Kiemeney Michael, Morris James, Lamparter Lauren, Weizberg Moshe, Little Andy, Milman Brian
Loma Linda University School of Medicine, Loma Linda, California.
Texas Tech University Health Sciences Center, Lubbock, Texas.
West J Emerg Med. 2025 Mar;26(2):261-270. doi: 10.5811/westjem.21249.
Emergency medicine (EM) historically enjoyed a nearly 100% match rate. A rapid change saw 46% of EM programs with one or more unfilled positions after the 2023 Match. Much has been discussed about potential causes, and characteristics of unfilled programs have been investigated. We surveyed recent applicants to EM to further understand what continues to draw them to EM and what concerns deter them from choosing a career in EM.
A cross-sectional, mixed methods survey was distributed in the summer of 2023 to a convenience sample of respondents via the listservs of national EM resident and student organizations as well as clerkship directors in EM. We did not calculate response rate due to listserv convenience sampling. A total of 213 responses were received, representing 7.7% of the total number of EM applicants (2,765) in 2023. Applicants were asked to rank from 1 to 5 their experiences with EM and the characteristics of the specialty that were important in their career decision. We calculated means and 95% confidence intervals for quantitative results. We performed qualitative analysis of free-text responses to identify themes.
Positive factors for applicants were interactions with EM faculty (4.29 on 1-5 scale) and residents (4.42) as well as clinical experiences in third-year (4.53) and fourth-year clerkships (4.62). Applicants continue to be drawn to EM by the variety of pathology encountered (4.66), flexible lifestyle (4.63), and high-acuity patient care (4.43). Most applicants (68.5%) experienced advisement away from EM. Of those who received negative advisement, non-emergency physicians were the most common source (73.3%). Factors negatively influencing a career choice in EM were corporate influence (2.51), ED crowding (2.52), burnout (2.59), presence of advanced practice practitioners (APP) in EM (2.63), and workforce concerns (2.85). Job concerns stemming from the 2021 EM workforce report were identified by respondents as the primary reason for recent Match results.
Applicants noted clinical experiences in the emergency department and interactions with EM attendings and residents as positive experiences. High-acuity patient care, variety of pathology, and flexible lifestyle continue to attract applicants. Applicants identified EM workforce concerns as the primary contributor to recent EM Match results. Corporate influence, ED crowding, burnout, and presence of APPs in the ED were also significant issues.
从历史上看，急诊医学（EM）的匹配率几乎达到100%。然而，情况迅速发生了变化，在2023年的住院医师匹配之后，46%的急诊医学项目有一个或多个空缺职位。关于潜在原因已经进行了大量讨论，并且对空缺项目的特征进行了调查。我们对急诊医学的近期申请者进行了调查，以进一步了解是什么继续吸引他们投身急诊医学，以及哪些担忧使他们不愿选择急诊医学作为职业。
2023年夏季，通过全国急诊医学住院医师和学生组织的邮件列表以及急诊医学实习主任，对一个便利样本的受访者进行了一项横断面混合方法调查。由于采用邮件列表便利抽样，我们未计算回复率。共收到213份回复，占2023年急诊医学申请者总数（2765人）的7.7%。要求申请者对他们在急诊医学方面的经历以及该专业在其职业决策中重要的特征从1到5进行排名。我们计算了定量结果的均值和95%置信区间。我们对自由文本回复进行了定性分析以确定主题。
对申请者来说，积极因素包括与急诊医学教员（在1 - 5分制中为4.29分）和住院医师（4.42分）的互动，以及三年级（4.53分）和四年级实习中的临床经验（4.62分）。申请者继续被急诊医学中遇到的各种病理情况（4.66分）、灵活的生活方式（4.63分）和高 acuity 患者护理（4.43分）所吸引（此处“高 acuity”可能有误，推测为“高急症”）。大多数申请者（68.5%）经历过不选择急诊医学的建议。在那些收到负面建议的人中，非急诊医生是最常见来源（73.3%）。对急诊医学职业选择产生负面影响的因素包括企业影响（2.51分）、急诊科拥挤（2.52分）、职业倦怠（2.59分）、急诊医学中高级实践从业者（APP）的存在（2.63分）以及劳动力问题（2.85分）。受访者将源于2021年急诊医学劳动力报告的工作担忧视为近期匹配结果的主要原因。
申请者指出急诊科的临床经验以及与急诊医学主治医生和住院医师的互动是积极的经历。高急症患者护理、各种病理情况和灵活的生活方式继续吸引申请者。申请者认为急诊医学劳动力问题是近期急诊医学匹配结果的主要促成因素。企业影响、急诊科拥挤、职业倦怠以及急诊科中高级实践从业者的存在也是重要问题。
不确定“acuity”在文中准确含义，推测为“急症”，以上翻译供参考。
