Push and Pull: What Factors Attracted Applicants to Emergency Medicine and What Factors Pushed Them Away Following the 2023 Match.

Introduction: 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. Methods: 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. Results: 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. Conclusion: 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.