# Additional Commentary on “The Proposed 48-Month Emergency Medicine Residency Requirement Demands Immediate Scrutiny”

## TL;DR

This paper argues against extending emergency medicine residency to 48 months due to financial and educational concerns.

## Contribution

The paper proposes alternative training pathways instead of a longer residency.

## Key findings

- There is no objective data supporting a 48-month residency requirement.
- A longer residency could reduce resident class sizes and harm training quality.
- Alternative training options may better prepare physicians than extended residency.

## Abstract

This paper provides commentary on the accompanying publication, “The Proposed 48-Month Emergency Medicine Residency Requirement Demands Immediate Scrutiny.” The ACGME Residency Review Committee for Emergency Medicine recently proposed a change to the required length of training to 48 months. Currently, there is a lack of objective data to support the optimal duration of emergency medicine residency training. One of the primary concerns regarding a mandated fourth year is the significant financial burden it would place on training programs. If sponsoring institutions are unable or unwilling to provide the necessary resources to support a prolonged curriculum, programs could be compelled to reduce resident class sizes. A reduction in class size would negatively impact the educational environment, including emergency department coverage and participation in external rotations. To better prepare physicians for independent practice, it may be time to consider a base training length of 36 months, followed by alternative pathways such as fellowships, focused practice designations, or targeted curricula—all of which may be more effective than extending the duration of residency training.