The Case for Residency Application Caps

Dear Sheriff,
I agree with a lot of what you post on Twitter but not the stuff you say about application caps. For students like me who attend non-prestigious medical schools, this will destroy our chance to Match. It’s basic math. Suppose I have a 5% chance of getting an interview at each program to which I apply. I have to apply to 100 programs just to get a handful of interviews! Limit me to 20 applications, and I might get just one. Please help me understand how application caps would possibly help applicants like me.

Okay. I’ll try.

When they envision application caps, many people seem to imagine a residency application ecosystem exactly like the one we have now – the only difference being the number of applications they personally can submit. And sure, if I limited you to just 20 applications in the current environment – where programs receive hundreds of applications for every position – it might not go so well.

Of course, that’s not the right way to think about application caps. When you think about the effects of limiting applications, you have to think about how it will impact the entire system – not just yourself.

The more that applicants overapply, the more chaotic and unpredictable the entire marketplace becomes. Make the market less congested, and suddenly programs have an incentive to take each application seriously.

Remember, the residency application marketplace wasn’t always like this.

Go back to the mid-1980s, and the likelihood that a given application would result in an interview offer – across all programs and specialties – was 80%.

Yeah, you read that right. Eight-zero.

Of course, this was pre-ERAS, when applying to a program actually required more than a mouse and a credit card – and applicants limited their applications accordingly.

The Class of 1986 submitted way fewer residency applications than do students today. PubMed

My point is, support application caps or don’t – but don’t make up your mind based on shallow reasoning. Think it through.

And if you’re willing to give me a little more of your time, check out this post or the video below to better understand why I think application caps will be a net benefit.

Watch this video – and others – on the Sheriff of Sodium YouTube site.

Running time: 46:04


The Lecture That Never Got To Be

The Residency Selection Arms Race, Part 1: On Genghis Khan, Racing Trophies, and USMLE Score Creep

Grand Rounds: The Rise and Fall of USMLE Step 1