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After the game: no excuses not to recruit MRUs : Emergency Medicine News


URM, GME, equity in emerging markets


Health care facilities create or expand diversity programs to address gender, ethnicity, and sexual orientation gaps. Higher medical education has a particular interest in recruiting underrepresented minorities (URMs). This effort is more complex than I can cover in this space. Centuries of racial oppression are hard to unravel quickly in a profession that requires more years of education than any other in society.

My goal was to find effective methods to improve the diversity of my program. I have applied to join the Diversity Sub-Committee for GME at my institution; our goal is to develop strategies to increase the number of URM graduates from our programs. South Carolina has a relatively large number of black citizens (27% of the population, according to the US Census Bureau;, but we are struggling to enroll black doctors in our residencies.

My task on the committee was to survey the number of URMs currently in residence, regionally and nationally. My analysis indicates that we still have a long way to go and that it will be difficult to get more ERUs to undergo residency training in emergency medicine in the near future.

The Association of American Medical Colleges provides an annual resident report. (2021; A section titled “Number of Active Residents by Race/Ethnicity (Alone or in Combination) and GME Specialty” shows the number of residents of different ethnicities in each residency and fellowship by specialty.

Matching URMs

A summary of the ethnic composition of all allopathic and osteopathic residents relative to the population of the United States is presented in Table 1. Based on this information, Hispanics and Blacks are the most underrepresented minorities in relative to all higher medical education in the United States. The Emergency Medicine URM deficiency is similar to most other residency and fellowship programs. (Table 2.)

The total number of Hispanic and Black residents in emergency medicine programs during the 2020-2021 academic year were 679 and 456, respectively. If these URM residents were split evenly among the roughly 270 programs running at that time, that would mean 2.5 Hispanic residents and 1.7 Black residents per program (not just a single class). If the percentage of these URMs matched the population of the United States, more than double the number of residents would be in each program for each racial group.

Table 2. –
Emergency medicine residents by race/ethnicity, 2020-2021

Race US population allopathic Osteopathic
White 4035 (64%) 1609 (74%) 5644 (67%)
Asian 948 (15%) 316 (15%) 1264 (15%)
Hispanic 567 (9%) 112 (5%) 679 (8%)
Black 413 (7%) 43 (2%) 456 (5%)
Pacific Islander, Native American 99 (1%) 23 (1%) 122 (1%)
Other, unknown 231 (4%) 76 (3%) 307 (4%)


I suspect that all emergency medicine residency programs are actively recruiting applicants to URM. Many of them offer monetary stipends as an incentive for URM candidates to spin with their program in the months leading up to interview season. Applicants typically develop relationships with residents and participants during these rotations, and it is not unusual for many applicants who fit a given residency class to rotate to the program prior to the match.

However, with a limited number of URM candidates in the matching pool, most programs only maintain or slightly improve their number of URM residents. The critical point for increasing the number of Hispanic and Black residents appears to be the number of URMs in medical schools.

No excuses

A review of AAMC data on the race and ethnicity of American medical students demonstrated an increasing number of Hispanic and black men and women entering allopathic medical schools. (Table 3.) This is a slow process. The percentage of black allopathic students has increased from seven to eight percent over the past five years. The increase was six to seven percent for allopathic Hispanic students.

Given that the process of completing medical school takes at least eight years, the slow pace of change is understandable, but the urgency we now feel in light of recent events could dissipate if we are not vigilant to avoid d be distracted by other issues. We also must not let the slow progress in recruiting MRUs call into question our ability to stay focused on this issue.

The percentage of CRUs pursuing training in emergency medicine is comparable to other specialties, but we need to find strategies to attract more to our field. The current oversupply of EM residency positions and concerns about the future of the job market work against our efforts to increase diversity.

None of these obstacles is an excuse to give up trying. We must understand that the bottleneck for more URM candidates is their entry into medical schools and maintain our vigilance to correct the problem. Anything we can do to encourage an increase in URM enrollment will help us in the future.

Dr Cookis the director of the emergency medicine residency program at Prisma Health in Columbia, SC. He is also the founder of 3rd Rock Ultrasound ( Friend with him, follow him on Twitter@3rdRockUS, and read his past columns on