EM - We Have a Problem

Andy Little, DO, Drew Kalnow, DO, and Matthew DeLaney, MD, FACEP, FAAEM

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The summary below is from an episode of ERcast: Clinical Perspectives

Emergency medicine is under visible workforce and sustainability strain, with boarding, staffing limits, and post-pandemic attrition colliding with a collapse in Match fill rates. The 2023 EM Match left 555 positions unfilled at 131 programs, turning a long-building narrative problem into a specialty-wide credibility crisis.

Emergency Medicine Workforce Crisis

Match collapse signal: Unfilled emergency medicine residency spots jumped from roughly 30 in prior cycles to 219 in 2022 and 555 in 2023, a stark marker that the specialty’s recruitment problem is no longer theoretical.
Workforce projection fallout: The 2021 ACEP workforce study projected a surplus of 7,000 to 13,000 emergency physicians by 2030, and even critics of the model agree the narrative damage has outlived the paper itself.
Residency expansion pressure: New EM programs and expansion of existing residencies widened the gap between training positions and applicant interest, with smaller or newer programs facing the greatest vulnerability.
Operational stressors stack: Boarding, overcrowding, staffing shortages, and shifting performance metrics have compounded the burnout left by a two-plus-year pandemic, creating a plain sustainability problem at the bedside.
Turnover beyond physicians: Retention problems are not limited to attendings; APP turnover is part of the same workforce instability, adding another layer to coverage, culture, and continuity concerns in the ED.
Fragmented specialty messaging: Emergency medicine’s public narrative is diluted when major organizations send conflicting signals about workforce, training, and scope. We get into why that matters in the episode.

Subscribe to ERcast: Clinical Perspectives to listen to the episode.

References:

Marco CA, et al. The Emergency Medicine Physician Workforce: Projections for 2030. Ann Emerg Med. 2021;78(6):726-737. PMID: 34353653
Zink BJ, et al. The Perilous Prognostics of Emergency Medicine Workforce Planning. Ann Emerg Med. 2022;80(3):272-274. PMID: 35931607
Gettel CJ, et al. The 2013 to 2019 Emergency Medicine Workforce: Clinician Entry and Attrition Across the US Geography. Ann Emerg Med. 2022;80(3):260-271. PMID: 35717274
Adelman L. Unpacking the 2023 Match Week. ACEP Now. https://www.acepnow.com/article/a-profession-in-peril/. Published April 4, 2023.
2023 Match Statement. www.emra.org. Accessed May 6, 2023. https://www.emra.org/be-involved/be-an-advocate/working-for-you/2023-match-statement
Joint Statement on the Emergency Medicine 2023 Match Results. www.acep.org. Published March 13, 2023. https://www.acep.org/news/acep-newsroom-articles/joint-statement-match-2023
2023 Match Statement. www.sempa.org. Published March 17, 2023. Accessed May 6, 2023. https://www.sempa.org/about-sempa/statements/2023-match-statement
Adelman, MD L. Unpacking the 2023 Match Week. ACEP Now. Published March 14, 2023. Accessed May 6, 2023. https://www.acepnow.com/article/a-profession-in-peril/

Faculty

Andy Little, DO
Dr. Andy Little is an emergency medicine physician and educator. He earned his medical degree from the Ohio University Heritage College of Osteopathic Medicine and completed his emergency medicine residency at OhioHealth Doctors Hospital Emergency Medicine Residency, where he served as Chief Resident. He has received multiple national awards, including recognition from the American Osteopathic Association, American College of Osteopathic Emergency Physicians, and Emergency Medicine Residents' Association.
Drew Kalnow, DO
Dr. Drew Kalnow is an emergency medicine physician and educator based in Columbus, Ohio. He completed his emergency medicine training at OhioHealth Doctors Hospital Emergency Medicine Residency. Dr. Kalnow is passionate about advancing emergency medicine through high-quality education, with a particular focus on simulation, learning theory, and innovative teaching.
Matthew DeLaney, MD, FACEP, FAAEM
Dr. Matthew DeLaney is an emergency medicine physician and educator based in Birmingham, Alabama. A native of Mobile, he earned his medical degree from the University of South Alabama and completed his emergency medicine residency at Maine Medical Center.Dr. DeLaney has experience in both community and academic emergency medicine and is known for his commitment to teaching and medical education. He lives in Birmingham with his wife, Erin, who is also a physician, and their two daughters.