Between the Chaos and the Calling: Why Students Still Choose (and Sometimes Don’t) Emergency Medicine
By John E. Delzell Jr., MD, MSPH, MBA, FAAFP
Emergency Medicine has long been the specialty of
adrenaline and altruism. For decades, it was one of the most competitive
matches in the National Resident Matching Program—nearly every program filled,
and students lined up to join the front lines of acute care. Yet, as I
documented in my previous blog, in the past few years we have watched that
once-steady tide recede. In 2023, almost half of EM residency programs in the
US had unfilled positions on Match Day. The decline was so striking that it
forced a profession known for composure under pressure to stop and ask: What
happened?
My previous blog (1) talked about the data from the Match and some of the
background issues in the specialty. Now I want to talk about the other side,
the students who are considering EM. Three recent studies give us a window into
the minds of the students who are either drawn toward—or quietly walking away
from—Emergency Medicine. Together, they reveal a complex mix of inspiration,
disillusionment, and hope.
The Push and Pull
Kiemeney and colleagues’ 2025 Western Journal of Emergency
Medicine study (2) captured the voices of over 200 recent EM applicants. Their
findings read like a portrait of a generation standing at the crossroads of
medicine’s promises and its pressures. Students were drawn to EM for familiar
reasons: the variety of pathology, high-acuity patient care, higher
compensation compared to primary care, and a flexible lifestyle. Many spoke
warmly of their third- and fourth-year clerkships, and of residents and attendings
who modeled teamwork and compassion in the organized chaos of the emergency
department.
But the same environment also revealed what pushes students away: corporate ownership
influence, crowding in the emergency department, burnout, and anxiety about
workforce projections. More than two-thirds of applicants said they were
advised against EM—most often by physicians from other specialties. The
perception of an oversupplied job market, coupled with the visibility of
exhaustion among practicing emergency physicians, created real hesitation.
What’s most sobering is that these deterrents aren’t about medicine’s
content—they’re more about its context. Students still love the medicine of EM.
They’re just unsure about the system that surrounds it.
Early Exposure, Lasting Impact
The 2018 study (3) by Ray and Colleagues reminds us how
EM’s appeal once took root. Surveying nearly 800 applicants (fourth year, EM
bound, MD & DO students), they found that early exposure—before or during
the third year of medical school—was one of the strongest predictors of
choosing Emergency Medicine as a specialty.
Students who worked as scribes, EMTs, or ED technicians, or who trained at
schools with EM residencies, made their decision earlier and more confidently.
Conversely, delayed exposure often meant that students had already committed
elsewhere before they truly encountered the specialty.
That insight still feels true. Students can’t fall in love with what they don’t
see. Emergency Medicine, which traditionally appears late in the clinical
curriculum, may lose future physicians simply because it shows up too late in
their professional identify formation. By the way, this is commonly seen in
specialty choice. It can be true for Family Medicine, medical and surgical
subspecialties, and other specialties that may not be part of the core clinical
curriculum in medical school.
Defying the downtrend
A new 2025 study from Brown University by Kerrigan et al.(4)
offers a glimmer of optimism. While most of the country saw steep declines in
EM applicants, Brown’s numbers actually increased. Their secret wasn’t a
marketing campaign or a higher salary projection—it was mentorship and
meaningful clinical engagement. Students credited resident-led mentoring,
advising from faculty, and hands-on electives during the third and fourth years
as decisive influences.
Interestingly, pre-clinical exposure and interest-group events mattered less.
Students learned about EM in those settings, but they chose EM only after
authentic, human interactions in the clinical environment. Residents—still
close enough to remember the decision themselves—proved to be the most trusted
guides.
In other words, people and practice still matter more than perception. This was
a small study (31 students) from one allopathic school which makes it hard to
generalize the results but those feel like good strategies that could work in
other settings.
What Students See—and What Can Change
Across all three studies, a few themes are remarkably
consistent:
• Physician mentors matter most. Whether in the chaos of a resuscitation bay or
the calm of post-shift debriefing, physicians shape students’ career decisions
through the moments they share.
• The third year is the tipping point. By that time, half of students have made
their specialty decision. If a clinical experience does not happen until the
fourth year, the clinical experience is probably already too late.
• Students worry about the future. Job-market uncertainty, “Scope creep,” and
corporatization have become part of the specialty’s narrative. Unless national
leaders in Emergency Medicine actively address these concerns, it will continue
to erode trust.
• Positive culture keeps hope alive. The “people and culture” of EM—its
teamwork, humor, and humanity—remain attractive to medical students. Even in
difficult times, they remind students why the field matters.
Reclaiming the Story
Emergency Medicine sits at a defining moment. Its students
see both the calling and the cost. They know that the specialty saves lives,
but they also see the toll it takes on those who practice it.
If Emergency Medicine’s leaders want to reverse the trend, there
needs to be more than workforce data. They will need stories—of balance,
belonging, and purpose. They need to invest in resident mentors and clinical
clerkships. EM needs to show students that the specialty is not just a job in
crisis—it’s a career built on courage, adaptability, and service to every
patient who walks through the door.
When students step into an emergency department and see compassion under
pressure, they still fall in love. That spark is still there. The challenge for
educators, leaders, and professional societies is to keep it alive long enough
for them to choose it.
References
1. https://educationinmedicine.blogspot.com/2025/10/emergency-medicine-at-crossroads.html
2. Kiemeney M, Morris J, Lamparter L, et al. Push and Pull:
What Factors Attracted Applicants to Emergency Medicine and What Factors Pushed
Them Away Following the 2023 Match. West J Emerg Med. 2025; 26 (2): 261-270.
3. Ray JC, Hopson LR, Peterson W, et al. Choosing Emergency
Medicine: Influences on Medical Students’ Choice of Emergency Medicine. PLoS
ONE. 2018; 13 (5): e0196639.
4. Kerrigan D, Knopov A, Lipner K, et al. Defying the
Downtrend: Factors Driving Medical Students to Pursue Emergency Medicine. AEM
Educ Train. 2025; 9: e70057.
