Little Has Changed in the Competition for EM Jobs


Every year the National Residency Matching Program publishes an annual report detailing how graduating doctors are matched with residency opportunities. The report provides an interesting snapshot of the competitiveness of various medical specialties. This year’s report was especially interesting to people who follow emergency medicine jobs.

Emergency medicine has long been viewed as a competitive field due to its high fill rates. But when you dig deeply into the 2018 numbers, you discover that all is not as it would seem. There is still plenty of competition for emergency medicine jobs, just not as much as you might think.

Job Numbers Continue to Climb

The first aspect of the 2018 report comes as no surprise to people who follow medical jobs. Data reveals that the total number of emergency medicine jobs offered through the residency matching program this year was 2,278, up more than 200 from the previous year. The numbers have been steadily climbing since 2011.

Likewise, the number of approved emergency medicine residency programs rose from 191 last year to 220 this year. Back in 2011 the number was just 150. As you can see, the data clearly shows that both residency and job numbers continue to climb in emergency medicine. But does that make the specialty exceptionally competitive? Not really.

How you Interpret the Data

It is generally assumed that you can tell the competitiveness of a medical specialty by its fill rate. As such, emergency medicine jobs are considered extremely competitive. According to ALiEM contributor Dr. Michael Gisondi, the data shows that fill rates for emergency medicine jobs have been upwards of 99.9% for several years. He says that the way to determine competitiveness is to look at how many of those jobs have been filled by graduating seniors.

When looked at in that light, it is easy to see that little has changed since 2011. The 2018 fill rate for graduating seniors was 70.9% as opposed to 78.4% in the previous two years. Since 2011, that fill rate has hovered between 78 and 80%. If anything, this year’s lower fill rate demonstrates slightly less competitiveness among graduating seniors.

Who Is Taking the Jobs?

The eight-percentage point drop between 2017 and 2018 fill rates for graduating seniors leads to the inevitable question of who is taking emergency medicine jobs. If fewer seniors are taking them, other doctors must be filling in the gap in order to maintain the 99.9% fill rate Gisondi says is the norm.

There are multiple possibilities. Here are just a few:

  • Former Locums – The first thing that comes to mind are locum tenens physicians who decide, for whatever reason, to leave the locum industry and take a permanent placement position. A locum may find a particular emergency department attractive enough to go permanent hire.
  • Foreign Doctors – It is not uncommon for recruiters to look outside the U.S. for new doctors. It is no secret that there are plenty of doctors in other countries desperate for good paying jobs, many of whom will gladly come here to work in our EDs.
  • Other Specialists – We certainly can’t rule out doctors from other specialties who make the transition to emergency medicine just because they want to do something new. Switching specialties is more common in the medical industry than most people realize.

The data is out, and it clearly shows that, although the competitiveness of emergency medicine jobs is certainly there, little has changed in the overall picture for the last six to seven years. That is not necessarily a bad thing in the grand scheme of things.

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