4-Year Emergency Medicine Residency: Winners & Losers Edition

How long should Emergency Medicine residency be? Well, that depends who you ask. Recently, in a sweeping proposal that would reshape residency training in emergency medicine, the ACGME recommended extending the training period for all EM programs to 4 years, starting in July 2027.

Will this lead to more rigorous resident education? Improve patient care? Shore up sagging board passage rates? What will it do to the supply of emergency medicine physicians, or the EM job market, or access to emergency care? And what’s driving this change, really?

There are a lot of important questions here… so you know what that means.

It’s time to break it down, WINNERS & LOSERS style.
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REFERENCES
(in order of mention)

Mills JD. Emergency medicine 1947-1987: a PGM retrospective. Postgrad Med 1987; 81(3):81-88.
https://www.tandfonline.com/doi/abs/10.1080/00325481.1987.11699728
Morton JH. Report of the September 1977 meeting of the American Board of Medical Specialties. Fed Bull 1978; 65(1): 15-24.
http://www.jstor.org/stable/45463912


Emegency medicine core content. Ann Emerg Med 1979; 8(1): 34-41.
https://www.annemergmed.com/article/S0361-1124(79)80448-7/abstract
ACGME Green Book, 1981-1982.
https://www.acgme.org/globalassets/PDFs/1981-82.pdf
Gray BK, et al. Length of residency training in emergency medicine: an outcome-oriented approach. Ann Emerg Med 1986; 15(4): 493.
https://www.annemergmed.com/article/S0196-0644(86)80205-0/abstract
Schnabel N, et al. The expansion dilemma: a critical look at the 13-year increase in emergency medicine residency positions. AEM Educ Train 2025; 9(3): e70064.
https://pmc.ncbi.nlm.nih.gov/articles/PMC12159687/
HCA Healthcare. 2023 Investor Day Presentation. November 9, 2023. Online at:
https://s23.q4cdn.com/949900249/files/doc_downloads/investorDay2023/MASTER-LEGAL-BOOK-110723.pdf
Sheriff of Sodium. Budgetary Gerrymandering.
https://youtu.be/HoVTL1KMifs
HCA Healthcare Magazine. Educating the Next Generation of Physicians: Improving Care and Investing in the Future. May 14, 2024.
https://magazine.hcahealthcare.com/people/educating-the-next-generation-of-physicians-improving-care-and-investing-in-the-future/
Congressional Research Service. Medicare Graduate Medical Education, 2025. August 20, 2025. Online at:
https://www.congress.gov/crs_external_products/IF/PDF/IF13088/IF13088.1.pdf
Topping CEW, et al. Patient volume requirements: evaluation of the 2025 ACGME proposal for emergency medicine residency programs. AEM Educ Train 2025; 9(3):e70071.
https://onlinelibrary.wiley.com/doi/10.1002/aet2.70071
Beeson MS, et al. Comparison of performance data between emergency medicine 1-3 and 1-4 program formats. J Am Coll Emerg Physicians Open 2023; 4(3):e12991.
https://pubmed.ncbi.nlm.nih.gov/37304857/
Nikolla DA, et al. Four- and three-year emergency medicine residency graduates perform similarly in their first year of practice compared to experienced physicians. Am J Emerg Med 2023; 69:100-107.
https://pubmed.ncbi.nlm.nih.gov/37086654/
ACGME. Shaping GME: The future of emergency medicine.
https://prod.acgme.org/globalassets/pfassets/reviewandcomment/emergencymedicinethemesinsights.pdf
Regan L, et al. Building the future curriculum for emergency medicine residency training. J Grad Med Educ 2025; 17(2):248-253.
https://pubmed.ncbi.nlm.nih.gov/40417083/
Association of American Medical Colleges. AAMC Survey of Resident/Fellow Stipends and Benefits.
https://www.aamc.org/data-reports/students-residents/report/aamc-survey-resident/fellow-stipends-and-benefits
American College of Emergency Physicians. 2025 Salary Survey Findings.
https://www.acep.org/siteassets/sites/acep/media/compensation-report/2025-salary-survey-findings.pdf
HBO Max – The Pitt. “It the job that keeps giving.”
https://youtube.com/shorts/5nVJm0-5sNk?si=4o00mBznfBIqKkqR

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IMAGE CREDITS:

Title slide courtesy of ChatGPT, based on EM physicians from…

Dr. Glaucomflecken
https://youtu.be/AWMiG_7PwbM?si=vBTtDX17EtDz72S1

Preston
https://youtu.be/yaISa9-oMF0?si=VcXKP3_t1-rV2AnZ

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MUSIC:
“Clutch,” by Nicolas Major.
(license B5VB0T7WXN4SV9HC)

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