ERAS: Can It Be Revamped? One Point of View
Each year, a large number of medical school graduates apply for residency positions across the United States. At the end of recruitment processes, not all graduates have matched into their desired residency programs to pursue their medical career. The issue we would like to highlight here relates to rethinking the process that generates millions of electronic residency applications each year. Due to logistics constraints, this large number of applications cannot be appropriately and fairly reviewed by residency programs, even if they wanted to do so.
Per our calculations from previously available online public data (although currently archived and available only on request), 3.44 million applications were submitted through the Electronic Residency Application Service (ERAS) for residency programs in 2014.1 Based on minimum fees of greater than or equal to $9.50 per application, this resulted in more than $30 million in gross revenues, representing over one-fourth of the service programs' revenues of the Association of American Medical Colleges.2 However, this being said, the focus of our letter is not revenues, but the redundant number of electronic applications.
Filters used by residency programs to select individuals for residency interviews allow only a small percentage of submitted applications to eventually be reviewed by programs. These filters are in place to manage the major logistic challenge of reviewing hundreds or even thousands of applications for each residency program, resulting in an unknown percentage of submitted applications that are eventually reviewed. Examples of the filters available, among others, include test scores, place of medical school graduation, and years since graduation.
We suggest that residency programs should be required to submit their annual updated filters to ERAS before the application submission process begins mid-September. That way, applicants would be able to run screening scans to better understand the eligibility standards for each program and their likelihood of being selected for an interview. In this process, ERAS could further serve its applicant community by offering added useful services. Without increasing the burden on residency programs, these filters would allow applicants to more appropriately focus their selection of programs at the time of submitting the applications. In addition, this approach would reduce the burden on residency programs, as the programs would receive a lower number of applications, which could then be reviewed and given due consideration.
Additionally, residency programs, in collaboration with ERAS, could explore the feasibility of paying for (and issuing) “OVERRIDE tokens” to potential applicants whose history with residency programs may make them eligible for an interview, but whose eligibility characteristics may not pass the preset thresholds in the filtering process. In essence, such a process would create a more feasible and transparent application process by disclosing the existing filtering processes used by programs. Applicants would benefit from having a centralized screening of their applications' eligibility for each program, using a transparent, objective, and disclosed filtering process.
In summary, this letter puts forth a point of view that the filtering process currently used by residency programs could be changed from the post-application transmission stage to a pre-application submission stage, so that only a limited and manageable number of applications are actually transmitted to residency programs, which can then give these applications their due review.
Our hope is that the question “Can ERAS be revamped?” can turn into “Yes, they can!”
