Residency Applications Down

Fourth-year medical student William Keller, who asked Medscape not to use his real name, is interviewing with residency programs. He completed 42 applications at a cost of more than $500. The med student from Philadelphia, Pennsylvania, requested anonymity over concerns that disclosing his identity might impact his prospects for a successful residency match. 

Keller told Medscape Medical News that he likely submitted more applications to the Electronic Residency Application Service (ERAS) than the average candidate. Turns out, he actually submitted fewer applications than the average. 

As of mid-October, Doctor of Medicine (MD) candidates like Keller submitted an average of 58 applications across all specialties; Doctor of Osteopathic Medicine (DO) candidates submitted an average of 72 across specialties; and international medical graduates submitted an average of 129 applications, according to the Association of American Medical Colleges (AAMC), which oversees the ERAS program it developed nearly 30 years ago. 

Preference Signaling = Reduced Applications

Residency candidates are applying to fewer programs this year, mainly as the result of a preference signaling process that allows students to indicate which program they are most interested in at the time of application, AAMC recently reported. 

The AAMC saw an overall reduction of 7.3% in the average number of applications per residency candidate, with a 9.97% decrease for MD applicants and an 11% decline for DO applicants. As a result of submitting fewer applications and a new fee structure, applicants also paid less to apply in the current 2025 application cycle than in the past, the AAMC stated.

A handful of specialties also had a 35%-40% decrease in application volume, according to the organization. Dermatology, for instance, saw a 42% decrease in applications from 72 in 2023 to 40 in 2025. The decrease resulted in applicants saving $949. 

Otolaryngology, the first specialty to test signal preferences in 2020, saw a 42.5% drop in applications per applicant, resulting in $1009 savings per applicant, AAMC reported. 

For years, AAMC has been trying to reduce the number of residency applications submitted by each applicant attempting to match into their dream program or land any spot in a limited pool of openings, said Gabrielle Campbell, AAMC chief services officer.

Having fewer applications per applicant helps reduce application costs. It also addresses the rising number of applications residency programs receive and has to sift through to fill a limited number of residency spots, Campbell told Medscape Medical News. “They [candidates] have so much fear they will not get a spot.”

Keller said he applied to more programs to stand a better chance of securing a spot. He added that certain programs will only interview students if they signal the program among their top choices. 

While he said that the application process through ERAS was “pretty smooth,” he wished it provided more information about individual programs, so he didn’t have to search their websites for their preferences. 

He applied to programs in pediatrics and internal medicine-pediatrics (med-peds). While med-peds doesn’t use signals, internal medicine has 15, and pediatrics has five. He applied to 15 med-peds programs and 27 pediatric programs, “slightly higher than I would have otherwise because of couples matching.” His girlfriend, a fourth-year med student in Baltimore, Maryland, is applying to internal medicine.

Couples matching makes applying to programs more complicated, requiring more coordination and adding additional costs, he said. “We applied to more because we mostly applied to competitive academic institutions in Boston, New York, Philly, and DC, and there’s a lot of unknowns with the process. We likely would have been able to apply to fewer and be safe, but you never know.”

Meanwhile, the couple aren’t guaranteed to interview at the same program, so there’s more incentive for them to apply to more schools to increase their chances of interviewing in the same city. 

“One school, for instance, says that if only [one of the pair] signal their program, they will consider it as though neither person signaled. Instead, the program requires both applicants signal to indicate they truly are interested. 

How Signaling Impacts Interviews 

AAMC tested preference signaling with a few specialties before expanding it this year to 21 specialties. Last year, the not-for-profit began collaborating with Thalamus, an interview management platform, to see which applicants received interviews and how preference signaling influenced that outcome, Campbell said. Students could use this information to help guide their choices and reduce excessive applications. 

Overall, 93% of all programs accepting applications in ERAS agreed to receive program signals this season. 

The changes also reduce the burden on program directors, who felt overwhelmed with the number of applications they had to review, Campbell noted. “The volume of applicants is way beyond the number of spots.” Program directors have a limited amount of time to interview candidates. Signaling helps them focus on the candidates who really want to interview for their program. 

This is the first year that AAMC could compare data showing how the relatively new preference signaling option impacted whether an applicant received an interview, Campbell said. 

It’s also the first year that the American College of Obstetrics and Gynecologists is offering its own residency application platform. Last year, the specialty announced its alternative to ERAS. In its first year using the new platform, the professional organization reported a drop in the number of applications submitted per applicant. Nearly all applicants used program signaling, ACOG reported. Most applicants, 96%, also used all of their 18 allotted signals.

In its recent news release about the drop in applications, ACOG cited AAMC data showing “ program signaling to be an effective tool for enhancing the quality of applicant-to-program matches while reducing the burden of applications.” 

ACOG applications per applicant dropped from a peak of 75 in the 2022-23 application cycle to 64 for the current cycle. In terms of mean, the number of US applicants dropped from 59 two years ago to 52 today, ACOG reported. 

The Council of Residency Directors in Emergency Medicine also announced earlier this month it is exploring potential alternative residency application options. Ob/gyn and plastic surgery have recently parted ways with ERAS, but emergency medicine would be the largest specialty to back out. 

Room for Improvement

Bryan Carmody, MD, who blogs about medical education, noted the positive trend of fewer applications per applicant. “It’s good it’s coming down, but there’s still a lot of room for improvement.” He added that the number of applications still exceeds the signal limits of the specialty. For example, 42 applications per applicant in dermatology are still higher than the 28 signal limits for the specialty. 

He said he believes preference signaling benefits residency programs slightly more than applicants. Programs “drowned” in applications will be able to focus on those signaled among a student’s top choices, he said.

If a student wants all their work to be evaluated in more than a superficial way, they will use the allotted number of preference signals allowed for a particular specialty. Many programs will have more than enough applicants to fill all their spots with only those who used their preference signals without having to consider students who didn’t signal the program as a top choice. 

However, he still argues that students don’t have enough tools to realistically decide whether they are considered competitive in certain programs, so most will continue to apply beyond the allotted preference signals. It depends on how they see themselves. 

They may overestimate or underestimate their competitiveness. “Preference signaling benefits anyone who knows where their application may be favorably reviewed … those who know how competitive they are,” Carmody said.

Keller said, “It is tough to understand exactly how important it is to signal and which schools consider them the most important. … The signaling program is very new. If the goal is to decrease the number of applications, it may be too early for some people to feel comfortable severely limiting their application number to the number of signals allowed.”

Students can review the data on the importance of signaling over time, and they may apply only to the number of signals they are allotted per specialty if they feel that number is sufficient.

Roni Robbinsis a freelance journalist and former editor for Medscape Business of Medicine. She’s also a freelance health reporter for The Atlanta Journal-Constitution. Her writing has appeared in WebMD, HuffPost, Forbes, New York Daily News, BioPharma Dive, MNN, Adweek, Healthline, and others. She’s also the author of the multi-award–winning Hands of Gold: One Man’s Quest to Find the Silver Lining in Misfortune.