Historically, Emergency Medicine has been regarded as a competitive specialty, nowadays more and more so as medical students gravitate toward fields of medicine that offer what they perceive to be a good balance between work and play. For these reasons, EM - with its shift-based nature, relatively good hours and freedom from call, and combination of medicine and procedural work has become increasing popular. Over the last several years the general consensus is that Emergency Medicine has become increasingly competitive. Is this actually the case? Let's see what we can glean from the hot-off-the-press NRMP Advance Data Tables and the preliminary ERAS data for 2020.

The first thing to notice is that the number of EM residency slots has been steadily increasing annually, in the range of 7-9% year-after-year. With the exception of 2016-2017, by contrast, the increase in the number of EM applicants has remained relatively lower in the range of 5-6.5%. And while the absolute number of EM positions filled by US MDs has increased proportionally, but over time the classic benchmark of US MD fill rate has actually dropped slightly, with this year actually having the lowest US MD fill rate at 64.6%.

What does this mean in 2020, the first year of the combined MD/DO single accreditation and unified match system? Make no mistake, the numbers have not changed drastically and emergency medicine can and should still be regarded as a competitive specialty, although this may change in a few years if the supply of new EM programs (and by extension new EM residency positions) continues to outpace applicant demand. As one would expect, the fill rate for DOs (both seniors and grads) increased to 711 / 2652 = 26.8%, a slight increase from 26.3% in 2019. And perhaps somewhat better news for IMGs - 155 USIMGs and 30 non-US IMGs matched into EM this year, for a combined (but still paltry) IMG fill rate of 6.98%, compared to (112+27) / 2458 = 5.66% in 2019.

What will the 2021 match for Emergency Medicine look like, especially with the havoc the COVID-19 pandemic has wrought on medical students seeking away rotations in Emergency Medicine? Will students be less interested in EM as a result of the impact COVID-19 has had on frontline providers such as emergency physicians? Will program directors employ different selection methods in lieu of away rotations, and will this drastically impact the demographics of EM applicants next year? That remains to be seen.