Emergency medicine residencies are empty because unmatched students, programs shuffle through SOAP

Emergency Medicine Physicians at Einstein Montgomery Medical Center huddled in a room over the past few days, scrambling to fill unclaimed residency slots. Colleagues stopped by snacks from Wow. Others gathered on social media to support the program: “Please check us out.”

On Monday, the program learned it had filled just four of eight positions in the national match, which matches medical school graduates with hospital training programs.

About two dozen emergency medicine residencies remain throughout the Philadelphia region to grab after it matches.

Vacancies highlight a two-year national trend showing a growing number of medical students choosing not to spend their careers in emergency rooms.

» READ MORE: On match day, medical students learn where they will start working as doctors. Four in Jefferson offers an inside look at the process.

Einstein Hospitals is part of Jefferson Health, which had a quarter of its emergency medicine slots unclaimed. Einstein Medical Center on North Broad Street matches six of its 14 locations.

Separately, Nazareth Hospital in Northeast Philadelphia, part of Trinity Health Mid-Atlantic, did not fill any of its six emergency medicine residency slots.

In the whole country, an unprecedented 555 of the roughly 3,000 emergency medicine residency slots remained unfilled after this year’s match, the American Academy of Emergency Medicine and other professional societies said in a joint statement. Last year, 219 slots went unclaimed in the game, a nearly 20-fold increase from 2018, when 13 spots went unclaimed.

Some emergency medicine doctors now question whether their the once coveted major is an “occupation in jeopardy.”

In addition to Einstein-related programs, Jefferson trains emergency medicine physicians at three different regional hospitals. Some programs performed better. The emergency medicine program at Thomas Jefferson University Hospital in downtown Philadelphia, the largest in the region with 17 seats, has indeed filled up up. And Jefferson’s South Jersey program fills 12 of the 13 slots.

Another smaller program at Jefferson Northeast, based in Torresdale, filled just four of eight spots.

Among the factors contributing to lower interest: This graduating class of medical students saw emergency room workers on the front lines of a pandemic, when personal protective equipment was scarce and burnout was high, said Elizabeth Dattner, chair of emergency medicine at Einstein Healthcare Network.

The Philadelphia area has high rates of drug overdoses and gun violence, among other health problems crises, further strain emergency departments and the people who work there.

“People talk about dying by a thousand cuts,” Dattner said.

There are also probably staff shortages and patients waiting for hours in emergency rooms affected the way students perceive specialty, said Angela Mills, chair of the department of emergency medicine at Columbia University and president of the Society of Academic Emergency Medicine.

» READ MORE: At Children’s Hospital St. Christopher’s children wait for hours to be seen in the emergency room as they struggle to breathe.

The number of emergency medicine residencies has also increased in recent years, although the number of applicants decreased. In 2018, about 230 programs offered about 2,300 places across the country. By 2022, their number had grown to 277 programs and 2,921 places.

Philadelphia has seen new emergency medicine residency programs opened in recent years at Einstein Montgomery and Nazareth, while other local programs grew in size.

The National Resident Match Program, a nonprofit organization that oversees the process, did not release match statistics until the process ended Friday.

The Inquirer confirmed that in addition to the Jefferson Hospital program, the emergency medicine residencies at the Hospital of the University of Pennsylvania, Chester-Croser Medical Center, Cooper University Health and Temple University Hospital fill all slots.

Confusion for residents

Incompatible slots are not necessarily means fewer residents appear. The match takes a week for a reason.

On Monday, fourth-year medical students across the country learned whether they are a good fit for a residency program, the next phase in a doctor’s clinical training.

The process known as Coincidence, it starts in autumn every year and ends for one week in March.

First, students apply for their choice of programs, interview and rank the programs they like best. Programs rank their favorite applicants, and an algorithm matches students and programs based on their preferences.

Then in March, the students find out at the beginning of the week if they fit at all. Only at the end of the week, on the day of the match, do they learn where they will spend the next few years of their studies.

» READ MORE: On game day, Temple med students learn where they’ll spend their residency with tears, hugs and sighs of relief

The period between the two notices allows for the “discount,” the term used to describe the supplemental offer and acceptance program. This connects non-responding students and programs with unclaimed seats.

This year, students who originally applied to other majors but were not matched may have considered emergency medicine because there were many residency slots.

The Einstein Montgomery program had one unmatched slot last year, and it was filled during the race, Dattner said. This year she released him directors to interview candidates and focus on filling all positions a week.

By Friday, the program had managed to fill all of its unmatched slots, as well as others associated with Jefferson.

During its 72-hour scramble, Nazareth Hospital said it screened 350 applicants for its six vacancies and eventually filled them all.

“I’ve even had residents from other specialties line up outside my office asking if I have openings for peerless fellows,” Nazareth Emergency Medicine Residency Director Kanika Gupta said in an email.

A sense of mission

Among the approximately 2,500 graduating medical students who respond to emergency medicine is Sharon Perkins of the Philadelphia College of Osteopathic Medicine.

Originally from New Orleans and a first-generation physician raised by a single mother, Perkins learned Friday that she will be a resident at Louisiana State University’s Spirit of Charity Hospital in New Orleans. Just the coincidence earlier in the week felt like a dream come true.

“I screamed and screamed and screamed and when I finally calmed down I just started crying,” she said.

Sharon Perkins, a fourth-year medical student at the Philadelphia College of Osteopathic Medicine, matches with an emergency medicine program. On Friday, she found out she would be at Louisiana State University’s Spirit of Charity Hospital in New Orleans..Read moreCourtesy of Cheron Perkins

Where others go, Perkins sees a mission, even after seeing the impact of the COVID-19 pandemic on emergency rooms. She is excited about the volume of patients and the quick thinking required in the emergency department.

“Those who are passionate about emergency medicine, these things don’t scare them,” she said.

This story has been updated.

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