Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Advanced emergency ultrasound (AEMUS) fellowships recently experienced an unexpected decrease in the number of positions filled in the match. Our study aimed to characterize this trend over an eight-year period.

Methods: We performed a cross-sectional observational study of AEMUS fellowships participating in the National Resident Matching Program (NRMP) from the 2019–2026 match cycles, cross-referencing the publicly available database from the Society of Clinical Ultrasound Fellowships. The primary outcome was both the proportion of AEMUS fellowship positions filled and a program complement fill percentage. Secondary outcomes included stratification by geography and duration since program establishment.

Results: We included a total of 138 of the 141 programs listed in the NRMP Match. From 2019 to 2026, there was a 28.2% increase in the number of programs and a 34.5% increase in available positions. There was a general increase in the percentage of positions filled from 2019 to 2022, with 53.7% (87/162) of positions filled to 74.4% (145/195), peaking at 81.1% (137/169) in 2021. This upward trend reversed in 2023 with a decrease to 65.1% (142/218). The percentage of positions filled has continued to decrease through 2026, with a fill rate of only 56.0% (122/218). In the eight years of NRMP data, 97 of the 138 programs (70.3%) went unfilled at least once. Programs participating in the Match for a longer period had a statistically significant higher fill percentage, with 27 programs in the 1- to 4-year group with a total fill percentage of 46.0%, 32 programs in the 5- to 7-year group with a fill percentage of 59.0%, and 79 programs in the ≥ 8-year group with a fill percentage of 72.8% (P < .01) using a Kruskal-Wallis test. Spearman correlation analysis found no association between geographic proximity and likelihood of a program being fully filled.

Conclusion: This cross-sectional study of NRMP data showed a decrease in the percentage of positions filled for adult AEMUS fellowships starting in 2023, which continued through 2026. Programs with greater longevity exhibited higher fill percentages, showing resilience in the face of this pattern.