200+ Unfilled EM spots in 2022 match

[Drägerman]

People are sharing the soap data and EM went from <10 unfilled spots in 2021 to >200 unfilled spots without a corresponding increase in total number of positions. It looks like the job report scared away a big group of applicants. Other reasons so many would jump ship??

It is also notable that anesthesia had a single unfilled pgy-1 spot. This is in-line with what many have said on here that anesthesia is on an upswing.

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[2brads]

Isn't the "traditional" pathway for anesthesia PGY-2? What were the numbers there?

 

[Shimmy8]

Isn't the "traditional" pathway for anesthesia PGY-2? What were the numbers there?

No. Not any longer. There are a few advanced spots scattered in some ivory towers, but the vast vast majority are categorical.

 

[GassYous]

The real question is why did those 2900 grads choose to match em

 

[nimbus]

The real question is why did those 2900 grads choose to match em

They probably think they will enjoy EM and anticipate a shift in the supply demand balance. Nothing lasts forever. The early 2000s were good times in anesthesia.

https://medicine.umich.edu/sites/default/files/content/downloads/History_0.pdf

 

[Gilakend]

It is also notable that anesthesia had a single unfilled pgy-1 spot. This is in-line with what many have said on here that anesthesia is on an upswing.

Not disagree with anesthesia being on the upswing, but is this much different from previous years? Only thing I could find was 2021 data and there were 3 unfilled spots. Was it higher in recent history?

From the data I was looking at (ERAS Statistics) I was actually (pleasantly) surprised anesthesia didn't see way more apps. I figured a good amount would be jumping ship from EM --> anesthesia. But only a small % increase compared to some other specialties (rads was one I noticed).

 

[Drägerman]

They probably think they will enjoy EM and anticipate a shift in the supply demand balance. Nothing lasts forever. The early 2000s were good times in anesthesia.


View attachment 351798

https://medicine.umich.edu/sites/default/files/content/downloads/History_0.pdf

This is great historical perspective

 

[Drägerman]

Not disagree with anesthesia being on the upswing, but is this much different from previous years? Only thing I could find was 2021 data and there were 3 unfilled spots. Was it higher in recent history?

From the data I was looking at (ERAS Statistics) I was actually (pleasantly) surprised anesthesia didn't see way more apps. I figured a good amount would be jumping ship from EM --> anesthesia. But only a small % increase compared to some other specialties (rads was one I noticed).

Very fair points!

 

[BLADEMDA]

This is great historical perspective

Not "history" to many of us senior attendings on SDN. The job market was saturated with lowball offers in the 1990s causing many medical students to reject the profession. Hence, around 2001 there was a huge shortage of anesthesiologists resulting in a wide open job market with good pay. But, history repeats itself and as the number of position in residency programs increases in anesthesiology the job market will once again tighten up in 4-5 years.

 

[anbuitachi]

isnt this data from before scramble? it wont affect the market if 200 spots are filled after scrambling by who knows who. lot of med students looking for residency spots.

also it's also possible programs themselves are not receiving applicants 'good' enough and they are not ranking as many as before? i know one of the anesthesiology programs preferred to keep spots unfilled rather than match a poor fit applicant

 

[dannyboy1]

isnt this data from before scramble? it wont affect the market if 200 spots are filled after scrambling by who knows who. lot of med students looking for residency spots.

also it's also possible programs themselves are not receiving applicants 'good' enough and they are not ranking as many as before? i know one of the anesthesiology programs preferred to keep spots unfilled rather than match a poor fit applicant

Agreed. These days the HCA residencies open specifically for cheap resident labor and to flood the attending market. They will take whatever warm body is willing to scramble. Back in the day when anesthesia went to $hit residencies contracted spaces.

 

[coffeebythelake]

The scramble..? That's a breakfast right?

