How the residency application process has changed forever [PODCAST]

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“The collective resiliency of the medical education community shone through the challenges of the past year. In medicine, physicians must adapt to all situations, and GME is no exception. Even in a pandemic, everyone adjusted as needed. Program coordinators and faculty were flexible and creative, while applicants remained passionate and pushed past roadblocks. It seems that there is no situation to which GME cannot adjust. With the financial and time-saving benefits of an all-virtual and/or hybrid recruitment model on the horizon, applicants and programs can rest assured that, while it will take some getting used to, the residency recruitment process will be changed forever.”

Jason Reminick is a physician-entrepreneur.

He shares his story and discusses the KevinMD article, “A transformative year for GME recruitment: How the process has changed forever.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Jason Reminick. He is a physician-entrepreneur, and he wrote the KevinMD article “A transformative year for GME recruitment: How the process has changed forever.” Jason, welcome to the show.

Jason Reminick: Thank you, Kevin. It’s great to be here.

Kevin Pho: We’ll get into the article a little bit, but first off, can you share your story and journey to where you are today?

Jason Reminick: Sure. I’m originally from Long Island, New York. I went to college at the University of Pennsylvania in Philadelphia, where I studied biochemistry and theater arts and also got a master’s degree in chemistry. From there, I took a gap year working in pharma for a bit to understand how that influences the health care system, and then made it up to the University of Rochester, where I did my medical school degree but also did an MBA at the Simon Business School. Then I applied to residency in pediatrics and anesthesia and trained out at Stanford in their combined program there.

Along the way, in 2012, I got stuck in New York City during Hurricane Sandy during my residency recruitment cycle, and many of my interviews were canceled. That kind of led me down the path of where I am today, in trying to build technology to improve and streamline the way that process is run, which would result in the creation of Thalamus, which I am the CEO and founder of today. I stepped away from clinical medicine in 2018 to focus on that full time, and we’re now serving thousands of residency and fellowship programs and close to 90 percent of applicants applying through the process.

Kevin Pho: I talked to a lot of physician-entrepreneurs on this podcast, and some of the challenges they describe are getting the uptake of new technology from a lot of these startups. So what are some of the challenges that you face as a health technologist to have more uptake and influence?

Jason Reminick: Yeah, that’s a great question. I teach a lot of entrepreneurship, and I’m a big proponent of physicians getting involved in the entrepreneurial process. The challenge, particularly in health care, is always that technology tends to lag behind where the rest of tech ends up being, and medical education tends to lag even further behind that. So it’s not traditionally a market where you would say, “Let’s go here.” But at the same time, there’s ample opportunity in medicine, so it’s really about getting the buy-in and the trust, and that was probably the hardest hurdle we had to get over.

We initially started with 20 anesthesiology programs. My co-founder is a residency program director. She had colleagues who wanted to try it at their programs, and we were able to get that initial group to try the technology. Then we had the proof points and the data and the metrics that we needed to show that it would work, but we also built that trust. And I think that is the key for anyone trying to build a health tech, digital health, medical device, etc.: You need to get the trust of the physicians and the clinicians in order to adopt that into the health care system, because ultimately, most of this is affecting patient care in some way, and they need to know that it’s going to work for their patients as well.

Kevin Pho: Now, for those physicians who are interested in getting into that entrepreneur space, what would you say is your number one tip for them?

Jason Reminick: I would say it’s that balance is important in your clinical practice. I think the idea of a great clinician should also include balance. I think burnout and wellness have become sort of hot topics, and I think balance is the key in there. That balance will allow you to have other interests, where you can take your very well-sought-after clinical skill set and apply it to something else, and I think physicians are uniquely equipped to impact and lead innovation in health care.

So it’s finding that balance, so that you can network and find those opportunities, and kind of pushing yourself a bit, whether it’s going to a talk on entrepreneurship, going to a co-working space, finding a networking event, or joining an accelerator. Just plugging yourself into the innovation ecosystem is really, I think, what it takes to push physicians to the next level.

Kevin Pho: All right, let’s talk about the KevinMD article that you wrote. It’s titled “A transformative year for GME recruitment: How the process has changed forever.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Jason Reminick: Yeah, absolutely. The residency recruitment process, applying for medical school to residency, has been considered sacred in many instances, and prior to the pandemic, everything was still done in person, increasingly competitive over the last decade, with candidates applying upwards of 70-plus programs now, when five, 10 years ago it was closer to 15. It’s very expensive. Candidates have to pay for everything out of pocket, traveling to 20 or 30-plus interviews around the country, paying for all their airfare and hotels, and it was equally expensive and time-consuming for the programs to have faculty available and conference rooms and offices available. And so it was this very sacred, and rightly so, process where everything was done in person.

