Senior Resident

This is a rough guideline on how to navigate the job/fellowship application process to give you a sense of what to expect. Your own journey into an emergency department (ED) administrative career may be very different depending on your career goals and personal background. There is no one formula for success. When in doubt, rely on your trusted mentors. Their advice will likely supersede any guide you read.

By the beginning of your last year of residency, you should have a good sense of whether you want to pursue the fellowship, degree, or job experience pathway into ED administration. While these pathways are separated below for clarity, keep in mind that some fellowships offer one or more degree programs, and some jobs can sponsor a degree as well.  Regardless of which pathway you choose, join an administration, patient safety, or quality improvement (QI) senior track or focus in your residency program (or create one if not available). An additional consideration would be to find an external elective at an outside institution that either has administrative distinction or an administrative fellowship. Leverage your involvement in national organizations like SAEM, the American College of Emergency Physicians (ACEP), the Council of Emergency Medicine Residency Directors (CORD), or one of the many ED administration associations to find contacts that can help you set up an elective. If you’re looking to stay within your own institution after residency, consider starting a new ED administration senior track if one doesn’t yet exist. Identify a faculty mentor and a few other interested residents and put together a proposal to present to your Program Director or Department Chair. This will make some waves within your residency and help distinguish you as someone who is truly passionate and capable of starting an ED administration career. Depending on whether you choose the fellowship, degree, or job experience pathways, your preparation will be different.

During PGY3 Year

Seek leadership roles at both the local and national levels, and consider publishing and presenting findings from your administrative projects at both the local and national levels.

• Find or create an administrative project (lead with passion; gain expertise) and take ownership of all or part of it under faculty mentorship. No matter which pathway you take into ED administration, you will encounter a question about this during your interviews.
• Consider pursuing a significant resident advocacy or leadership role at your institution, such as chief resident or the resident representative on a major hospital committee (Medical Board, Root Cause Analysis, etc.). Chief resident is a common choice among aspiring ED physician leaders but it is not a prerequisite for becoming an ED administrative leader. It is more important that you demonstrate passion and competence in your area of interest. If chief duties do not align with your interests, or get in the way of other significant administrative work you're doing, it may not be entirely beneficial to seek out that role.
• Engage in state-level advocacy. Many states have ACEP chapters that are actively engaged in advocacy, medical directorship, and system learning.
• Consider pursuing a significant leadership role at the national level, such as the chair of a committee in a national resident organization such as SAEM's Resident and Medical Student (RAMS) community, the Emergency Medicine Residents' Association (EMRA), or Resident and Student Association (RSA).
• Submit abstracts and posters to major national conferences or regional/local conferences.
• Consider writing QI articles for resident publications.
• Publish papers in peer-reviewed journals if possible.

You should also become the "admin person" within your residency. With your mentor's assistance, help facilitate the administrative track content. Take opportunities to teach junior residents or medical students about ED workflow or patient safety. Read up on departmental or institutional policies and guidelines so you can answer questions from other residents or faculty. When you are given a chance to present during morning report, M&M, or didactics at resident conference, think of administrative topics or tie in systems-level analysis in your teaching points. You should also try to synergize your clinical, educational, and administrative efforts in preparation for a career in ED administration, and start to explore the fellowship, degree, and experience pathways into ED administration.

Pathways Into ED Administration

There are myriad ways to engage in ED administrative growth. Generally speaking, there are three common pathways to build your credibility and help create a career after residency:

1. ED Administration fellowship (non-ACGME accredited; SAEM approved)
2. Master's degree in administration (MBA, MHA, MHL, etc.)
3. On-the-job administration experience
4. Ongoing conference-based education (i.e. ACEP Director's Academy, etc.)

The above by no means encompasses all approaches, although provides some perspective. These options provide much flexibility and choice, and for some it can also be very challenging to navigate. Although there is no standardized curriculum, degree, or certification across the different fellowships, the SAEM certification process has helped to normalize the quality of the content and educational offerings. However, recognize different institutions and degree programs have different timelines and requirements. The best advice is to research all your options thoroughly, speak with the fellowship directors if considering this pathway and talk to as many mentors as possible.

