Meeting Our Needs: Rural Training Experiences in Emergency Medicine Residencies

Board-certified emergency medicine (BCEM) physicians make up less than half the clinician workforce in rural emergency departments (EDs). Fewer of these specialists are entering rural EDs annually than are leaving, and this discrepancy is projected to increase in the next decade. We sought to investigate the current landscape of EM residency rural rotations in the US, including barriers to offering rural rotations, in order to identify potential residency-level interventions that could bolster the population of BCEM physicians in rural EDs.

Surveys were sent to program directors (PDs) of all 290 EM residences currently accredited by the Accreditation Council for Graduate Medical Education (ACGME) in the US and its territories. PDs were asked about the availability of rural rotations and how they were established. We also obtained information regarding the initial job selection of graduating residents from 2023 to 2024. Descriptive statistics and analyses were performed using IBM SPSS Statistics.

We received responses from 174 (60%) EM residencies describing 3411 graduates over the last 2 years. Of all respondents, 48% (83) did not offer rural rotations while 52% (91) offered rural rotations, of which 47% (43) were required and 52% (47) were elective, with one program not specifying. Residents were more likely to enter the rural ED workforce immediately upon graduation from programs with rural rotations (15%), compared to those without (8%, Z = 6.28, p < 0.001), and especially if rotations were required (21%) versus elective (11%, Z = 6.35, p < 0.001).

Rural ED rotation experience in residency is associated with an increased likelihood of graduates entering the rural workforce, especially if rural rotations are required as opposed to elective. The addition of rural rotations to EM residency programs may increase the presence of BCEM physicians in rural emergency medicine settings.