Administration & Operations, Fellowships, Medical Education, Career Planning

What You Need to Know About EM Administration Fellowships

EMRA's Administration and Operations Committee recently held a virtual panel of EM Administration Fellowship Directors and Co-Directors.

The panelists included:

  • James Heilman, MD, MBA, of Oregon Health and Science University
  • Mahesh Polavarapu, MD, of Columbia Medical Center
  • Robert Tanouye, MD, of New York Presbyterian/Cornell
  • Thomas Spiegel, MD, MBA, MS, FACEP, of the University of Chicago

This article summarizes key points from the conversation as well as other important information about administration fellowships, from applications to fellowship structure.

What are emergency medicine administration fellowships?
EM administration fellowships are designed to prepare emergency physicians for careers in departmental and hospital leadership through training in everything from administration to quality and safety to operations. The first EM administration fellowship was founded in 1990, and many more fellowships have been developed since that time.1 There are now dozens of these fellowships around the country, and each has unique structures and characteristics.

EM administration fellowships range from 1 to 2 years, and some of them include a master’s degree as part of the educational curriculum. The type of degree can vary, but is commonly a Master’s of Business Administration (MBA) or Master’s of Health Administration (MHA). These degrees may be obtained at a university affiliated with the hospital, another nearby university, or remotely. Typically, EM administration fellowships that include a master’s degree are 2-year fellowships. Most 1-year fellowships do not have an associated master’s degree. 

Many EM administration fellowships are affiliated with departments that have residency programs. Practice settings vary from academic centers to community programs. Others may be associated with regional practice groups, and some large contract management groups also offer their own administration fellowships.2

Each fellowship program offers unique training experiences, including opportunities to work on different quality, operations, and process improvement projects, as well as serving on various department and hospital committees. Most fellowships require at least one quality improvement project during the fellowship. Fellows tend to work closely with mentors in department and hospital administration. Fellows are also frequently involved in resident education, preparing lectures on topics in administration and operations. Additionally, fellows often attend national conferences such as ACEP’s ED Directors Academy. 

Why should you consider an EM administration fellowship?
When considering an EM administration fellowship, one should first examine his or her career goals. This type of fellowship may be most beneficial for those interested in roles in ED leadership, such as medical director or department chair, or hospital leadership roles, such as chief medical officer.

While a career in these areas doesn’t require a fellowship, this opportunity provides additional experience and education in healthcare, business, and management. The mentorship and connections integrated in fellowship may also help accelerate a career.

Advice for Applicants
Applicants for EM administration fellowships should typically prepare to apply in the summer of their final year in residency. There is currently no formal match process for EM administration fellowships; to apply to these programs, candidates typically reach out directly via email to the program coordinator and program directors or fill out an online application. Many programs have rolling admissions, so it is helpful to be prepared and apply early. Offers are extended to candidates throughout the application cycle rather than on a single, specific day.

When considering where to apply, take into account several factors:

  • Length of program (1 or 2 years)
  • Associated master’s degree
  • Overall career goals

Each fellowship is different, and it is important to research each program to assess overall fit. Applicants tend to apply to a relatively small number of programs compared to residency application numbers.

When applying to a program with an affiliated master’s degree, one should also consider that the program may require an entrance exam, such as a GRE or GMAT, prior to applying. Additionally, you may be required to complete a separate application to the master’s program. Acceptance to the fellowship does not necessarily guarantee acceptance to the master’s program.2

More Information
You can learn more about EM administration fellowship programs through EMRA’s Fellowship Guide at Additionally, if you are interested in learning more about various topics related to administration and operations, be sure to join EMRA’s Administration and Operations Committee at


  1. Scott BC. Administrative fellowships in emergency medicine. Physician Exec. 1995 Aug;21(8):35-6. PMID: 10161212.
  2. Jarou Z. Administration/ED Operations/Patient Safety & Quality Improvement Fellowships. In Schafer K, ed. EMRA’s Fellowship Guide, 2nd Edition. Irving, TX: Emergency Medicine Residents’ Association; 2018: Section 4.

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