 

[anbuitachi]

The scramble..? That's a breakfast right?

i'm not sure. i dont have time for breakfast

 

[JiPo]

i'm not sure. i dont have time for breakfast

We all know you don't have time for breakfast. I didn't think you even have time for breaks. 😉 I kid, I kid

 

[nimbus]

isnt this data from before scramble? it wont affect the market if 200 spots are filled after scrambling by who knows who. lot of med students looking for residency spots.

also it's also possible programs themselves are not receiving applicants 'good' enough and they are not ranking as many as before? i know one of the anesthesiology programs preferred to keep spots unfilled rather than match a poor fit applicant

There will be many more unmatched applicants than unmatched spots so I bet the unmatched spots will largely fill. And many unmatched applicants will still be SOL.

 

[Gilakend]

There will be many more unmatched applicants than unmatched spots so I bet the unmatched spots will largely fill. And many unmatched applicants will still be SOL.

Completely agree. Every single EM spot will fill. Guaranteed.

 

[Status Sciaticus]

There will be many more unmatched applicants than unmatched spots so I bet the unmatched spots will largely fill. And many unmatched applicants will still be SOL.

Completely agree. Every single EM spot will fill. Guaranteed.

Indeed they will. However, the results will serve as a harbinger for prospective applicants in the future, and likely the studious and hungry applicants will veer away from the specialty.

 

[ambiturner]

Would you still recommend anesthesiology to students currently entering medical school? I imagine it would be a top choice for students originally inclined towards EM.

I got into this field when the roles were reversed - that is, anesthesia wasn't much more competitive than internal medicine and EM was the hottest field for people seeking lifestyle (other than derm). Anesthesia has definitely done a better job policing its numbers. Yes this means an MD can't sit every case in the country but that was never going to happen. My experience in anesthesia has been about what I expected - predictable hours, leaving work at work, fun job. Where it has underperformed has been income (has not kept pace with heme-onc/cardiology/psych/neurology/etc and nowhere close to surgery), incessant CRNA creep (at least where I work), declining influence in the hospital, and the gradual destruction of small private practice groups. I don't see this reversing.

The biggest issues in EM I see are that they are producing too many graduates and there is no incentive for a hospital to have a competent clinician running the ED. They make more money on an NP that admits every chest pain patient for CT/troponins/echo/cath than an MD who does a more thoughtful workup and sends the person home. Ditto for the nursing home patient who 'doesn't look right.' COVID also unmasked how much emergency care is unnecessary BS. In anesthesia the hospital's incentive is to get cases done - in my experience, anesthesiologists are less likely than CRNAs to ask for pointless labs/consults/etc and will use their brains and do the case.

Biggest issue both face is awful reimbursement from government payers. Any push toward government healthcare with result in mandatory employment by a hospital or, god forbid, national company. This fact alone would make me suggest other options - ortho and derm are probably the best at collecting what they charge, and other procedural fields are better bets as well.

 

[coffeebythelake]

Would you still recommend anesthesiology to students currently entering medical school? I imagine it would be a top choice for students originally inclined towards EM.

I dont like the politics and bs with midlevels, but I like the physiology and the actual practice of anesthesia.

 

[GassYous]

I get the idea that things might change but with the proliferation of cmg residencies, cmg leadership at the top of representative groups and cmg takeovers of private practice, it seems like it is something that won't be reversible any time soon. My crystal ball is cloudy however.

 

[nimbus]

I get the idea that things might change but with the proliferation of cmg residencies, cmg leadership at the top of representative groups and cmg takeovers of private practice, it seems like it is something that won't be reversible any time soon. My crystal ball is cloudy however.

And the dearth of GME spots relative to med school graduates means that virtually every spot will fill whether it is considered desirable or not.

 

[anesthesiadoc]

Are we certain this is simply a supply and demand problem? Alternatively, if the EM programs didn't interview enough folks and made shorter rank lists underestimating the Zoom factor, I can see this happening pretty easily. The opportunity cost for applicants who don't have to travel and can potentially interview at multiple programs in the same day from their couch has changed the game for programs. We've had to interview nearly double the number of candidates that we did pre-pandemic because it is so difficult to judge the commitment of any particular applicant.

