Emergent Phenomenon

Dr. Louis Binder has compiled his annual emergency medicine match statistics. It's currently available on StudentDoctor.net:

1. Emergency Medicine experienced an increase of 37 entry level positions in the 2005 Match over 2004 Match numbers (a 2.9% increase), occurring from a combination of quota increases occurring in EM 1-3 and 1-4 programs, and three new programs in the EM match. Emergency Medicine now comprises 5.5 percent of the total NRMP positions and 8.4% of matched US seniors (both all time highs).

2. The overall demand for EM entry level positions increased substantially, from 52 additional US graduates ranking only EM programs to 113 more US graduates and 182 more total applicants ranking at least 1 EM program in 2005, after similar levels of growth of the applicant pool in 2004. The majority of this increase came from US seniors who ranked EM programs. This growth in demand for EM positions far exceeded the increase in supply of positions. The excess applicant demand over and above the size of the training base is 48 to 356 applicants (4% to 27% surplus), depending on how the parameters of the applicant pool are determined.

More programs (now 132), with more spots at existing programs, but still the demand for emergency is outstripping the supply. Of all incoming spots at all residency programs, 5.5% are now EM, and 8.4% of US senior med students matched into emergency medicine. That's 991 of us this year.

It's hard to pin down why these shifts occur, why some specialties prosper as others fade. Some would argue economics dictate everything -- students go where they'll be well-compensated, where the hours are benign, etc.

I'm not denying it plays a role. But I think most students are insightful enough about themselves and their path to place too much importance on these considerations.

Because the latter half of med school is essentially just auditions in various specialties, we can see how we fit in these different settings -- get to know potential colleagues, get a feel for the challenges and demands of each field.

It was suggested to me, early on, that the decision to specialize isn't made by cool calculations of pros and cons, or financial benefits. Instead, through sampling the third year clerkships, we simply choose the field where we met the most inspiring doctors, saw the most incredible patients, and had the most fun.

And now, medical schools are offering better clerkship experiences in emergency medicine, with more mentorship opportunities. Academic EM is coming into its own. And, given the proper exposure, more of us are concluding it's the best field to be in.