ERAS Applications Are Trending Down With Program Signaling, but Still Too High

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Data are promising, but more needs to be done to reduce applications, experts say

by
Rachael Robertson, Enterprise & Investigative Writer, MedPage Today
October 7, 2024

Compared to recent years, residency applicants are, on average, applying to fewer programs and paying less in the 2025 application cycle, according to preliminary data from the Association of American Medical Colleges (AAMC).

At the start of this year, the AAMC, which runs the Electronic Residency Application Service (ERAS), announced it was revamping its pricing structure to a simplified two-tier system where the first 30 applications are $11 each and anything above 31 is $30 apiece. This change was designed to work in harmony with program signaling, since the most number of signals any specialty that uses ERAS has is 30. In total, 93% of programs that use ERAS opted to accept program signals.

Gabrielle Campbell, the AAMC’s chief services officer, told MedPage Today that the preliminary data affirm AAMC’s goal of reducing both costs to applicants and the burden on programs through the pricing overhaul and adoption of program signaling.

“Not only are the costs going down, but the programs themselves are receiving fewer applications,” Campbell said. “And the applications they’re receiving are people who really, really want to interview at their program, because that’s what preference signaling is for — to be able to show that really keen interest at the point of application.”

In the past 2 years, dermatology, orthopedic surgery, urology, anesthesiology, and otolaryngology had the greatest decrease in the average number of applications per applicant across all applicant types. All of these specialties are on the higher end of allotted signals, having between 15 and 30.

“The programs across these five different specialties all saw 35% to 40% decreases in the number of applications they received,” Campbell said.

From 2023 to the current cycle, dermatology dropped from 73 down to an average of 42 applications, while orthopedic surgery went from 77 to 46, urology from 85 to 54, anesthesiology from 65 to 48, and otolaryngology from 80 to 46.

On average, otolaryngology applicants saw the biggest cost reduction. Before, applicants paid $1,819 on 80 applications, which dropped to $810 for around 46 applications. Between the lower application numbers and new pricing structures, these applicants each saved more than a thousand dollars.

Most other specialties saw a 10% or less decrease from last year to this year. The AAMC’s data are in line with ob/gyn, which broke from ERAS and used an independent residency application system this year, and also saw lower numbers of applications.

Bryan Carmody, MD, who runs the popular medical education blog “The Sheriff of Sodium” and closely follows residency and match data, commented that the “number of applications that people submitted is still significantly higher than the signal limit.”

“I think in successive cycles, as applicants perceive that there’s low value in applications over that [signal threshold] they’ll not waste their money,” he told MedPage Today. The AAMC itself has conducted research on “diminishing returns” — the point at which applying to more programs doesn’t actually increase an applicant’s likelihood of matching.

Still, Carmody added that “there’s a certain irony in the AAMC highlighting the amount that applicants save when they’re the entity that’s responsible for the pricing from the beginning.” It doesn’t cost the organization more to process the 31st application than the 30th, though he conceded it’s still a net good that applicants are, on average, paying less.

According to the AAMC data, pathology, thoracic surgery, and physical medicine and rehabilitation were the only three to have a slight increase in applications in the past year at 3%, 2%, and 1%, respectively.

“Those specialties share low signal limits and increasing popularity,” Carmody said. Pathology has five signals, thoracic surgery has three, and physical medicine and rehabilitation has eight. In that case, when applicants don’t have a lot of signals, most programs won’t receive so many signaled applications that they can ignore non-signaled ones.

“But as the number of signals goes up, especially in smaller specialties, what you end up with is that every program gets enough signaled applications to fill their entire interview schedule,” Carmody said.

For instance, Carmody explained, “when each applicant gets 25 signals, every program gets so many signal applications that there’s no reason for them to look at applications that don’t come with a signal when the applicant has already told you that … you’re 26 on their list at best.”

In other words, he said, “Why would you go chasing birds in the bush when you got so many birds in your hand?”