Pre- and Post-Pandemic Trends in Emergency Medicine Resident Attrition

Completion of EM residency is essential for the growth of the specialty and the strength of each residency program. Understanding resident attrition is paramount for program leadership and recruitment. We aimed to determine if there was a change in EM resident attrition rates after the COVID-19 pandemic. We also sought to determine whether residency attrition rates correlated to attending attrition rates or EM residency application numbers.

This was a retrospective cross-sectional study of publicly available data from the ACGME Data Resource Book from 2013 to 2023, NRMP Results and Data from 2014 to 2024, and the Medicare Physician and Other Practitioners database. When comparing the proportions of attrition between residents and attendings by year, the attending rate from 2 years prior was used, as we hypothesized a lag between attending and resident attrition based on structural factors in residency application and employment. To test whether attrition rates followed a similar pattern over time, slopes between residents and attendings were compared by year using a linear regression. A similar method was used to compare yearly resident attrition rate to annual application rates.

Between 2014 and 2021, there was a general decline in EM resident attrition, followed by an increase in attrition in 2021-22. This pattern mirrored attending attrition rates with a two-year delay. Attending and resident attrition persisted at a higher-than-baseline rate in 2021 and the 2022-23 academic years, respectively. Lower-than-baseline application rates by these students persisted in the 2022-23 academic year, as did higher-than-baseline resident attrition rates.

We found a spike in EM resident attrition for the 2021-22 academic year after a period of decline, mirroring trends in EM attending attrition, and an inverse correlation between EM residency application and attrition rates after 2021-22. Further studies are needed to elucidate the underlying factors determining resident attrition, attending attrition, and EM residency application.