Emergency Medicine May Join the ERAS Exodus

Emergency medicine is the latest specialty to explore potential independent residency application options outside the Electronic Residency Application Service (ERAS).

On October 8, the Council of Residency Directors in Emergency Medicine (CORD) announced that for the 2025-2026 application season and Match cycle, emergency medicine will likely be shifting to the same system that ob/gyn adopted for this year.

“CORD has decided to partner with ResidencyCAS to help us develop our own platform specifically designed to support our emergency medicine residency application process,” the statement said. The custom-built platform would streamline the entire application process while “reducing administrative and financial burdens, and will ultimately enhance the experience for everyone involved.”

A few other specialties, including ob/gyn and plastic surgery, have parted ways with ERAS, but if emergency medicine does, it would be the largest specialty to do so.

CORD’s president Boyd Burns, DO, told MedPage Today in an email that CORD has “initiated conversations with our membership regarding ResidencyCAS, and at this point, we have not officially moved away from ERAS,” though he added that ResidencyCAS has several advantages over ERAS. While not 100% committed to opting out of the current system, Burns said that CORD aims to prepare program leaders and coordinators for a potential transition away from ERAS next season.

“Although programs will have the option to adopt this new platform, our goal is to achieve unified action across the specialty to avoid potential disadvantages that multiple competing application platforms could pose to programs, applicants, and emergency medicine as a whole,” Burns said.

CORD’s Application Process Improvement Committee (APIC) spent a year looking into ERAS alternatives because emergency medicine programs expressed concerns about “growing challenges with ERAS” and “limitations of that platform.” APIC’s findings and recommendations were debriefed earlier this month at a CORD@ACEP Town Hall.

On October 17, CORD will host a special session with more information about this development, and said a more detailed proposed timeline will be shared soon.

In the meantime, emergency medicine is closely monitoring ob/gyn’s experience in their first cycle using ResidencyCAS. Preliminary ob/gyn data has shown that ob/gyn applications are stable in the first year, and every single ob/gyn program opted into the independent system.

Gabrielle Campbell, chief services officer for the Association of American Medical Colleges (AAMC), said that the AAMC has “heard from our medical school members that multiple platforms are creating confusion” and that a centralized residency application platform streamlines the process for all parties.

“Through this centralized process, the AAMC has been able to deliver greater transparency to applicants to enable them to apply to fewer programs, addressing the issue of application inflation, as well as supporting graduate medical education to train tomorrow’s doctors,” she said, adding that the AAMC is committed to all specialties using ERAS. Campbell also cited ERAS partnership with Thalamus as one way the association has “reduced administrative burden, saved time, and reduced costs for all applicants.”

Preliminary ERAS data from this past Match cycle revealed that the adoption of program signaling has contributed to a decrease in the number of programs each applicant applies to — and how many applications the programs must consider. Emergency medicine only allotted applicants five signals to show particular interest in programs this past season.

Bryan Carmody, MD, of Eastern Virginia Medical School, who blogs frequently about medical education issues, commented that the departure of such a large specialty, on top of the recent loss of ob/gyn, would “create a significant business challenge for the AAMC” as ERAS is about half of the association’s revenue.

This year, AAMC simplified the ERAS pricing structure, lowering the costs for many applicants, which it announced shortly after ob/gyn revealed its cheaper residency application pricing. But Carmody said it’s unlikely that AAMC would bump ERAS prices back up to make up for lost revenue “because that may inspire other people to leave” even if “their cash cow is a lot thinner than it used to be.”

Back when ob/gyn first departed from ERAS, Carmody discussed on his YouTube channel the potential for an “ERAS death spiral” — where loss of ERAS revenue and an exodus of medical specialties could tank the once-ubiquitous application system. In a discussion on r/medicalschool on Reddit about CORD’s announcement, many users referenced this video.

Ultimately, Carmody says this development from emergency medicine communicates that “program directors are tired of the product that ERAS is and the pace of innovation there” and want more out of programs and are willing to look outside the AAMC.

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