Timothy Cheslock, DO, FACOEP
As I write this article, the results of the 2023 Match have just been released and the internet is flooded with tweets and comments, opinions of many varieties as to what is happening to our profession. What went wrong? Why so many unmatched slots? Is EM no longer appealing to medical students? I do not profess to have the answers to all these questions and the opinions I express here are truly my own. Where does the future of our profession lie?
One of the foremost issues we need to confront head-on is what is our current state? Based on conversations with EM physicians all over the country it’s clear that our state of affairs is not good. Many departments are functioning out of a physical space severely restricted by boarding patients, are chronically understaffed by nursing, and lack the resources to deal with the daily deluge of patients redirected from primary care offices, urgent cares, and other settings where the on-site providers just don’t feel comfortable addressing what may or may not be a more complex problem. Hospitals were not prepared to deal with the issues that led us to our current state and either chose not to or have deflected in many instances back to us as to how we are going to fix the situation and still meet metrics that were designed for a fully operational department that is adequately staffed. Many of the problems we deal with are the result of the hospital failing to do its part to mitigate the situation due to cost or inconvenience. Regardless, it is our current work environment in many instances. Does this appeal to you? Now to be fair it is not like that everywhere. In many cases it’s better, in some cases even worse. Either way, the work environment has deteriorated for most of us to some degree over the last few years. The pandemic has forever changed the landscape of medicine. Many practices outside of EM have seemed to go entirely virtual. Sometimes coming to the ED is the only way patients get true human interaction and touch.
Selling the profession to a future generation of physicians within the confines of that landscape is challenging. It is not something you can hide either. Students see it as they rotate through our departments. They are very astute in picking up on the frustrations in a department. Hopefully, they are still able to garner educational value and pearls to take forward in their education, because even in harsh environments, learning can take place. Some students thrive in a challenging environment and those are the ones that we seek to match and we have! Over 2500 successful matches for EM took place this year.
What about the match itself? Are there inherent problems with the software, the algorithm? Are programs or students changing they way they submit their lists? These are great questions that have come up, but ones that I cannot shed any light on. It would be interesting to conduct a study and see if any of that had a bearing on the results. Are communications during interviews between students and faculty leading one or the other to rank a certain way and is that hurting prospective matches?
Barring a functional issue with the match, why is it that certain programs filled and others have not? Scanning the list it is hard to draw any definitive conclusions. Many well-established programs did not fill, many newer programs did not fill. It’s all over the map. I’m sure in the coming months feedback from these programs as to what their individual circumstances may have been will be sought out. How much of that you and I will be privy to remains to be seen. Most programs find it gut-wrenching enough to look introspectively. I don’t know many that will share their pain in public forums.
The number of new residencies has most definitely played a role in our current situation. Over the last few years, there has been an explosion of new programs. Many concentrated in my own state of FL but also in many other areas of the country. What brought about this rapid proliferation continues to be up for debate. Many of these programs have come under the umbrella of one or two large healthcare institutions. Was this a strategic move sparked by a tremendous desire to educate or some other factor that prompted the plunge into the GME environment? As it stands currently, the ACGME standards for opening a new program are fairly obtainable for even the most basic community hospital settings. Can you blame systems for taking advantage of it for their own gains? What can be done about it in the future?
By now you are thinking where is the good in all this? Is there any? Of course, there is, if not we would all just throw our hands up and walk away. We have a growing and dynamic specialty. Until now we have benefited from a highly sought-after profession with tremendous opportunity. Have we saturated the market? Hardly. Not a day goes by that I receive offers of employment from across the country. Could our profession use some fine-tuning? Absolutely.
Emergency Medicine is full of dedicated, well-trained professionals. We are in a fairly well-compensated specialty that affords us a lifestyle that many would be envious to have. It is challenging and stressful, but at the end of the day, we do our best to care for those that are in need. Nothing is more satisfying than a thank you from a patient who truly appreciated your care or better yet asks where is your office, can you be my doctor all the time?
As the president of our college, I can assure you that the board is keenly aware of all the issues I mention above and many more. We are active in collaborating with other national EM organizations to assure that your concerns are addressed. We advocate everyday to help strengthen the profession and make it the best it can be. Over the next several months myself and many other members of the board will be participating as your representatives at collaborative meetings on these topics. We have been invited by ACGME to send representatives to discuss new basic standards for EM residency training. I will be attending the EDPMA meeting along with the president of ACEP to address their organization and the challenges we all face. We are here for you and pledge to continue to represent your concerns for our specialty and our patients. The only way to make our specialty better is to be part of the solution. I invite each of you to do your part so that we can once again make Emergency Medicine the great professional we all devoted ourselves to when we made our own match! –•–