Emergency medicine (EM) has experienced major workforce changes in recent years. It leads to concerns about its future viability. A 2021 projection estimated a surplus of about 7,800 emergency physicians (EPs) by 2030, which sparked debate within the medical community. Simultaneously, interest in EM among U.S. medical students has changed, as evidenced by a high number of unmatched residency positions in 2022 and 2023, partly influenced by the impacts of the COVID-19 pandemic. There is a lack of clarity regarding how new graduates are navigating their career choices in this evolving landscape, specifically as EM physicians expand their roles to include observation medicine, hospital-at-home care, and emergency department (ED)-based critical care, areas that are important for workforce planning.
The study published in JAMA Network aimed to evaluate the career plans of a national cohort of graduating EM residents and identify key factors influencing their decisions. It also examined anticipated career duration and explored how demographic factors, burnout, and educational debt shape career preferences.
Researchers conducted a cross-sectional survey of residents graduating in 2023 from the Accreditation Council for Graduate Medical Education (ACGME), an accredited EM program in the U.S. The survey was administered electronically after the American Board of Emergency Medicine (ABEM) In-Training Examination. Participation was voluntary, and data were deidentified. Collected information included demographics (gender, race/ethnicity), educational debt, training characteristics, burnout (measured using the Copenhagen Burnout Inventory), immediate career plans, preferred practice settings (urban vs. rural), and expected years in clinical practice. Residents rated the importance of 10 factors influencing their career decisions, like lifestyle, salary, geographic location, professional fulfilment, burnout, COVID-19, and projected workforce surplus. Responses were analyzed by descriptive statistics and multivariate regression models, with outcomes reported as odds ratios (ORs) and 95% confidence intervals (CIs). Statistical significance was set at P < 0.05.
A total of 2711 of 2,782 eligible residents (97.4%) participated in the survey, which provides a highly representative sample. Among respondents, 51.4% were men, 33.6% women, and 0.9% identified as nonbinary, with 54% identifying as White. A majority (61%) reported educational debt exceeding $100,000. Burnout was highly prevalent, which affects 72.4% of the 2,239 residents who completed that portion of the survey.
In terms of career plans, most residents intended to work in community-based hospitals (31.4%) or hybrid settings (15.3%), with 58.9% planning to practice in urban areas and 24.1% in rural settings. Lifestyle emerged as the most influential factor in career decision-making (97.5%), followed by geographic location (88.7%), professional fulfilment (87.7%), and salary expectations (82.8%).
The COVID-19 pandemic (18.9%) and concerns about a projected physician surplus (33.9%) had relatively little influence. Regression analysis revealed many significant associations: residents from 4-year programs were less likely to choose rural practice as compared with those from 3-year programs (OR: 0.70, 95% CI: 0.55 to 0.88). White residents were more likely to choose rural settings than those from other racial and ethnic groups (OR: 1.76, 95% CI: 1.43 to 2.16). Higher educational debt (≥$200,000) was strongly linked to prioritizing salary (OR up to 2.31 for $300,000 to $399,000 debt). Female residents were less likely than male residents to prioritize salary (OR: 0.69, 95% CI: 0.54 to 0.87) but more likely to highlight professional fulfilment (OR: 1.73; 95% CI: 1.30 to 2.32) and burnout (OR: 1.40, 95% CI: 1.16 to 1.70).
Residents expected to practice clinical EM for 22.4 years (standard deviation [SD]: 8.3) with no significant differences by gender, program type, or debt. White residents anticipated practicing 2.1 years longer (95% CI: 1.4 to 2.9), and residents experiencing burnout expected to practice 5.1 years longer (95% CI: 4.0 to 6.2) than their counterparts. When planning to reduce or leave clinical practice, most residents anticipated retiring (38.7%), transitioning to nontraditional EM roles like urgent care or telemedicine (33.3%), or entering education (32.3%).
This study gives important insights into the evolving EM workforce by highlighting that graduating residents prioritize lifestyle, fulfilment, and geographic location over external concerns like workforce projections or the pandemic. Urban settings remain dominant, and long-term retention in underserved areas remains uncertain, while many express interest in rural practice. High levels of burnout and educational debt continue to influence career decisions, which affect both job selection and long-term planning. The expected career span of just over two decades suggests earlier attrition compared with other specialties. Addressing systemic challenges like burnout, financial burden, and rural workforce gaps will be important to ensure a stable and resilient EM workforce in the future.
Reference: Lu DW, Gu B, Courtney DM, et al. Career Plans Among Graduating US Emergency Medicine Residents. JAMA Netw Open. 2026;9(1):e2555376. doi:10.1001/jamanetworkopen.2025.55376 Crossref
