The growth of emergency medicine residencies: How does New York State compare to other States?

Joel M. Bartfield, MD FACEP, Associate Dean for Graduate Medical Education, Albany Medical College

Over the past one to two decades, Emergency Medicine training programs have grown in number. The Northeast has seen the largest growth in the number of training programs. New York State has more training programs than any other state in the country. Additionally, we can be proud of the fact that we have one of the lowest population per emergency resident graduate of any state in the country. This has not always been the case. In this article, I will outline the growth of emergency medicine in the state of New York. In order to do this, I will compare training programs and census data from the years 1990 and 2000.

Census data for each state in the nation was obtained from U.S. Census Bureau data available online at http:\\censtats.census.gov\. Number of residencies in emergency medicine and total number of residents being trained per state were obtained by reviewing green book data as published in the Graduate Medical Education Programs by ACGME for the years 1990-91 and 2000-01. Number of graduating residents per year was estimated by dividing the total number of residents per program by the number of years per program. Since accurate information for osteopathic residency programs in emergency medicine was not available for the academic year 1990-91, this information was not included in this article. Military training programs were also not included in this analysis.

Table I provides census information, number of emergency medicine residencies, population per graduating resident, and rates of improvement in this ratio for 1990 and 2000 in each state. Census data was divided by the total number of graduating residents in each year to obtain a population per emergency medicine graduate in 1990 and 2000. In order to determine the rate of improvement in population per graduating emergency medicine resident, population per graduating emergency medicine resident in 2000 was compared to population per graduating emergency medicine resident in 1990.

In 2000, New York State had 17 ACGME-approved training programs in Emergency Medicine. This places New York State first in the nation. Compared to California, which is second in the nation, at 12, New York State increased its number of training programs from 7 in 1990 to 17 in 2000, while California remained flat at 12 total training programs in both years. California did have a modest increase in the total number of emergency medicine residents from 298 in 1990 to 404 in 2000. This compares to an almost three-fold increase in emergency medicine residents in New York State from 148 in 1990 to 525 in 2000. In 2000, New York State had 114,000 residents per graduate of an emergency medicine training program, making it the fifth most desirable state in this category. Compared to 1990, when the ratio was close to 400,000 citizens per graduate, New York State had a 22-fold improvement in this metric. Only two other states in the country, Louisiana and Texas, can boast a more favorable improvement; however, a review of the data in the table below will indicate that New York had a more favorable population-to-graduate ratio than either of these two states.

New York State currently has 19 ACGME training programs and additionally, two osteopathic residency programs in emergency medicine. Although census data is not available for the current year, it is my strong suspicion that we continue to compare very favorably to the rest of the country regarding our supply of emergency medicine graduates for our population base.

This analysis has a number of limitations, which should be mentioned. First of all, I was unable to obtain accurate information for osteopathic training programs in the years studied. Therefore, these training programs were not included in this analysis. Secondly, the number of graduates per year was calculated by making the assumption that an equal number of residents were in each year of training. For instance, if there were a total of 30 residents in a 3-year program, the assumption was made that 10 residents graduated in the years in question. Clearly, this assumption may not be accurate and does not allow for variation in the number of residents per year in a program or changes in total resident complement per year in any individual program. Additionally, although green book information is generally accurate, no independent effort was made to verify that the information contained in the green book for the years in question was accurate. The number of residents graduating from military programs was not included in this analysis. The assumption was made that residents graduating from these programs would not be included in the pool of emergency physicians available to care for non-military citizens of individual states. To the extent that this assumption is inaccurate, the results are similarly inaccurate. Despite these limitations, the following conclusions can be drawn about the state of New York as compared to other states: New York has the largest number of emergency residencies, New York has the most emergency medicine residents, New York had the largest growth in emergency medicine residencies and residents in the 1990’s, New York has one of the lowest population per graduating emergency medicine resident, New York had one of the highest reductions in population per emergency medicine resident in the 1990’s.

This information could have important implications on the staffing of emergency departments in New York and on the role that New York ACEP can play to improve quality of care in our EDs. The New York State American College of Emergency Physicians should support a position that physician staffing of emergency departments of the state of New York should be of the highest quality. Given the fact that we have such a relatively large number of graduates for our population, now may be the time to push for expansion of the 405.19 regulations to include specifications for the credentials of emergency medicine attending physicians. In order to assure the highest quality of health care for our patients, attending physicians staffing our emergency departments should either be board-certified by the American Board of Emergency Medicine and/or the American Osteopathic Board of Emergency Medicine previously, or graduates of training programs as recognized by ACGME or the American Osteopathic Association. Clearly all residents graduating from training programs in the state of New York do not choose to stay in the state to practice. However, a significant percentage of our graduates are likely to remain in the state. We therefore have a large pool of graduating emergency medicine residents from which to draw. Given the fact that we have such a high supply we should assure that there is also a high demand. One way of increasing demand while improving quality of care is to expand the 405.19 regulations to specify the qualifications of attending physicians in our emergency departments.

Table I