Medical residents can change specialties during their training under certain conditions in many countries. However, the characteristics and underlying motivations driving these specialty changes remain poorly understood. This study aimed to assess the factors influencing residents’ decisions to join or leave the emergency medicine (EM) program, and the impact of specialty transition. This study was a nationwide e-survey targeting residents enrolled in an EM program in France (2017–2024). The survey included 37 questions structured into five key domains: personal quality of life, professional quality of life, specialty practice, education and training, and specialty perception. An anonymous online questionnaire was disseminated through the program directors, regional health agencies, and resident associations and unions. A total of 453 residents from 28 academic subdivisions participated, including 204 residents who underwent a specialty change (146 entered and 58 left the EM program). Family medicine was the most common origin specialty for those entering EM (89.1%) and the primary destination specialty for those leaving (53.5%). The key motivations for transitioning into EM included a preference for emergency decision-making (97%), the technical aspects of the specialty (96%), and its transversal nature (90%). The primary reasons for leaving EM were concerns about health/fatigue (86%), work-life balance (80%), and the nature of physician-patient relationships (78%). The EM specialty attracts residents who are drawn to its technical demands and versatility. However, factors such as work-life balance, fatigue, and the nature of patient interactions contribute to attrition from the specialty. Emergency medicine is characterized by high clinical workload and substantial physical and emotional strain, which contribute to significant challenges in long-term workforce retention. However, the underlying mechanisms driving these dynamics remain insufficiently understood in the international literature, particularly in France, where the specialty was formally established only in 2017. This nationwide survey found that residents entering EM were primarily motivated by urgent decision-making, procedural skills, and the transversal nature of the specialty (defined as its cross-disciplinary scope encompassing a wide spectrum of clinical conditions across organ systems, patient populations, and care settings), whereas those leaving most frequently cited fatigue, work-life imbalance, and dissatisfaction with patient interactions. Despite opposite motivations, 80% of residents reported that the specialty change met their expectations for personal quality of life, although professional satisfaction was lower among those exiting EM. In the French context, targeted policy interventions could include earlier and structured exposure to EM during undergraduate training, formalized mentorship pathways within EM programs, standardized evaluation of rotation quality across academic subdivisions, and improved regulation of workload and night-shift distribution. Additionally, enhancing transparency regarding career trajectories and working conditions prior to residency selection may help align expectations and reduce subsequent specialty transitions.
Gaillard et al. (Mon,) studied this question.