A new proposal to extend emergency medicine residency programs from three years to four has ignited a debate within the healthcare industry. Advocates argue that a longer residency would better prepare physicians for the complexities of emergency medicine, improve patient outcomes, and strengthen the specialty. However, critics—including industry leaders and healthcare technology experts—warn that the change could exacerbate physician burnout, create unnecessary barriers for new doctors, and primarily serve the financial interests of hospitals.
The move comes despite years of data indicating that three- and four-year emergency medicine residency programs yield comparable outcomes. Now, with the potential for a nationwide shift toward mandatory four-year residencies, many are questioning the motivations behind the policy.
“For many years, they have cited their own data and said three-year and four-year residency programs for emergency medicine were basically equal. Now, they’re proposing a four-year nationwide change,” says Sarah M. Worthy, CEO of healthcare technology firm DoorSpace. “At a time when we are watching talented physicians quit medicine entirely, we are making it harder for new doctors to start their careers. The only benefit from this longer program is to the hospitals who can profit off these residents for one more year under these new guidelines.”
A System Already in Crisis
The proposal comes as the healthcare industry grapples with high physician burnout and staffing shortages. Emergency medicine, in particular, has seen significant workforce instability, with increasing numbers of clinicians citing unsustainable workloads and administrative burdens. Critics argue that adding an extra year of training fails to address these systemic challenges and instead risks discouraging medical students from pursuing the specialty.
“It’s no wonder physicians are turning to unions—the people who are supposed to support their work are doing everything but,” Worthy adds. “At DoorSpace, we spend every waking hour looking for ways to automate and/or eliminate low-value tasks so clinicians have more time to spend with patients and with their families.”
Extending residency requirements means new physicians will spend an additional year working under reduced wages and grueling schedules before they can practice independently. Given the existing concerns about physician well-being, critics worry that lengthening residency may further contribute to burnout, particularly as more doctors struggle to balance personal and professional obligations.
Who Benefits from the Change?
Supporters of the four-year residency model argue that the additional training will produce more skilled emergency physicians who are better equipped to handle high-stakes situations. They suggest that extending the curriculum will allow doctors to refine their clinical decision-making and gain broader experience with complex cases before entering the workforce.
However, critics challenge whether patient outcomes would truly improve under this new model. They argue that hospitals, rather than patients or clinicians, stand to gain the most. Teaching hospitals rely heavily on residents to deliver patient care, often at lower costs than fully trained attending physicians. An extra year of residency means hospitals would benefit from an additional year of cost-effective labor.
“We understand the best way to get affordable, quality care for our families is to build technology that makes work better for the doctors, nurses, and other healthcare workers caring for us,” Worthy says. “Measuring which activities, including training activities, lead to better results versus worse or no results is core to our value proposition. It’s shameful to see leading healthcare organizations fighting against our work to reduce the time wasted in healthcare.”
The Bigger Picture
The debate over emergency medicine residency length reflects broader concerns about the future of medical training, physician workforce shortages, and the evolving role of technology in healthcare. As hospitals and policymakers consider the implications of this potential mandate, industry leaders continue to push for data-driven solutions that prioritize both clinician well-being and patient care.
“This policy change, should they follow through with it, doesn’t benefit patients or clinicians,” Worthy states.
With many hospitals and medical organizations facing financial pressure, residency expansion may serve institutional interests—but at what cost? As the conversation continues, stakeholders across the healthcare landscape are calling for a more transparent, evidence-based approach to medical training and workforce sustainability.