All of a sudden, the pandemic hits, and now what do you do with that? Especially when all of the program directors and the rest of the clinical faculty are battling the pandemic on the front line, the candidates are in medical school dealing with that at their own institutions, and of course, everyone can’t travel. And so what happened last year, as many other things did, obviously, was it went completely virtual.

That was a major transformation, because if you had asked, I think, anyone prior to that, “Will this ever be a virtual process?” the answer would have been no. Which comes back to your question from before about innovation in medicine: There’s that hesitancy, because we know it’s working, and we believed that we needed to meet everyone in person in order to best assess who was right for residency programs. No one had that luxury last year, and so everything went virtual, and GME, as it often does, quickly adapted to the technology. They changed their processes. They got faculty buy-in. The applicants learned what they needed to do also.

But as a result, it was just a very different environment. If you’re not traveling around the country and having to book hotel tickets and hotel reservations and plane tickets, are you still going to cancel your interviews at the same rate? Are you going to attend more interviews? What is it going to do in terms of the match rate? Is it going to affect where people match? And as the process has become more competitive, the great fear was: Is there going to be a match crisis?

So the idea was that only the top candidates would get a large percentage of the interviews that are available around the country. Because there was less of an opportunity cost to cancel, they would go to as many interviews as they possibly could, which would create a maldistribution of interviews, so that candidates who had not as great test scores, or who historically can be considered weaker applicants, and I think that is up for great debate as well, wouldn’t have as many interviews. And then, because of that, the top candidates would all match, but everyone else wouldn’t have enough interviews, so many programs would go unfilled and many candidates would go unmatched. That was sort of the big fear of everyone last year.

What we saw, and why I think GME recruitment will change forever, is that that match crisis did not happen. The National Resident Matching Program, NRMP, Match went exactly as it seems it always has in the past. Match rates were above 95 percent, as they historically have been, for MD students, in the high 80s, low 90 percentile for DO students, and international medical graduates, or IMGs, who have always historically matched somewhat less, were still in the 50 to 60 percent range.

And so the match rate did drop slightly, but that was because there was a record number of people entering the match, and the number of residency positions throughout the country has not increased. So there were more people applying than ever with a fixed number of spots, so the match rate overall did drop. But overall, nearly every residency program and slot in the country filled, with only seven spots remaining at the end of the process, which is better than most years.

What we learned also from that was that everyone saved a ton of money. It was a much more equitable process. Students didn’t need to travel. Programs and faculty could take the interview from home, from their office, wherever. And everyone ended up matching similar classes, from what we’re hearing as well. So we’ve learned that there are better ways for us to do this.

The question, just now that we’re going through our second season, which is essentially fully virtual interviews: What does it mean for the future? I think the most likely scenario is some sort of screen interview that’s done virtually, and then some sort of second look where you’ll go to campus, where you can meet the faculty in person and learn the hospital and the residents that are there as well. A lot of that still needs to be worked out, in terms of policies and equity and how it will affect match rates, and trying not to benefit students who have, of course, the means to be able to fly to various places as well. But I think what it’s shown is that GME is very willing to innovate, and always willing to innovate, especially when they have to, and I think that was just very reassuring to see overall.

Kevin Pho: Do residency programs now have to prepare for many more applicants, and do applicants have to apply to many more residencies, now that that barrier for a virtual interview is lowered?

Jason Reminick: Yeah, it’s a great question. What we saw last year was programs across the board interviewed more candidates, on average around 10 percent more, but applicants also interviewed at more programs, and that was also across the board. So there were more interviews completed by everyone. There was a slightly lower cancellation rate, as would be expected, because you didn’t have to fly, and it’s much easier to take an interview from your couch. But it resulted in everyone interviewing at more places.

And so we are doing a lot of research on our end with our data team, and the amount of interviews people were going on prior to the virtual recruitment season was way more than they needed. With the pandemic and the virtual recruitment season, everyone is still interviewing at many, many more places than they need to. We completed a study in anesthesia looking at the data going back over a four-year cycle, and roughly, the average anesthesia program in the country could cut out 18 percent of their interviews, very-low-likelihood-to-match interviews, and their final match list wouldn’t change. We’re repeating that study now in primary care, for pediatrics, internal medicine, and family medicine, and seeing that number actually jumps up.