 

[nimbus]

In 2021, there were 48,700 applicants competing for 38,106 total positions. Remember that expensive MD degree is largely worthless without a residency. It will be interesting to see how 2022 shakes out.

2021 Match hits record highs despite pandemic’s disruptions

2.7% rise in PGY-1 positions offered. IMGs see notable drop in match rate during this unprecedented residency-application cycle.

www.ama-assn.org

 

[dannyboy1]

Are we certain this is simply a supply and demand problem? Alternatively, if the EM programs didn't interview enough folks and made shorter rank lists underestimating the Zoom factor, I can see this happening pretty easily. The opportunity cost for applicants who don't have to travel and can potentially interview at multiple programs in the same day from their couch has changed the game for programs. We've had to interview nearly double the number of candidates that we did pre-pandemic because it is so difficult to judge the commitment of any particular applicant.

Didn’t seem to be a problem for any other specialty except the one that is currently a dumpster fire …..

 

[BLADEMDA]

I expect the Match rate (success) for 2022 to be even lower. We will have that data next week. Here was 2021:

• 92.8% of U.S. MD seniors matched to postgraduate-year one (PGY-1) positions, a drop from 93.7% in 2020.
• 89.1% of U.S. DO seniors matched, which fell from 90.7% in 2020.
• 54.8% of non-U.S. citizen international medical graduates (IMGs) matched, a drop from 61.1% in 2020.

So, about 10% of USA seniors (MD/DO combined) do not match at all. That is a startling statistic.

 

[Shimmy8]

Function of for-profit schools (MD and DO) being able to open with very little turnaround time while traditional schools increase their med school classes in the name of “physician shortsge” while expansion and/or application of a new residency program is an 8-10 year endeavor.

And it’s going to get worse. As much as we hate on the HCA type residency programs, they’re at least helping address this problem.

 

[ValentineD]

Perhaps their exposure to EM was through the lens of the Covid-19 pandemic and they decided they'd rather be elsewhere.

 

[anesthesiadoc]

To Blade’s point, wait until step 1 is pass fail (we still had numerical scores to look at for this year’s applicants). Folks in DO and international schools are going to be at an even greater disadvantage.

 

[anbuitachi]

I expect the Match rate (success) for 2022 to be even lower. We will have that data next week. Here was 2021:

• 92.8% of U.S. MD seniors matched to postgraduate-year one (PGY-1) positions, a drop from 93.7% in 2020.
• 89.1% of U.S. DO seniors matched, which fell from 90.7% in 2020.
• 54.8% of non-U.S. citizen international medical graduates (IMGs) matched, a drop from 61.1% in 2020.

So, about 10% of USA seniors (MD/DO combined) do not match at all. That is a startling statistic.

So basically they created too many students for available residency spots?

 

[2brads]

There’s gotta be a small number of schools with awful match rates that are bringing the average down. 10% unmatched would be a giant red flag, in my opinion. I think my class had 2 unmatched (<2%). I graduated a long time ago though. But still, I doubt I would have gone to med school if there was a 10% chance I wouldn’t match and have enormous student loans with no prospect of paying them off.

 

[aneftp]

This is great historical perspective

Medicine is/was weird. No new medical school (LCME) from 1976 (university of south florida) all the way to year 2000. Since 2000 tons of new lcme medical schools 17? I believe. Plus all the DO schools.

Jobs report said rads/em/anesthesia over supplied in 1994. That’s what caused 1996
Being the worst (aka easiest year to match or get a job in 1996 residency class)

Historically those same finishing residents (many of them not the greatest) accounted for horrible ABA written and oral passing rates in 2000-2002 years. I think the passing rate was in the high 60s for first time test takers (vs in the high 80s in this current era)

The best of the best (in my opinion) were med students entering residency in 1990. They were simply the most competitive Sadly as they finished in 1994. Lack of jobs. Cause many to do fellowships they really didn’t want to.

Starting salary was as low as 70k in the south in 1995. My family members were paid 110k for full time ob cardiac trauma etc in 1996 year. The salaries were horrible in many large cities.

