Career Plans Among Graduating US Emergency Medicine Residents.

Importance: The emergency medicine (EM) workforce is undergoing complex change, including a potential projected physician surplus, the volatile and evolving interests of medical students, and the continued high rates of burnout. Understanding the career intentions of graduating residents is critical to inform workforce planning. Objective: To examine the career plans, anticipated career durations, and key factors associated with the career decisions of graduating US EM residents. Design, Setting, and Participants: This cross-sectional survey study, which sampled graduating residents from all Accreditation Council for Graduate Medical Education-accredited categorical EM programs, was conducted after the 2023 American Board of Emergency Medicine In-Training Examination. Resident-level characteristics, including gender, race and ethnicity, educational debt, and burnout status, were examined. Data were obtained from June 20 to August 18, 2024, and analysis occurred from December 16, 2024, to August 12, 2025. Main Outcomes and Measures: Primary outcomes included immediate postresidency career plans, intended practice setting, anticipated years of clinical practice, and importance of 10 career decision factors. Results: Of 2782 eligible residents, 2711 (97.4%; 1394 men [51.4%]) responded to at least 1 survey item. Most respondents (1654 [61.0%]) reported educational debt exceeding $100 000; 1964 of 2239 respondents (72.4%) met criteria for burnout. Immediate career plans included community-based practice (852 [31.4%]), fellowship (631 [23.3%]), hybrid (community-based hospital affiliated with an academic medical center) (416 [15.3%]), and academic EM (161 [5.9%]). Most residents (1597 [58.9%]) intended to work in an urban setting, with 652 (24.1%) planning to work in a rural setting. The mean (SD) anticipated duration of clinical EM practice was 22.4 (8.3) years. The most important career decision factors were lifestyle (2135 of 2189 [97.5%]), geographic location (1930 of 2176 [88.7%]), professional fulfillment (1906 of 2173 [87.7%]), and salary expectations (1808 of 2183 [82.8%]). Female residents were more likely than male residents to report professional fulfillment and burnout as important factors and less likely to prioritize salary expectations. Residents with $200 000 or more in debt (1376 [50.7%]) were significantly more likely to cite salary as a major factor ($200 000-$299 000: odds ratio [OR], 2.01 [95% CI, 1.39-2.89]; $300 000-$399 000: OR, 2.31 [95% CI, 1.58-3.39]; ≥$400 000: OR, 1.58 [95% CI, 1.05-2.42]). Conclusions and Relevance: In this survey study of graduating EM residents in 2023, most respondents planned to practice clinical EM for 2 decades primarily in community or hybrid settings, with a minority of residents interested in rural practice. Career decisions are overarching and encompass career factors; lifestyle, location, professional fulfillment, and salary were the strongest career factors. Burnout, educational debt, and demographic characteristics were associated with career decisions. These findings have implications for workforce modeling, retention strategies, and policies to support the EM workforce.