So while it has been competitive, and students are applying to more places, which is creating somewhat of a transparency problem, there are still many interviews going on that have a very low likelihood of success. There are predictors in the data as to who ends up matching where, and all in all, the match rate has held pretty consistent over time.

So I think the challenge for GME right now is finding those processes where we can show the applicants real data that says, “You don’t need to apply to this many programs.” Or maybe if you’re coming from an area or a part of the world, or essentially outside the United States, where your match rate is historically lower, maybe you do need to apply more, but here’s where you can target yourself, so you don’t have to fill out as many applications. And that will result in just a more targeted recruitment. I think programs are looking into that as well, for the first time having to essentially brand their program in the digital sense, and I think a lot have adopted that on social media and various accounts, and getting their residents involved. So it’s been a very interesting transformation of the process.

Kevin Pho: You mentioned this upcoming interview season, the first pass is still all virtual. Where do you see that trend going in the next three to five years?

Jason Reminick: Yeah, I think it’s going to take some time. I think what we saw this year, prior to Delta coming back around, was that there was a big push among programs to try and continue to do it in person. There was a lot of discussion just within medical education: “Well, how do we do this?” And, “Maybe my program wants to do this fully virtually.” I think we’re going to see different shifts and different models. I think some will go back to in person, I think some will stay virtual, and I think you’ll see various forms of hybrid. I think it will take probably, say, three to five years to settle on what that’s going to mean.

In the meantime, there’s been a lot of innovative spirit among GME, and the specialty organizations overall are getting quite involved, and they’re trying different ideas. Otolaryngology is trying a preference signaling solution. Internal medicine, surgery, and dermatology are trying a supplemental application. And there are various other universal interview offer days done by OB/GYN and plastic surgery. And so everyone’s trying something new, and I think that’s exciting to see, because I think in recent years, this is the first time we’re ever seeing this sort of big push from GME universally.

Kevin Pho: We’re talking to Jason Reminick. He’s a physician-entrepreneur, and he wrote the KevinMD article “A transformative year for GME recruitment: How the process has changed forever.” Jason, knowing what you know about the trends and the data, what kind of advice can you give to prospective residency applicants going forward?

Jason Reminick: I think it’s really important to understand what your goals are as a physician and finding the program that’s right for you. A lot of applicants come to us and say, “I want to get into the best program, the highest-ranked program,” etc., and that’s not necessarily the best way to look at it, because you need to find the practice environment and the program that’s going to help you obtain your professional goals. That could be serving an underserved population in a rural area, in an urban center, in a big city, in a small city, with a particular patient population, or otherwise, and that’s what you need to focus on and target.

So it’s understanding where you are as an applicant, trying not to buy into the anxiety of the process, and just taking a step back and saying, “Where am I going to be successful as a physician? Where am I likely going to get into that program, based on historical data, based on who I am as a person, how I’m putting my application together?” Talking with mentors, talking with upperclassmen, people who’ve graduated from your medical school or otherwise, and really just figuring out what are going to be the best programs for me.

I think it’s so easy to say that. It’s obviously much harder to adopt that practice, especially when you’re going through a very anxiety-provoking recruitment process, when you’ve worked your whole life to get somewhere. But I think at the end of the day, that’s ultimately what’s going to succeed. You see that transformation every year after Match Day, for the people who have matched, like, “I probably could have approached this a little bit differently.” And I think the more we can get that perspective at the beginning of the process, the better off applicants and programs will be overall.

Kevin Pho: And my final question, what’s your take-home message?

Jason Reminick: I think it’s really important to look at the residency recruitment process as something that every practicing physician in the U.S., whether they trained in the U.S. or trained in another country, or practice medicine in another country. And it ultimately affects the entire physician workforce, but it’s rarely looked at and discussed. There are many ways that all of us as physicians can impact not only our profession but also patient care.

So I think it’s very important for us to recognize our pipeline, as to where our physicians are coming from and who they are, but also that this ultimately affects how we treat patients and ultimately how health care can change for the better in the future. Because this is sort of our minor league system coming up into the major leagues, and if we want to continue to win the World Series, or whatever other metaphor you’d like to use, this is the future of medicine coming through this pipeline. And so I think the more we can bring it to light, and the more we can innovate and make it better for ourselves and our practice, it will ultimately affect our patients.

Kevin Pho: Jason, thank you so much for sharing your time and insight, and thanks again for being on the show.

Jason Reminick: Thanks so much.

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