions. Buckle in folks, and let’s get started! 🧵

We know the drop in applicants is multifactorial, EM is about problem-solving, we're working to make the ED a better place for ourselves/our patients, & at the end of the day the majority of EM docs will still tell you how much pride we take in our work & being badass #EMdocs. 🧵

First, those who were shocked by the # of unfilled positions in the EM #Match2023 were not following the preliminary applicant data we have had since @ERASinfo released data in Oct. showing 3,023 students had applied to EM at that time (down from 3,632 in the #Match2022). 🧵

Check out @DrAdkinsMurphy’s @emresidents President’s Message and analysis of the preliminary data we had this fall/winter: emra.org/emresident/art… 🧵

With 3,010 EM positions available (up from 2,921 last year), this left us with ~609 fewer applicants at the time of applicant data release in Oct. ‘22 & 89 more positions than #Match2022. That is approx. how we get to the 555 positions available in the 2023 #EM #SOAP. 🧵

Thus, the #Match2023 results were expected, and it’s likely that programs that did not course correct and interview applicants who best aligned with the program’s mission and values or had ties to their geographical location were left high and dry to #SOAP. 🧵

Without a doubt, @jbcarmody has the best illustrations of the decrease in #EM applicants. Below, you can see the number of applications vs. positions available, with a clear downtrend in applicants in the @TheNRMP #Match2022. 🧵

.@jbcarmody also recently updated this graph with the final EM applicant to position numbers (note – the numbers are slightly off from the Oct. ‘22 numbers, as not everyone who submits EM applications ends up ranking EM as their first preference). 🧵

For those concerned “no one is going into EM anymore” – if you look at the number of EM applicants over the past 5 years, #s have dropped back down near pre-pandemic (2019) levels. They are down, but not as alarming given the significant peak in 2021. Table credit @francisdeng 🧵

Next, @jbcarmody used the preliminary @ERASinfo applicant data from Oct. ‘22 to illustrate the decrease in #EM applicants based on MD/DO/IMG status, with the biggest drop in MD applicants. 🧵

Some have suggested we need to “focus on increasing MD applicants,” given they have had the largest drop in #s. However, we need to look into the fact that even though our MD students have the best access to EM residency programs/mentors, they have dropped in applicant #s. 🧵

Given they have had the most EM exposure, why are MD students deciding not to pursue EM? Have they had more exposure to the possible #burnout occurring in the specialty? Are they more likely to have repeated exposure to the difficulties of EM #boarding in more academic EDs? 🧵

We also need to take a step back and assess why *all* students who were planning on going into EM changed their minds (not only MD students). Only then can we take this knowledge and course correct. We need to focus on finding solutions to these problems. 🧵

The good news is there is a multi-organizational #EM task force focused on finding these problems and brainstorming interventions to bring students back to the *best* (unbiased, I know 😉) specialty in the House of Medicine. Look for more info from us, soon! 🧵

In the meantime, we know #EDboarding is a problem highlighted by #EMbound students. EM docs are some of the best problem solvers, and EDs across the nation have started to come up with solutions to the boarding crisis. 🧵

.@EmergencyDocs has sounded the alarm on boarding in the ED (

https://twitter.com/EmergencyDocs/status/1589654394047705088?s=20

). Certainly, advocating on a local and national level for added resources and increased staffing in EDs while boarding is at an all-time high is essential. 🧵

Students have voiced concern about the workforce. Further data suggests the attrition rate in EM remains unusually high, but with continued growth in residency positions (new & existing), there will eventually be a surplus: acep.org/life-as-a-phys… 🧵

Next, let’s address the “the @acgme needs to shut down all the HCA programs” take. There are 16 HCA-affiliated programs (acep.org/life-as-a-phys…), which is the largest hospital system affiliated with EM residency programs. 🧵

First, @EmergencyDocs has met with HCA leaders and discussed their concerns with the rate at which they have been opening EM residency programs. It will likely take continued vocal pressure from the EM community for them to curb their rate of opening new programs. 🧵

Only 7 of 57 programs accredited by the @acgme from 2018-2023 are HCA affiliated. While HCA-affiliated programs are growing at an alarming rate, 87.7% of EM programs started in the last 5 years *are not* HCA affiliated. See how that wouldn’t completely fix our program? 🧵

It is also worth noting that programs increasing their complement size has led to an increase in the total number of EM residency positions as well, leading to a further surplus in positions available in the Match. 🧵

Secondly, the @acgme is an accreditation council, and they cannot take into account workforce projections when deciding on which programs to newly accredit or close down. To understand this, one must understand antitrust law and how the ACGME and NRMP are exempt from it. 🧵

Antitrust law is the law of competition. To understand how antitrust law intersects with GME, the ACGME, and the NRMP, read @jbcarmody’s blog, here: thesheriffofsodium.com/2021/03/03/the… 🧵

So, if a program meets the Common Program and Specialty Specific requirements, the @acgme legally has to grant them accreditation. You might ask, how the heck do we increase the standards so all EM residents get high-quality and high-value education? 🧵

Every 10 years, the @ACGME Review Committees are required to evaluate the applicable specialty-specific Program Requirements for revision. For EM, this major revision process will begin in 2023. 🧵

Theoretically, one could conclude the best way to decrease available EM residency positions is to elevate the EM program requirements. The breadth of EM practice is expanding, and now more than ever EM physicians need to be trained to a higher standard. 🧵

Collectively, if the #EM community’s goal is to decrease residency positions, we must advocate for higher residency standards – did you know right now an EM resident only needs 35 intubations to graduate?! 🧵

Additionally, ideas around designating an acceptable trauma level distinction for a program’s primary ED, fellowship training requirements for program leaders, etc. have been proposed in the EM community. 🧵

The comment period for the initial stages of the @acgme EM residency program requirement changes (Summary of Themes and Insights for Emergency Medicine Scenario-Based Planning for Program Requirement Revisions) is open until April 5th (acgme.org/what-we-do/acc…). 🧵

If you have recommendations for EM residency program requirement changes, reach out to @emresidents to share your feedback and concerns. Advocacy is the best way to increase the program standards! 🧵

To conclude, the drop in EM applicants is multifactorial, we are working to make the ED a better place for ourselves/our patients, & at the end of the day, the majority of EM docs will tell you how much pride we take in being badass #EMdocs who treat Anyone, Anything, Anytime. 🧵

Well folks, if you made it to the end of this thread, congrats! Thoughts? Questions? Concerns? Let me know! 🧵