A Systematic Survey of Emergency Medical Services Fellows in the United States.

Emergency medical services (EMS) fellowship program accreditation in the United States began in 2013, and the number of available programs has rapidly expanded since then with a corresponding increase in the number of fellows. Despite this increase in program number and attendance, there is a paucity of data in the literature reviewing personal and professional characteristics of the fellows, their experiences during fellowship, or understanding of their intended desires from fellowship. This study surveyed 2020-21 and 2021-22 EMS fellows regarding their personal and professional characteristics, motivations for program choice, remaining school debt, and the effects of COVID-19 on their training. Fellows' contact information was obtained individually from program directors as listed in the National Association of EMS Physicians fellowship list. A link to the 42-question electronic survey and periodic reminders were sent to fellows using REDCap. Descriptive statistics were applied to analyze the data. Ninety-nine responses (72%) were obtained from a list of 137 fellows. Most were White (82%), male (64%), 30-35 years of age (59%), with MD degrees, from three-year residency programs. Few (9%) had advanced degrees, but many (61%) had prior EMS experience, mostly at the EMT level. Most had $150,000 - $300,000 of school loan debt, and worked for a resident salary with additional benefits. Fellows were attracted by overall program offerings, physician response vehicles, availability of air medical experience, and the quality of faculty, and tended to stay where they did residency. A few (16% of the 2021-22 cohort) reported increased motivation to apply due to COVID-19 worsening job prospects. Graduating fellows felt most comfortable in clinical competencies and least comfortable in special operations, unless they had previous EMS experience. Sixty-eight percent had jobs as EMS physicians in June of their fellowship year. Most (75%) felt that the pandemic had made it harder to find jobs, and half were forced to move for employment. The demographics and graduate's level of preparedness appear similar to those reported from 2016, and reflect the demographics of emergency medicine residents. Other new information including desired program qualities and offerings is potentially useful for program directors. COVID-19 did appear to have a small effect on fellow's actions and possibly on ease of post-graduation employment.