AAMC Overhauls Pricing for Residency Applications

Starting in the 2025 residency application season, the Electronic Residency Application Service (ERAS) will have a simpler and potentially cheaper pricing structure.

The Association of American Medical Colleges (AAMC), which runs ERAS, announced its plans for next season less than 2 weeks after ob/gyn residency programs, which split from ERAS and created an independent application system called ResidencyCAS, announced a cheaper pricing structure.

Historically, ERAS prices went up slightly each year but maintained a four-tier pricing structure. However, the updated pricing structure is simplified into two tiers. For the first 30 applications, the cost is $11 each. At application 31 and above, the cost per application jumps to $30 each. For reference, the current prices for the ongoing 2024 season are $99 for up to 10 applications, $19 for applications 11 through 20, $23 per application for 21 through 30, and $27 for each application after that.

Gabrielle Campbell, MBA, the AAMC’s chief services officer, told MedPage Today that the new two-tier structure aligns with program signals. Unlike ResidencyCAS, ERAS spans specialties that vary in the number of signals that applicants can express increased interest in. For instance, thoracic surgery applicants only get three signals, while orthopedic surgery has the most signals at 30. Now all ERAS applicants can apply to the maximum number of programs they can signal within the lower price tier.

Campbell said that AAMC worked with focus groups and consultants to restructure the ERAS fee model in a way “that would be beneficial for students” and “that would not exacerbate the over-application.” She added that in the more than two decades since ERAS started, applicants have changed their behavior a lot.

“So 2 years ago, we recognized that the escalating applications were probably not going to change unless we did something pretty dramatic,” Campbell said. “We didn’t want to make it so cheap that they just apply to ridiculous numbers, because that really hurts the programs as they’re reviewing and it hurts their ability to do holistic review.”

Last week, ob/gyn programs also noted that the skyrocketing number of applicants has put financial and time strains on both applicants and residency programs. Campbell said that nearly half of ob/gyn applicants also apply to another specialty. For these dual applicants who have to use two systems, there will be less financial burden under the new price structure. At most stages, ResidencyCAS is cheaper than the new ERAS prices, though at some points the difference is small.

Previously, the AAMC conducted research on “diminishing returns” — the point at which applying to more programs doesn’t actually increase an applicant’s likelihood of matching. Campbell said they found that applications 30 through 35 were usually “where the point of diminishing returns was on average for applicants.”

With the new pricing, as well as other changes such as the expanded Fee Assistance Program for residency applications that gives qualifying applicants an automatic 60% discount, AAMC is hoping to reduce the number of applications per person to a more reasonable number in a way that benefits applicants and programs alike.

Bryan Carmody, MD, of Eastern Virginia Medical School in Norfolk, who frequently shares analysis of residency and Match data online, told MedPage Today that ultimately “paying less for residency is absolutely a good thing” — but he’s still skeptical of the timing of this decision and thinks that AAMC could have reduced costs for applicants much earlier.

Carmody also pointed out that certain groups of applicants, such as international medical graduates (IMGs), tend to apply to more programs and have a harder time matching into residency. While many ERAS applicants will pay less, there is a breaking point at which the new pricing structure is actually more expensive than the old one, which could disproportionately impact groups like IMGs.

But at the same time, most medical school graduates have such high amounts of debt that the cost of not matching into residency is much higher than the price of residency applications.

“I don’t think that the cost has ever been a major influence on the number of applications people submit,” Carmody said. Rather, he thinks applicants weigh other factors in deciding how many programs to shoot their shot at — and program signaling is a major consideration.

“If you want applicants to apply to fewer programs, what you should do is you should set a larger number of signals and applicants. What that does is that devalues applications above the signaling limit,” he said.

Further details about the ERAS changes are available on the AAMC website.