The Expansion Dilemma: A Critical Look at the 13-Year Increase in Emergency Medicine Residency Positions.

Background: Over the past decade, the number of Emergency Medicine (EM) residency positions has drastically expanded. Little is known about the contributions of different program types to this increase. Our objective was to determine the relative contributions of different types of EM residency programs to the observed increase in positions. Methods: Publicly available resources were used to develop a dataset of all Accreditation Council for Graduate Medical Education (ACGME) accredited EM residency programs, along with program characteristics (program length, training environment, ownership structure, new vs. established), prior American Osteopathic Association (AOA) accreditation, and number of positions represented in the Main Residency Match. Results: There was a growth of 1458 EM positions from 2010 to 2023. The largest growth in residency positions came from programs that were 3 years in length (82%), community-based university-affiliated (48%), with a health system ownership structure (49%), and newly accredited by the ACGME (76%). Significant contributions were also made from programs that were university-based (28%), community-based (24%), corporate or national partnerships (33%), regional partnerships (15%), ACGME-accredited at the onset of the study time period (24%), and prior AOA-accredited (23%). Conclusions: There is no one sole contributor to the rapid rise in EM residency positions, with growth spread across a variety of formats and sponsorship types.