Applicant Rank List Preference for Emergency Medicine From 2020 to 2026

Emergency medicine (EM) training programs have experienced disruptive challenges in recent years. However, enthusiasm for EM, as measured by National Resident Matching Program (NRMP) rank order list preference data, remains high among senior United States (US) allopathic (MD) applicants who apply to the specialty. Although osteopathic (DO) and international medical graduate (IMG) applicants comprise a growing share of the EM resident workforce, there is little data evaluating their preference for EM.

This retrospective analysis of NRMP rank order list preference data includes four types of applicants: US MD seniors, US DO seniors, IMGs with US citizenship, and IMGs without US citizenship. For each applicant category, we recorded the number (and calculated the percentage) of EM applicants who ranked EM as their only choice, first choice, and not first choice during the 2020-2026 NRMP. The number and percentage of applicants ranking EM as their preferred choice were determined by combining the first choice and only choice categories.

During the study period, the percentage of EM applicants ranking EM as their preferred choice ranged from 91.8% to 95.8% among US MD seniors, from 86.9% to 93.6% among US DO seniors, from 76.5% to 88.8% among US IMGs, and from 57.3% to 83.3% among non-US IMGs. The percentage of EM applicants ranking EM as their "not first" choice peaked in 2024 and then declined for each applicant category in 2025 and 2026.

Despite recent challenges, our findings demonstrate that EM remains the preferred specialty choice for the majority of US MD senior, US DO senior, US IMG, and non-US IMG applicants who ranked EM residency programs.