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Match Results 2023: Why Did Emergency Medicine Do So Badly?

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Emergency medicine has had its ups and downs over the years with regard to desirability. Soon after the show “ER” became popular, emergency medicine programs also were suddenly in vogue. Over the interim years, the field’s cachet has declined and increased, but up until recent years, emergency medicine programs routinely filled 99% of their available spots in the Match.

The fact that 554 emergency spots went unfilled in this past Match was particularly distasteful to many emergency physicians, accordingly.

The reasons for this plummeting interest in the field is well described in a recent piece in ACEP Now. (ACEP stands for the American College of Emergency Physicians.) The authors note multiple issues, including burnout, decreasing remuneration, and systemic problems in the emergency healthcare system that frustrate clinicians. 

Of note, these issues have driven out many middle-aged emergency physicians, as well.

Even if you are not interested in becoming an emergency doctor, take a look at the piece here, keeping in mind that certain factors may soon adversely affect other specialties as well.

(I’d like to give a shout out to my old friend Jonathan Fisher MD MPH who was one of the reporters on this article.) 

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Being Valued is Undervalued

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I read an interesting JAMA study on burnout recently. We’ve all heard about the problem and its growth over the past few years. But I found the results of this study particularly interesting: The authors found that chaotic workplaces and lack of control of workload were associated with higher burnout (think emergency departments or a poorly run, overscheduled clinic), while efficient teamwork and feeling valued were associated with lower burnout. People sometimes pay lip service to the importance of being appreciated, but this study really proves its significance.

It’s worth considering this study’s results when making decisions about what field to choose, where to train, and what position to take after residency. Here’s the article.

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Understaffing is Affecting Patient Care

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I am only middle aged, and yet, so many of my cohort, including myself, have recently left clinical medicine. There are layer upon layer upon layer of reasons: Even before the pandemic, burnout and discouragement about the current healthcare system were big problems amongst providers. Then, COVID facilitated more departures because of the need to stay home to care for children or even illness and death, sadly. Finally, the national workforce shortage and economic cuts have led to a real crisis in our medical system. 

See this piece by Dr. George Hyde, a pediatric resident at Harbor UCLA, as he describes how understaffing is directly harming patient care.

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Medscape’s National Physician Burnout Report 2021 is out – and it’s Troubling

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The Medscape National Physician Burnout & Suicide Report 2021 is now available, and it seems rather evident that the pandemic has negatively affected physicians who were already under a lot of stress, especially those in critical care medicine.

More than half of critical care physicians report being burned out (51%), and critical care ranks as the highest specialty in the burnout questionnaire, followed by rheumatology (50%) and infectious disease (49%). Those numbers compare with last year’s report at 44%, 46%, and 45%, respectively. This year, my field of emergency medicine (EM) was at 44%, which sounds high, but, sadly, EM was not even in the top ten burned out specialties. That gives you an idea of the severe scope of the problem.

Women reported burnout at 51% compared to 36% for men, and while this disparity has been present for many years, the discrepancy between the genders was greater in this most recent report.

Seventy-nine percent of those surveyed relayed that their burnout started before COVID, while 21% reported after. Bureaucratic tasks and too many hours at work were the major reported contributors to burnout.

Take a look at the Medscape National Physician Burnout & Suicide Report 2021 slide deck yourself for more interesting details, and check out my Kevin MD piece on EM burnout here.

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Burnout and Does the Patient Always Come First?

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Although written somewhat tongue-in cheek, “A Totally Novel Concept: The Patient Comes Second” – sent to me by an emergency medicine colleague – is worth a quick read. Considering the huge problem with physician burnout, putting the patient second sometimes is an interesting intellectual exercise.

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About Dr. Michelle Finkel

Dr. Michelle Finkel

Dr. Finkel is a graduate of Stanford University and Harvard Medical School. On completing her residency at Harvard, she was asked to
stay on as faculty at Harvard Medical School and spent five years teaching at the world-renowned Massachusetts General Hospital.
She was appointed to the Assistant Residency Director position for the Harvard Affiliated
Emergency Medicine Residency where she reviewed countless applications, personal statements and resumes. Read more

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