2023 Match leads to heated opinions

Time to step back and consider how over 500 spots did not fill opening day.

With the results of the initial 2023 match in hand, we know that over 120 programs and over 500 spots did not fill on the initial day. Since the news hit social media there has been a definite backlash, with some choosing to be “all in” on proclaiming the sky is falling, with a growing group calling to remind us all that despite these events EM is still the best place to practice.

As the SOAP (aka Scramble) happens this week, be sure to watch what organizations and people say. It will be a mix of pledges to get to the root of the issue, and a lot of folks using this event to push their personal/organizational agendas. I ask you to pay attention as people speak, they’ll make their intentions very clear.

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As we all wait for the final match results to come out Friday, and the following weeks as groups look at the data, I wonder if we all would consider taking a pause and asking ourselves, and our specialty a few questions.

Why did this happen?

When the dust settles, this will come down to a multi-issue problem.

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• The ACEP workforce study was flawed from the day it was published, and it was used to push the narrative that the future is not bright.
• We probably expanded the number of spots too rapidly (both by increasing the size of current programs and by adding new programs in the past three to five years). This is exacerbated by many of these spots being at for-profit hospitals sponsored by HCA.
• EM has taken its fair share of abuse during the COVID pandemic, with the effects lingering today in every shift we work. Boarding, low staff numbers and high attrition of EM physicians over the past two years.
• Moving all interviews to virtual has caused an over-interview phenomenon, leading many programs to interview and rank a larger percentage of the same people. Leaving many qualified students with few interviews and going unmatched.
• Probably most importantly, seeing a significant drop in the number of US MDs and Dos applying to EM over the past two years. The reason for this phenomenon is also multifactorial.
• Negative messaging from EM organizations and prominent EM physicians, tearing the specialty down and encouraging potential residents to “stay away.”
• And I’m sure there are things we are not seeing that will come to light.

What is to be done?

Here is where this is tricky, as some of it is out of our control, and some of it isn’t.

• Until the RRC steps up and alters the program requirements, we will probably not see a decrease in the number of spots or programs. Resident labor is the cheapest way to staff EDs and until that changes, this will be a problem.
• Presenting new data showing EM is now physician poor and there are ample opportunities to work in our field.
• Work on increasing the number of EM-bound students through honest discussions about our specialty while highlighting this is still the best specialty in the house of medicine (apologies for my bias coming out there).
• Encouraging and enforcing practical interview practices. Organizations should push for accountability and transparency from AAMC on this.

How can I help?

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Lift where you stand.

• If you work in academics make sure your programs are teaching at the highest level, and that your programs aren’t just in the business of running your ED with residents to save your hospital some cash.
• If you work in undergraduate medical education, help your students practice reasonable and fair interview practices rather than interviewing as many places as possible to make sure your school’s match rate looks good each year.
• If you mentor students, keep up the good work and continue to inspire our future workforce.
• If you work with one of the many committees or organizations involved in EM, spend your time working on ways to build our specialty rather than tear it down with infighting, building a house of EM anyone and everyone would want to be a part of.
• If you are just a practicing EP, remind yourself and others around you about the good in what we do (and I know it isn’t all roses), and be honest about where we can improve without making it personal.

This is a serious time for EM, it’s a wake-up call for sure. But we need to all take the time to thoughtfully investigate what happened, and why it happened and come up with realistic, metered solutions, and that all starts with pausing to consider where we as an EM family stand.