 

[deleted1130227]

Medicine is/was weird. No new medical school (LCME) from 1976 (university of south florida) all the way to year 2000. Since 2000 tons of new lcme medical schools 17? I believe. Plus all the DO schools.

Jobs report said rads/em/anesthesia over supplied in 1994. That’s what caused 1996
Being the worst (aka easiest year to match or get a job in 1996 residency class)

Historically those same finishing residents (many of them not the greatest) accounted for horrible ABA written and oral passing rates in 2000-2002 years. I think the passing rate was in the high 60s for first time test takers (vs in the high 80s in this current era)

The best of the best (in my opinion) were med students entering residency in 1990. They were simply the most competitive Sadly as they finished in 1994. Lack of jobs. Cause many to do fellowships they really didn’t want to.

Starting salary was as low as 70k in the south in 1995. My family members were paid 110k for full time ob cardiac trauma etc in 1996 year. The salaries were horrible in many large cities.

Spot on.

 

[RemyMcswain]

Medicine is/was weird. No new medical school (LCME) from 1976 (university of south florida) all the way to year 2000. Since 2000 tons of new lcme medical schools 17? I believe. Plus all the DO schools.

Jobs report said rads/em/anesthesia over supplied in 1994. That’s what caused 1996
Being the worst (aka easiest year to match or get a job in 1996 residency class)

Historically those same finishing residents (many of them not the greatest) accounted for horrible ABA written and oral passing rates in 2000-2002 years. I think the passing rate was in the high 60s for first time test takers (vs in the high 80s in this current era)

The best of the best (in my opinion) were med students entering residency in 1990. They were simply the most competitive Sadly as they finished in 1994. Lack of jobs. Cause many to do fellowships they really didn’t want to.

Starting salary was as low as 70k in the south in 1995. My family members were paid 110k for full time ob cardiac trauma etc in 1996 year. The salaries were horrible in many large cities.

70k for a full time Anesthesia job with call? That is insane. What were CRNAs making?

 

[coffeebythelake]

70k for a full time Anesthesia job with call? That is insane. What were CRNAs making?

How much is that in inflation adjusted dollars?

 

[anbuitachi]

100k in 1995? how many houses could that afford?
4x salary in 25 years? maybe in 2050 we all make 2m a year? yes?

 

[nimbus]

100k in 1995? how many houses could that afford?
4x salary in 25 years? maybe in 2050 we all make 2m a year? yes?

Many people were making 400-500k in 1996 but they were offering 100k to new grads. Pre-NAPA LIJ/north shore guys were making 600-700k. Same for St Francis on Long Island.

 

[GassYous]

Many people were making 400-500k in 1996 but they were offering 100k to new grads. Pre-NAPA LIJ/north shore guys were making 600-700k. Same for St Francis on Long Island.

Had an attending that was offered 700 for gi only no call during that time. Didn't pick it up though

 

[DrZzZz]

100k in 1995? how many houses could that afford?
4x salary in 25 years? maybe in 2050 we all make 2m a year? yes?

4x in 25 years would only put you at ~400k assuming you stay at your current gig, right?
/s
The material writes itself until you get a new job. Sorry.

 

[Lecithin5]

University of Michigan med students’ match: number one specialty was anesthesiology, and number two was ED.

Lol.

 

[ToKingdomCome]

University of Michigan med students’ match: number one specialty was anesthesiology, and number two was ED.

Lol.

Do you have their match list ?

 

[voxveritatisetlucis]

Stanford also had like 13 anesthesia matches and it was their most popular iirc. Seems to be getting tougher

 

[deleted1130227]

Looks like word of a recently improving anesthesia job market has garnered interest among the medical students. Like always, they are just following Willie Sutton's law.
Rightly or wrongly, It appears that Anesthesia is judged to be the least dirty shirt in the laundry basket.

 

[nimbus]

University of Michigan med students’ match: number one specialty was anesthesiology, and number two was ED.

Lol.

Stanford also had like 13 anesthesia matches and it was their most popular iirc. Seems to be getting tougher

It probably helps that both of those institutions have great anesthesia departments and their medical students probably had excellent elective experiences.

