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1 in 4 emergency medicine residency spots at Jefferson Health, Einstein unfilled ahead of Match Day, following ‘unprecedented’ national trend

Nationwide, over 550 emergency residency spots remain empty after the Match, leaving programs and graduating medical students to scramble.

A Match Day celebration at Thomas Jefferson University, Sidney Kimmel Medical College, in Philadelphia. This year, the number of applicants who chose emergency medicine as their preferred residency continued to decline.
A Match Day celebration at Thomas Jefferson University, Sidney Kimmel Medical College, in Philadelphia. This year, the number of applicants who chose emergency medicine as their preferred residency continued to decline.Read moreALEJANDRO A. ALVAREZ / Staff Photographer

Emergency medicine physicians at Einstein Medical Center Montgomery huddled in a room for the last few days, scrambling to fill unclaimed residency spots. Colleagues dropped by with snacks from Wawa. Others rallied on social media to support the program: “Please check us out.”

On Monday, the program learned that it had filled only four of eight positions in the national match, which pairs medical school graduates with hospital training programs.

Throughout the Philadelphia region, about two dozen emergency medicine residency spots remained up for grabs after the match.

The unfilled positions underscore a two-year national trend showing a growing number of medical students opting not to spend their careers in emergency departments.

» READ MORE: On Match Day, medical students learn where they’ll start work as doctors. Four at Jefferson offer an inside look at the process.

The Einstein hospitals are part of Jefferson Health, which had a quarter of its emergency medicine spots unclaimed. Einstein Medical Center on North Broad Street matched six of its 14 spots.

Separately, Nazareth Hospital in Northeast Philadelphia, part of Trinity Health Mid-Atlantic, didn’t fill a single one of their six emergency medicine residency slots.

Nationwide, an unprecedented 555 of roughly 3,000 emergency medicine residency slots remained unfilled after this year’s match, the American Academy of Emergency Medicine and other professional societies said in a joint statement. Last year, 219 slots were unclaimed in the match, a nearly 20-fold increase from 2018, when 13 spots went unfilled.

Some emergency medicine physicians now question whether their once coveted specialty is a “profession in peril.”

In addition to its Einstein-affiliated programs, Jefferson trains doctors in emergency medicine at three different regional hospitals. Some programs fared better. Thomas Jefferson University Hospital’s emergency medicine program in downtown Philadelphia, the region’s largest with 17 spots, did fill up. And Jefferson’s program in South Jersey matched 12 of 13 slots.

Yet another smaller program at Jefferson Northeast, based in Torresdale, filled only four of eight slots.

Among the factors contributing to lower interest: This graduating class of medical students saw emergency room workers on the front lines of a pandemic when personal protective equipment was scarce and burnout high, said Elizabeth Datner, chair of the department of emergency medicine at Einstein Healthcare Network.

In the Philadelphia area, a high rate of drug overdoses and gun violence, among other health crises, further strain emergency rooms and the people who work there.

“People talk about death by a thousand cuts,” Datner said.

Staffing shortages and patients waiting in emergency departments for hours have likely also affected how students perceive the specialty, said Angela Mills, chair of the department of emergency medicine at Columbia University and president of the Society of Academic Emergency Medicine.

» READ MORE: At St. Christopher’s Hospital for Children, children are waiting hours to be seen in the emergency room as they struggle to breathe.

The number of emergency medicine residency slots has also increased in recent years, even as the number of applicants declined. In 2018, about 230 programs offered about 2,300 spots nationwide. By 2022, the numbers grew to 277 programs and 2,921 spots.

Philadelphia has seen new emergency medicine residency programs open in recent years at Einstein Montgomery and Nazareth, while other local programs grew in size.

The National Resident Match Program, a nonprofit that oversees the process, does not release statistics on the match until the process is over on Friday.

The Inquirer confirmed that in addition to the Jefferson Hospital program, the emergency medicine residencies at the Hospital of the University of Pennsylvania, Chester-Crozer Medical Center, Cooper University Healthcare, and Temple University Hospital matched all slots.

Scrambling for residents

Unmatched slots don’t necessarily mean fewer residents show up. The match takes a week for a reason.

On Monday, fourth-year medical students all over the country learned whether they matched into a residency program, the next phase in the clinical training of physicians.

The process, known as the Match, starts in the fall each year, and culminates over a week in March.

First, students apply to their choice of programs, interview, and rank the programs they liked the best. The programs rank their favorite applicants, and an algorithm matches students and programs based on their preferences.

Then in March, students find out early in the week whether they matched at all. Only at the end of the week, on Match Day, do they learn where they will do the next few years of their training.

» READ MORE: On Match Day, Temple med students learn where they’ll spend their residency with tears, hugs and sighs of relief

The period between the two notices allows for the “scramble,” the term used to describe the Supplemental Offer and Acceptance Program. This connects students who didn’t match and programs with unclaimed spots.

This year, students who originally applied to other specialties but didn’t match might have considered emergency medicine, because there were many residency spots to snag.

Einstein Montgomery’s program had one unmatched slot last year, and it was filled during the scramble, Datner said. This year, she freed its directors to interview candidates and focus on filling the spots all week.

By Friday, the program managed to fill all its unmatched slots, as did others affiliated with Jefferson.

During its 72-hour scramble period, Nazareth hospital said it screened 350 applicants for its six open slots, and ultimately filled them all.

“I even had residents from other specialties lining up outside my office, asking if I had spots available for friends who went unmatched,” Nazareth’s emergency medicine residency director, Kanika Gupta, said in an email.

A sense of mission

Among the roughly 2,500 graduating medical students who matched in emergency medicine is Cheron Perkins of the Philadelphia College of Osteopathic Medicine.

Originally from New Orleans, and a first-generation physician raised by a single mother, Perkins learned on Friday that she will be a resident at Louisiana State University’s Spirit of Charity Hospital in New Orleans.Just matching earlier in the week felt like a dream come true.

“I screamed and screamed and screamed, and then once I finally calmed down, I just started crying,” she said.

Where others are walking away, Perkins sees a mission, even after seeing the COVID-19 pandemic’s impact on emergency departments. She is excited about the high volume of patients, and the quick thinking that’s required at the ER.

“The ones that are passionate about emergency medicine, those things don’t scare them,” she said.

This story was updated.