WASHINGTON, D.C.—A new analysis of the emergency physician resident workforce in Annals of Emergency Medicine finds that while the number of residency programs is increasing, new residency programs are disproportionately located in urban areas in states with existing programs, rather than rural communities with limited access to emergency care.

“Predictions of an oversupply of emergency physicians in the next decade may not apply to every part of the country,” said Christopher L. Bennett, MD, MA, assistant professor of emergency medicine at Stanford University School of Medicine and lead study author. “Regional differences over time need to be considered in any discussions of workforce challenges—these findings underscore the likelihood that rural emergency physician shortages will persist.”

A small number of states with an already high number of residency programs gained the most programs between 2013 and 2020, according to the study. At the same time, there is an emergency physician “desert” in the rural United States characterized by a lack of residents and residency training programs.

The six states with the largest increase in residency programs were Florida (increased from five to 19), Michigan (increased from 11 to 25), New York (21 to 31), Ohio (nine to 18), Pennsylvania (12 to 21), and California (14 to 22). Twenty states did not gain a program and some states do not have any emergency medicine residency programs, including Idaho, Montana, North Dakota, South Dakota, and Wyoming.

The number of emergency medicine residencies expanded from 160 to 265 between 2013 and 2020, according to Accreditation Council for Graduate Medical Education (ACGME) data analyzed. The study also notes that of 6,993 emergency medicine residents in the 2020 American Medical Association data set, 98% were in urban areas.

This analysis of residencies is consistent with a 2020 study by the same authors that found most emergency physicians (92%) were in urban areas and that clinically active emergency physicians in rural communities skewed older and closer to retirement than their urban area peers.

Urban residency programs that can expand opportunities for rural training rotations may be able to help solve aspects of the projected workforce challenges, the authors note.

“Emergency physicians tend to practice where they train,” said Dr. Bennett. “As newer physicians seek footing in a challenging job market, exposing residents to rural emergency medicine can open doors to rewarding career paths while addressing the critical need to improve access to emergency services in these communities.”