Graduating US emergency medicine residents expected to practice clinical emergency medicine for more than 22 years on average, despite high rates of burnout and substantial educational debt, according to a recent study.
Immediate postresidency plans most commonly included community-based practice at nonacademic hospitals, followed by fellowship training and hybrid roles affiliated with academic medical centers. Burnout and educational debt were prevalent and were associated with how residents prioritized these factors, whereas concerns about a projected emergency physician (EP) surplus and the COVID-19 pandemic exerted comparatively little influence.
These findings were drawn from a national cross-sectional survey study of residents graduating in 2023 from all Accreditation Council for Graduate Medical Education (ACGME)-accredited categorical emergency medicine (EM) programs. Researchers administered an electronic survey following the 2023 American Board of Emergency Medicine In-Training Examination, collecting deidentified data between June 20 and August 18, 2024, with analyses conducted from December 16, 2024, to August 12, 2025. Survey measures included demographic characteristics, educational debt, burnout status assessed using the abbreviated Copenhagen Burnout Inventory, immediate postresidency career plans, intended practice settings, anticipated duration of clinical practice, and the perceived importance of 10 predefined career decision factors.
Of 2,782 eligible residents, 2,711 responded to at least one survey item, yielding a response rate of 97%. More than 60% reported educational debt exceeding $100,000, and among respondents who completed the burnout assessment, 72% met criteria for burnout. Fewer residents planned to enter academic EM. Most respondents anticipated practicing in urban settings, while approximately one-quarter reported plans for rural practice.
"These findings provide timely insights into the perspectives of the next generation of EPs and highlight important considerations for workforce planning and career sustainability initiatives in EM," noted lead study author Dave W. Lu, MD, of the Department of Emergency Medicine at the University of Washington School of Medicine in Seattle, and colleagues.
The mean anticipated duration of clinical EM practice was 22 years. Lifestyle was identified as a major influence by nearly all respondents (98%), followed by geographic location (89%), professional fulfillment (88%), and salary expectations (83%). Multivariable analyses showed that residents with educational debt of $200,000 or more were significantly more likely to prioritize salary expectations. Female residents were more likely than male residents to identify professional fulfillment and burnout as important influences and were less likely to emphasize salary. Burnout status and race were associated with differences in anticipated years of practice, whereas gender, residency program length, and debt level were not.
The researchers noted several limitations, including missing data for some survey variables despite a high overall response rate, which may have limited the generalizability of certain subgroup analyses. Because participation was voluntary, the findings may also have been influenced by response or social desirability bias, particularly for self-reported burnout, educational debt, and career plans. In addition, the cross-sectional design captured career intentions at a single point late in residency, and these reported plans may not reflect actual postgraduation career paths. Finally, the observational nature of the analysis allowed for identification of associations but did not support causal conclusions.
Bryan G. Kane, MD, received a waived registration fee from the American College of Emergency Physicians for serving as a research moderator at the ACEP Scientific Assembly. No other disclosures were reported.
Source: JAMA Network Open
