Patient Volume Requirements: Evaluation of the 2025 ACGME Proposal for Emergency Medicine Residency Programs

The 2025 ACGME proposed that all EM residency programs must be 4 years and achieve a minimum of 3000 patients per resident. We characterize the current residency program patient volume per resident based on the proposed requirements. Secondarily, we describe the number of programs that meet the proposed visit volume requirement and the estimated impact of the 4-year length mandate.

We conducted a cross-sectional analysis utilizing a linked dataset of the 2023 American Hospital Association Annual Survey and 2025 EM program information from ACGME's website. Hospital zip codes were linked with Rural-Urban Commuting Area Codes. We calculated the estimated residency program patient volume per resident as proposed by ACGME. Secondarily, we calculated the estimated change in patient volume if 3-year programs converted to 4 years.

Of 286 programs, the median program patient volume was 7300 (IQR: 5190-10,207). Among the 232 (81%) 3-year programs, the median volume was 7616 (IQR: 5292-10,639), while the 54 (19%) 4-year programs demonstrated a median of 6520 (IQR: 4930-9304). Rural programs (3%) had a median patient volume of 7744 (IQR: 5453-13,209), compared to 7300 (IQR: 5190-10,207) for urban programs (97%). Nine programs (3%) were below the 3000-patient volume threshold; 7 of these were 3-year programs, and transitioning to 4 years could bring 6 above the threshold.

Currently, 97% of EM programs meet the proposed 3000-patient volume threshold, with a median volume well over double this value and similar volumes across program lengths and rurality. Transitioning from 3 to 4 years may enable all but one current 3-year program to meet the new volume requirement. Therefore, the proposed ACGME changes may not increase the minimum required clinical exposure for EM residents as originally intended and should prompt re-examination.