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15 Oct, 11 tweets, 4 min read
Preliminary data from ERAS are out… looks like another record-setting year.

The average number of applications received by residency programs is up in most specialties - in some cases, by 30-40% versus 2019.

#ApplicationFever Graphic showing the percentage increase in number of applica
The average number of applications submitted by applicants is up, too.

Here are the current averages for each specialty (considering all applicant types - MDs, DOs, and IMGs). Mean number of residency applications per applicant, by spec
MD applicants in dermatology, otolaryngology, urology, and neurosurgery now submit a mean of around 80 applications or more - and the average MD applicant in orthopedics submits nearly 100 applications.
And here are the data for DO applicants.

In most specialties, DOs submit more applications than their MD peers. (The exceptions are a few highly competitive specialties, in which there are still programs that do not seriously consider DO applicants). Graphic showing the mean number of residency applications pe
As a reminder, the figures above show only the average *within that specialty.*

But these days, many applicants apply to more than one specialty… so the total number of applications submitted by each applicant is even higher than the figures above would suggest.
Here are the 2020 ERAS cross-specialty applicant data, which show the extent of multiple-specialty application.

e.g., 148 applicants applied to both ortho and otolaryngology programs; 126 applied in both derm and PM&R; 169 applied in both psychiatry and general surgery; etc. ERAS cross specialty applicant data for 2020. For instance,
Here’s how the average number of applications submitted has grown over time - doubling in little over a decade.

cureus.com/articles/47109… Graphic from the linked article demonstrating the rise in th
Think these trends are sustainable?

Me, neither.

Can I interest you in application caps?

thesheriffofsodium.com/2020/04/07/on-…
Or, if you prefer a video version…

thesheriffofsodium.com/2021/01/01/the…
ADDENDUM:

Lots of questions about why I compared 2021 to 2019 (not 2020) in the first graphic.

Application numbers vary over the course of the season - but the start of the 2020 season was delayed. So to to make an apples-to-apples comparison, I went back a year.
Also - these aren’t my data. They’re from the AAMC, and they’re available to anyone who wants to splice them a different way.

aamc.org/data-reports/i…

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More from @jbcarmody

Bryan Carmody Profile picture
6 Oct
It’s one thing for an insurer to DENY a claim. But why do so many insurers expend such effort to DELAY payment, even for justified claims they know they have to pay?

If you didn’t know already, let me teach you about “float.”

(thread)
Ten years ago, I was a pediatric nephrology fellow.

One of the the most tedious parts of my job was working on insurance denials.

We’d prescribe an expensive but clearly indicated/necessary medication - say, ESAs or growth hormone for kids with CKD - and it would be denied.
So I’d call the company.

I’d work my way through the computerized phone tree.

Then I’d talk to a representative.

The representative would nice me up; make me recite policy numbers they already had; maybe ask for a new a lab value or two.

Then the medication would be approved.
Read 11 tweets
Bryan Carmody Profile picture
29 Jan
You asked. So here are my thoughts on how osteopathic medical students should respond to the NBOME.

(thread)
Look, even before the Step 2 CS cancellation, my DMs and email were flooded with messages from osteopathic medical students who are fed up with the NBOME.

There is *real* anger toward this organization. Honestly, more than I even heard about from MD students and the NBME.
The question is, will that sentiment translate into action?

Amorphous anger on social media is easy to ignore. But if that anger gets channeled into organized efforts to facilitate change, then improvements are possible.
Read 12 tweets
Bryan Carmody Profile picture
24 Nov 20
Yes, it’s true:

The reason a physician in graduate medical education training is called a “resident” is because back in the day, they *literally* lived in the hospital.

(a short thread)
One text recommended two medical and two surgical residents per 100 beds, a number which would “prove sufficient for all purposes.”

(If you’re wondering why the residents lived on the upper floors, it’s because “in case of fire, they, being in good health, could easily escape.”) Screenshot of an 1859 textbook describing how to build a hos
But that’s not all.

A century ago, residency had no fixed time endpoint - training could last any amount of time.

Most programs also had a ‘pyramid’ structure, in which many interns competed for fewer resident positions at each level and ultimately just one chief resident spot.
Read 5 tweets
Bryan Carmody Profile picture
19 Jun 20
Yes, I do have some thoughts on the pathways through which IMGs can bypass USMLE Step 2 CS and receive ECFMG certification.

(thread)
The messaging from the ECFMG has been that IMGs who complete

a) English proficiency test

-and-

b) one of these five pathways

will be equivalent to IMGs who pass Step 2 CS.
That’s an interesting assertion.

Because although 95% of US MDs pass Step 2 CS on their first attempt, only around 75-82% of IMGs do.

How, then, can the ECFMG be so confident that the applicants they certify would have passed USMLE Step 2 CS if they’d had the chance?
Read 16 tweets
Bryan Carmody Profile picture
5 Jun 20
Back when I was an intern, I was chatting with the grandmother of one of my patients.

Her granddaughter was about to begin 9th grade, and she recalled how excited she’d been to start high school herself - but the school was closed.

I was puzzled. I didn’t know what she meant.
She was talking about Massive Resistance.

After Brown v. Board of Education, Virginia’s governor had an idea to avoid desegregating the state’s schools.

The federal government can’t force you to integrate the public schools... if there are no public schools to integrate.
So rather than letting white and black children attend school together, many Virginia schools shut down completely.

Most white children attended private schools. Many black children got no education at all.

My patient’s grandmother missed out on high school because of this.
Read 13 tweets
Bryan Carmody Profile picture
8 May 20
Well, it’s (all but) official:

The AAMC has recommended that residency programs offer only virtual interviews for the upcoming season.

Who wins, and who loses? Let’s find out!

(thread)
WINNER: Homegrown applicants.

Every year, many students choose to stay at the same institution for residency. Many PDs will be eager to snap up these “known quantities” from an otherwise more uncertain applicant pool.

LOSER: DOs and IMGs, who may not have a “home” program.
WINNER: Student travel budgets.

Previously, many applicants spent upwards of five figures traveling to in-person interviews. You gotta try *really* hard to spend that kind of money sitting in your living room doing Zoom and WebEx interviews.
Read 11 tweets

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