To determine current trends in emergency medicine residency length, US emergency medicine residency directors were asked to describe their 1986-87 and 1987-88 year configurations. In January 1986, 66 of 67 residencies (98%) were contacted by phone, and 62 (94%) completed a validation form. Of the 67, 19 (28%) changed their length of training in 1987-88. Of the 19 programs that changed, 17 (90%) increased residency length by adding a fourth postgraduate (PGY-4) year of training. Two have moved to PGY-1,2,3 configurations. Two new programs are starting in 1987-88; one a PGY-1,2,3, the other a PGY-2,3,4. One program has lost accreditation for emergency medicine training. In 1986-87, 44 of 67 (66%) programs were 36 months long; for 1987-88 the number is 60 of 68 (88%). The number of four-year programs is increased from six (9%) to eight (12%). Both the average length of emergency medicine residency training and the average length of postgraduate training are increased in 1987-88. The number of programs whose graduates train for a minimum of four years prior to sitting for the boards has increased from eight (12%) to 26 (38%). The number of programs that begin at the PGY-I level increased from 48 (72%) to 50 (74%). The Midwest region has the greatest number of residencies and the most programs of the PGY-1,2,3 configuration. The implications of this change, including new curriculum development, differing training patterns, and budget concerns, are discussed.