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Leaked emails from the Association of American Medical Colleges (AAMC) reveal concern about what the recent exodus of plastic surgery and ob/gyn from the standard residency application pathway means for the future of the Electronic Residency Application Service (ERAS), which AAMC runs.

The emails were sent to Bryan Carmody, MD, of Eastern Virginia Medical School in Norfolk, who then on social media.

One of the leaked screenshots is an email from , the AAMC's chief academic officer, sent to the Council of Deans (COD), from all 156 Liaison Committee on Medical Education (LCME) accredited medical schools in the U.S., plus 14 Canadian members. The email suggested that COD members request meetings with their specialty and residency leaders to discuss the improvements ERAS has made to its process and encourage them to stay within ERAS.

It also recommended that the COD express concern over "fragmentation in the transition to residency process," such as the "potential risks and disadvantages to applicants, additional administrative burden for schools, and obstacles to transparency for everyone."

Another leaked document is titled, "Talking Points for Outreach Efforts Regarding ERAS Continuous Improvement and Benefits to the Academic Medicine Community," and is dated February 22, 2024. It further expands on background information and suggested discussion questions.

The last leaked screenshot is an email template for how deans can reach out to residency teams and program directors on behalf of ERAS.

In a statement emailed to MedPage Today, Whelan confirmed the screenshotted emails were indeed sent by her.

"I shared information with medical school leadership because some had expressed concern about the negative implications of having multiple residency application services and asked how they can help," she wrote.

She also pointed out that a key piece of information was omitted in the leak: from the 2023-2024 academic year, which she shared with MedPage Today.

"These data are critical because those learners will be most negatively impacted by multiple application platforms. And that impacts our medical education leaders who support cross-specialty application strategies to help all students find a residency program," Whelan wrote.

According to the AAMC cross-application data, a little over half of ob/gyn applicants apply to ob/gyn alone, though for U.S. MDs, it's more than 70%.

Earlier this year, the American College of Obstetricians and Gynecologists (ACOG) disclosed more details about its new independent residency system, ResidencyCAS. AnnaMarie Connolly, MD, chief of education and academic affairs at ACOG and a former ob/gyn residency director herself, told MedPage Today that ResidencyCAS was developed "to offer our applicants, residency program teams, medical school advisors, and deans many benefits, one among them being burden-relieving efficiency."

Connolly also said that "this platform will be able to support applicants who plan to apply to more than one specialty in a fashion that facilitates this important work," and that ob/gyn is "prepared to work collaboratively with the AAMC once it agrees to allow for direct secure data sharing, something that ACOG has made clear from day one of this work that we are committed to doing."

In the leaked talking points document, the AAMC says it is "aware that specialties and residency programs may be considering leaving the AAMC ERAS program for other application platforms run by software companies or individual members of the specialty. This will create fragmentation across the transition to residency, and it's bad for everyone."

It's unclear if AAMC is referring to ob/gyn and plastic surgery, or if the AAMC is aware of other specialties that may be a flight risk.

, many users said they preferred the Plastic Surgery Common Applications (PSCA) to ERAS. Others pointed to the high cost of applying to residency as unacceptable -- especially from nonprofits like the AAMC. According to the , ERAS alone brought in nearly $120,000,000 in revenue, which is about half of the AAMC's total revenue.

Carmody voiced heavy skepticism of the AAMC's messaging, too.

"When you say fragmentation, I see competition. ... I hear monopoly," Carmody told MedPage Today. "I think that competition will make ERAS better and I think that it'll make things better for applicants and programs, too."

For instance, ERAS changed their pricing structure to be cheaper for most applicants this upcoming cycle shortly after ob/gyn announced its pricing, though the AAMC has noted it began strategizing this pricing change 2 years ago.

"Our goal in medical education is not to limit clerical work in the Dean's office," Carmody said. "Our goal in medical education is to train people ... to take care of human beings."

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