The Fellowship Pathway

As of 2025, there are approximately 40 ED administrative fellowships and 14 patient safety and QI fellowships offered throughout the United States. They are all non-ACGME accredited fellowships, though this may change. They typically last one-two years, often depending on concurrent degree paths. ED administrative fellowships vary widely in their curriculum and scope, with new ones being formed every year.

Generally speaking, ED administrative fellowships fall into two broad categories: those affiliated with an academic or training institution (e.g., Yale, Wake Forest, Stanford), and those affiliated with an independent physician-owned organization or group (e.g., Vituity, formerly CEP America). Some offer a master’s degree in business or hospital administration as either an option or requirement, while others offer to sponsor an external degree, and the rest offer no degree option. The type of degree is also highly variable, with MBA, MHL, MHA, MPH, and MS degrees being offered at different programs, sometimes in combination.

While the variety may seem somewhat overwhelming, keep in mind that it also allows you to find a program that caters to your goals instead of forcing you to conform to a universal standard. While ED Administrative Fellowships have no ACGME requirements, many have sought approval through the SAEM pathway. Seeking those that have been approved elevates the standard and curriculum quality. As much as possible, identify what you hope to gain and/or learn through the fellowship and your current area of interest. This will help inform the ideal questions before starting the interview process or committing to a program. Research the fellowships thoroughly, talk to former or current fellows, and don’t be shy to compare notes with other applicants during the interview trail.

Many programs are additionally offering further sub-specialized tracks with a specific focus. These often include operations, patient safety, financial management, research, health policy advocacy, digital healthcare, and more. If you have a particular career focus in mind, consider adding the availability to a focused track to your program research. While an increasing number of institutions are offering structured fellowship or degree programs for ED administration, keep in mind that graduating from these programs does not guarantee you a management position right out the gate. On-the-job experience still matters tremendously. That being said, academic institutions often view administrative fellowships very favorably, and give preference to candidates who can join the ED with pre-existing administrative training and skills. This may increase your competitiveness for an academic faculty position and may help expedite your trajectory toward an administrative leadership position.

The SAEM Fellowship Directory was developed in order to promote standardization of fellowship training. Eligible fellowship programs earn the endorsement of “SAEM-Approved Fellowship” in order to be included in the directory. SAEM has developed guidelines for training programs that address milestones in curricular elements, faculty support recommendations, and career development opportunities.

The Degree Pathway

Many ED physicians successfully advance their careers by obtaining a master’s degree in administration independent of a fellowship program. The most popular options are MBA, MHA, or MPH. There are also several physician-dedicated MBAs available and an increasing number of MHLs with increased focus on the leadership aspect of administrative efforts. This is a great mid-career option several years out of residency, especially if an institution is willing to sponsor your degree or it is included as part of a promotion track. It’s also a great alternative for residents who don’t want to pursue fellowship but are still looking for formal administrative training. Some medical schools offer dual MD/MBA degrees for those with an early inclination in this area. However, recognize that education also comes when you may have limited clinical or healthcare experience which may influence the overall understanding and value proposition at this stage of career for some.

The Experience Pathway

It is entirely possible to become a successful ED administrative leader through on-the-job experience alone, without any fellowship training or additional degree. However, accomplishing this immediately after residency is becoming increasingly difficult as more and more aspiring physician leaders are acquiring formal administrative training with the support of their institutions. That being said, a strong track record of effective leadership and successful administrative projects has tremendous weight. Simply completing a fellowship program is no substitute for real proven experience. If you are fortunate enough to have both an administrative fellowship offer and an administrative job opportunity, you should consider both options very seriously. Make certain the fellowship offers you value beyond just another line on your CV. Is there also a sponsored or subsidized degree that is valued by the administration community? Will you participate in an interesting project or publication that directly aligns with your career goals? Is there opportunity to interface with hospital leadership that you otherwise would not have access to? How will this advance your short-term and long-term career goals? If you’re stumped, reach out to as many people and mentors as you can for advice, both inside and outside your institution.

If you cannot find an ED administrative mentor at your institution, engage in your regional and national EM student sections. There are ample ways to engage in committees as students. Find your area of interest and begin networking, and volunteer when an opportunity is available. Also, try to attend the Speed Mentoring session at the SAEM Annual Meeting, which is a great way to gain exposure. The more involvement you have, the bigger your network of potential mentors.