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ACEP Now: Vol 41 – No 07 – July 2022Dr. Schmitz speaking at ACEP’s 2021 Scientific Assembly.
Dr. Schmitz: Isn’t that the very essence of emergency medicine—that we succeed when everyone else thinks we’re going to fail? I love to keep proving them wrong. Advocacy is what ACEP does best. Most people don’t understand that 99.9 percent of bills never become a law; they rarely even get out of committee. I want to particularly highlight the work of Brad Gruehn, Laura Wooster, Ryan McBride, and Jeff Davis, who fought relentlessly to help pass the bipartisan legislation that is the Lorna Breen Act.
I also want to recognize the grassroots efforts of emergency physicians nationwide, the ACEP members who specifically met with their legislators during our LAC conference to garner support, Senator Tim Kaine (D-VA) who helped introduce the bill, and of course Lorna’s family and the Lorna Breen Heroes Foundation that helped this come to fruition. ACEP continues working on both the legislative and regulatory front at the federal and state level to address some of the remaining challenges and barriers to mental health for health care workers and our patients. This is really just the beginning.
Question: This year‘s Match was concerning due to hundreds of empty residency spots. Anecdotally, people have said this might be due to ACEP’s workforce projections or due to the explosion of EM residency programs in recent years. What‘s your take on why so many EM programs went unfilled?
Dr. Schmitz: I believe the results of this year’s Match were a good wake-up call and an opportunity to do things differently. The reasons so many EM programs went unfilled is multifactorial. First and foremost, it was not because we had a drop-off in applicants. Emergency medicine continues to be one of the most competitive specialties in medicine and we would like it to stay that way. The number of applicants in 2022 was roughly on par with where we have been over the past five years. We had more students apply this year than we did in 2019. We did see a drop from last year, but that’s only because 2021 was an anomaly and we saw a record number of applicants during the beginning and peak of the pandemic. If you take out the 2020–2021 match season as an outlier, the number of applicants were exactly what we expected.
I believe the match went initially unfilled for a number of other reasons. First, there were more residency spots as a few new EM programs were approved and some existing programs expanded their class size. Financial pressures will incentivize residency programs to grow. We need to start having some difficult conversations on how we control that growth in a responsible manner and put the needs of the specialty ahead of an individual residency program’s best interests. Second, we had another year of virtual rotations and interviews. One of the main reasons applicants cite when creating their rank list is perceived overall “fit” with the program. It is hard to replicate those personal experiences over webcam and the virtual recruitment season likely swayed the match results. Finally, there are probably some residency programs who miscalculated their overall competitiveness amongst applicants. If a program only submitted 50 names (when they should have submitted 100+), they are likely not going to fill all of their spots. It is possible that many of the applicants ranked all the same programs and that impacted the match.
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