The State of the Profession: A National Survey of Emergency Medicine Assistant/Associate Program Directors

Methods: We conducted a cross-sectional survey during the spring of 2023 of all newly matched applicants to firstyear post-graduate programs amongst the largest sponsor for United States graduate medical education.Respondents differentiated between whether they matched into, or considered, but did not match into, EM and were asked to rank factors influencing their decision-making.Knowledge of EM workforce projections and source of information regarding the potential for limited availability of EM jobs was also ascertained.The analysis included comparing differences in influence between the main study groups.Results: 1336 newly matched applicants completed at least one question in the survey.Of these, 326 considered EM but pursued alternative specialties, and 138 pursued EM.Relative to those pursuing EM, there was disproportionately more influence for concerns regarding relatively high rates of burnout and the limited number of future jobs available and disproportionately less influence for concerns regarding boarding, compensation, and corporatization.The most common source of information regarding an EM physician surplus were fellow medical students whereas deans, advisors, and mentors were the least.Conclusion: Concerns regarding burnout and job availability appear to have been the most substantial influences in deciding not to apply to EM residency among those considering the specialty.These findings inform efforts to engage prospective applicants and address larger systemic issues affecting the field.