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In August, MedPage Today published a story on how applications to medical schools were coming in at a higher rate than usual. Here's a review of what's happened since.

The surge in medical schools applications reported over the summer has held, as applications to MD programs are closed and most submissions to DO schools have arrived.

Applications to Association of American Medical Colleges (AAMC) schools are up 18% over the last cycle, while those to American Association of Colleges of Osteopathic Medicine (AACOM) schools are up 19% over this time last year. With about 2 months remaining in the AACOM cycle, submissions are already up 7% over the previous year's total.

These figures are well above recent annual increases, which have typically been less than 6%, but insiders don't expect acceptances to increase accordingly. That means this cycle's applicants will face a more competitive process.

"It is unprecedented," said Geoffrey Young, PhD, AAMC's senior director of student affairs and programs.

"The slots don't increase just because there are more people applying and those [slots] are already set," said Jayme Bograd, AACOM's director of application services, recruitment, and student affairs. "There will be qualified people that just don't have a seat to medical school this year."

Besides current applicants, the rise in applications is also affecting schools' faculty and admissions staff. Faculty are attending more interviews and spending more time reviewing candidates' profiles, Bograd said. Admissions staff workloads have increased by nearly 20% on average, at several schools, and Stanford reported a 50% increase in staff workload, , with 11,000 applicants being reviewed for just 90 spots.

reported that admissions staff are extending timelines and working more hours to handle the increased volume.

"We know we're just going to have to plow through," Tulane's admissions director told AAMC; he noted his team was taking more time to offer interview invitations to ensure they were still being thorough.

Neither Bograd nor Young expect the surge to have an impact on current students.

It is too early to tell whether this year's increase will affect application cycles next year and beyond, said Bograd and Young, but they speculated that large applicant numbers may be seen next year as well. Assuming most of this cycle's applicants are qualified, Young said he expects many students not admitted this year to reapply next year. Bograd noted that the percentage of re-applicants this cycle so far is very similar to the previous one, so if that rate holds, the next cycle would again feature more total applicants than usual.

Sources including Young and Bograd listed several anecdotal factors for the surge over the summer. While the AAMC and AACOM have not yet identified concrete factors, they suggested a few new possibilities that have emerged since the summer.

Osteopathic schools have enhanced awareness campaigns, Bograd said. AACOM has hosted more open houses than usual, leveraging virtual platforms, and offered more scholarship funds. In addition, a new osteopathic school -- Noorda, in Provo, Utah -- is accepting applications for the first time, and a few schools are expanding.

With travel significantly curtailed by the pandemic, both AACOM and AAMC schools are offering virtual interviews and thus reducing the cost burden of applying.

But, while reports have cited more students scrapping gap years because of the pandemic to apply now, Bograd questioned whether that has indeed been a significant factor. She noted that the average age of applicants this cycle (23.9) mirrors last year's exactly.

Young also questioned how much the pandemic is driving the surge. He noted most serious applicants don't suddenly decide to submit; they need a competitive portfolio that typically takes years to amass.

Acceptances, Residency Openings Not Increasing Accordingly

An increase in applications -- albeit an outlier in magnitude this cycle -- follows recent trends, as MedPage Today reported in August.

New figures bear out this trend too. For example: AACOM applications were up 5% for the 2019-2020 cycle, Bograd said, after increasing 3% in 2018-2019 over 2017-2018. That 3% jump was the largest increase since at least 2015. (AACOM final 2019-2020 figures were not available in August.)

AAMC applications were already up 49.4% from 2004 (35,735) to the last cycle (53,371).

But while application volumes continue increasing, another trend that has not changed since the summer: most schools are not planning to admit students at the same clip. While Young said some AAMC schools may admit two or three additional students, schools lack the necessary resources to accommodate much larger enrollments and need to pass lengthy accreditation to alter class sizes.

"A planned class size increase is viewed as a substantive change by the COCA [Commission on Osteopathic College Accreditation], which requires prior application to and approval by COCA," wrote Jed Brinton, vice president of accreditation at the American Osteopathic Association, in an email.

On the back end, the number of residency spots is not increasing as fast as medical school applications either.

A record-high , according to the National Resident Matching Program, up 5.9% over 2019. The number of matched residency slots (35,258) increased 5.6% this year over last year.

But while the rate of residency positions per active applicant has increased slightly since 2010, that figure is still down over 2003, and well below the rates of the late 1980s and early 1990s.

"The AAMC supports that would gradually add 15,000 Medicare-supported residency positions over five years," according to an AAMC news release issued in December that echoed Young's comments to MedPage Today over the summer.

Because of these factors, AAMC school acceptances increased only 0.9-1.8% each year from 2014-2020, and have gone up by more than 2% annually just four times since 2002. Matriculants increased by less than 2% each year from 2014-2020 and enrollment increased by less than 2% each year from 2015-2020.

That said, acceptances for the last cycle were up 31.3% over 2002, and matriculants increased 34.9% over that span. Enrollment for this school year is 94,243, up 35.2% over 2002.

Young expects about 18% of applicants this cycle to be accepted at AAMC schools, .

"We know interest in medicine is incredibly stable," Young said. "Folks will continue to apply to medical school."

But barring major changes, a smaller proportion will continue to be accepted -- especially this year.

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