Application Fever: Reviewing the Causes, Costs, and Cures for Residency Application Inflation

Abstract

Over the past decade, the number of residency applications submitted per applicant has nearly doubled. This epidemic of "Application Fever" is expensive for applicants, burdensome for programs, and ultimately does not improve overall Match outcomes. In this review, we discuss the phenomenon of Application Fever, with a focus on contributing factors and costs of this behavior. Application Fever has its origins in the early 1990s. At that time, the number of residency applicants began to outpace the number of available positions. Because an applicant who applies to more residency programs has a greater probability of securing a residency position than an otherwise equivalent applicant who applies to fewer, "overapplication" became a dominant strategy and residency applicants began to apply to more residency programs each year. This trend was enhanced and enabled by the introduction of the Electronic Residency Application Service (ERAS). Although Application Fever is a rational decision for applicants, it imposes a substantial evaluative burden on program directors and necessitates the use of convenience screening metrics. We then briefly review potential solutions, including informational strategies, application limits, and marketplace incentives to reduce application numbers. Although a fixed cap on applications would reduce application numbers and facilitate a holistic selection process, greater transparency from residency programs regarding their selection criteria would be required to help applicants choose where to apply. To improve the residency application process for programs and applicants alike, we call upon the medical community to further study Application Fever and carefully consider solutions, including fixed application caps.

An Outcomes-Oriented Approach to Residency Selection: Implementing Novel Processes to Align Residency Programs and Applicants

“…First, there is a significant fear amongst students of not matching, which drives this phenomenon of overapplication. 3,8,9 Capping applications, implementing an early Match, or adopting a preference signaling process will not sufficiently address this deeply rooted fear. These proposed logistical interventions will be unpalatable to applicants in the absence of solutions to also address the broader issues with the selection process itself.…”

“…13 Yet, not all these students choose specialties where they are guaranteed to match. 3,13,14 This leads many students to submit a large volume of applications in the hopes of securing a sufficient number of interviews in their chosen specialty to ultimately obtain a residency position. 3 Additionally, across all specialties, students apply broadly, particularly if they want to apply to programs they perceive to be a “reach,” if they are unsure of what they are looking for in a program, or if they lack sufficient understanding of what each program has to offer and how it aligns with their personal priorities for residency training.…”

General Surgery Residency Match: Time for More than a Virtual Change

“…In addition, application caps cannot succeed without transparency of information to help applicants assess their likelihood of matching at each program. 10 …”

“… 17 Carmody et al proposed a 100-point weighted point system to declare interest in programs rather than merely signaling a small number of potentially “reach” programs. 10 Further evaluation of the full effects of this process prior to consideration for the GS Match appears warranted.…”

Good Riddance to Step 1 Tiered Grading… But Now What?

“…The mean number of applications per applicant has skyrocketed in the past 20 years in a vicious cycle described as application fever. 16 Despite informational campaigns by medical schools and organizations, 17 the number of applications per applicant continues to climb. 11 In 2020, FM programs averaged 1,147 applications, 11 At 10 minutes per file, it would take 8 days working around the clock to perform even a cursory review.…”