By 2019, the three states with the highest percent net change in emergency physicians were Montana (+49.8), South Dakota (+36.7), and Vermont (+29.6). These three states all exhibited relatively low 2013 emergency physician densities and therefore the high net change seemed to be a reassuring finding, as emergency physicians migrated to the states where there was a perceived need for their services.

However, three states in the lowest quintile for 2013 emergency physician density also had negative percent net change by 2019. Idaho (-3.2), Arkansas (-2.6), and Nevada (-0.8) display concerning needs to further increase emergency physician density without positive change occurring over the study years. Separately, we identified clinician-dense states in which another mismatch of supply and demand occurred. Despite already being in the highest quintile of 2013 emergency physician density, states such as Rhode Island (+25.8), Pennsylvania (+19.2), and Michigan (+18.5) all still saw substantial increases in emergency physician density by 2019.

Implications

These findings are salient given worsening inequities in access to emergency physicians, specifically in rural designations. We anticipate persistence of the supply-and-demand mismatch unless substantial efforts are made to address emergency physician recruitment and retention issues. Additionally, these findings are particularly important considering the recent 2022 Match. Despite an increase in emergency medicine residency positions over the last several years, the number of medical school graduates matching into emergency medicine has plateaued. Data from the 2022 cycle even suggests that the entering pipeline may be diminishing, as the number of emergency medicine residency applicants decreased 17 percent (the largest decrease among all specialties) and the number of unfilled residency positions rose from 14 to 219 compared to the 2021 application season.3 It is therefore possible that the combination of increased attrition and decreased entry may reduce the magnitude of the expected 2030 surplus. Two key questions result:

1. Will inflow to the emergency medicine workforce continue to stagnate or even decline?
2. Will outflow from the emergency medicine workforce continue to increase? At minimum, if more recent attrition numbers mirror the years before COVID-19, the actual surplus may pale in comparison to prior expectations.

Looking Ahead

Amidst the Great Resignation, the emergency medicine community must preserve our workforce by ensuring a supportive work environment, redesigning care to accommodate shifts in the workforce, and developing approaches for periodic real-time future surveillance. This is all to avoid today’s feared surplus from turning into a shortage that leaves patients without quality emergency care in a few short decades.