 

[Lecithin5]

It probably helps that both of those institutions have great anesthesia departments and their medical students probably had excellent elective experiences.

Every anesthesia rotation that has ever existed is fun and amazing (do your own cases, intubate, get out early!)- Unfortunately this does medical students a disservice as most anesthesia jobs are not like this. It’s hard to convey that to rotating students as what they experience during a rotation is unlike the reality of being an attending (there are exceptions obviously- I’m thankful that I’m in a practice where I get to do my own cases).

And apparently the student at Michigan never got the memo about ER.

I agree with you- these students probably had an amazing experience. And I wish them nothing but the best- I really do. But boy, if you’re smart enough to go to a top medical school, I’d expect you to do your homework. Or heed the warnings. Especially ER. Maybe ER will become like anesthesia in 1996, with an eventual large upswing. But given what we know now and the trends for such hospital based specialties, I don’t know how anyone can enter such a field.

 

[Lecithin5]

Do you have their match list ?

No, but I know the stats. Third was gen surg, fourth was IM, fifth was peds

 

[nimbus]

No, but I know the stats. Third was gen surg, fourth was IM, fifth was peds

It’s pretty incredible that more students picked anesthesia over IM.

 

[nimbus]

Every anesthesia rotation that has ever existed is fun and amazing (do your own cases, intubate, get out early!)- Unfortunately this does medical students a disservice as most anesthesia jobs are not like this. It’s hard to convey that to rotating students as what they experience during a rotation is unlike the reality of being an attending (there are exceptions obviously- I’m thankful that I’m in a practice where I get to do my own cases).

And apparently the student at Michigan never got the memo about ER.

I agree with you- these students probably had an amazing experience. And I wish them nothing but the best- I really do. But boy, if you’re smart enough to go to a top medical school, I’d expect you to do your homework. Or heed the warnings. Especially ER. Maybe ER will become like anesthesia in 1996, with an eventual large upswing. But given what we know now and the trends for such hospital based specialties, I don’t know how anyone can enter such a field.

I intubate and do my own cases. But I get out early only about half the time. Sometimes I get out really late.

 

[coffeebythelake]

It’s pretty incredible that more students picked anesthesia over IM.

The anesthesia lifestyle, while not easy or glamorous, does have its perks.

 

[ambiturner]

Every anesthesia rotation that has ever existed is fun and amazing (do your own cases, intubate, get out early!)- Unfortunately this does medical students a disservice as most anesthesia jobs are not like this. It’s hard to convey that to rotating students as what they experience during a rotation is unlike the reality of being an attending (there are exceptions obviously- I’m thankful that I’m in a practice where I get to do my own cases).

And apparently the student at Michigan never got the memo about ER.

I agree with you- these students probably had an amazing experience. And I wish them nothing but the best- I really do. But boy, if you’re smart enough to go to a top medical school, I’d expect you to do your homework. Or heed the warnings. Especially ER. Maybe ER will become like anesthesia in 1996, with an eventual large upswing. But given what we know now and the trends for such hospital based specialties, I don’t know how anyone can enter such a field.

Students from top schools and programs who are interested academics have opportunities to do really great things in this field. At those programs they can do respected, actual ICU care, funded neuro and cognition research, collaborate with top medical/surgical departments, etc.

Sadly they’ll someday realize that doing the cool stuff means sacrificing a big chunk of their earning potential and many will take general jobs to pay the bills. But I guess that fact is no different in any other career.

 

[OptionOffense]

Not "history" to many of us senior attendings on SDN. The job market was saturated with lowball offers in the 1990s causing many medical students to reject the profession. Hence, around 2001 there was a huge shortage of anesthesiologists resulting in a wide open job market with good pay. But, history repeats itself and as the number of position in residency programs increases in anesthesiology the job market will once again tighten up in 4-5 year

Everything you say is correct. I still am not Bullish on anesthesia. There are many problems with this field long-term that will not be fixed. It is anything but stable.