Application Inflation: Housetaff recruitment is an area of critical focus at every training program. At an estimated cost of $14,162 per filled position, managing recent trends in a growing applicant pool poses an added challenge.
In this survey based study of IM program directors (PDs) in 2017 with wide representation from university and community programs, inclusion and exclusion criteria for interview granting, USMLE cutoff scores, process changes related to recent trends in application inflation, and the ability to conduct “holistic’ interviews were analyzed. To no surprise, USMLE Step scores (step 2 followed by Step 1) were cited as Single Most Important (SMI) factors for the decision to interview, followed by the candidates’ ranking in the chair’s departmental letter and MSPE ranking. Exclusion criteria for interviews focused on “hints of unprofessional behavior in the MSPE or recommendation letter” followed by Step 2 CK failure, negative comments in the MSPE, failure on the Step 2 CS and Step 1 failure, in descending order. The survey also inquired about the USMLE scores programs used for interview cutoffs and found the mean Step 1/2 cut offs for IMG’s were 224/ 228 and 211/216 for USG’s in 2017. These cutoffs were lower for internal medicine than for programs in dermatology, orthopedic surgery, plastic surgery and radiation oncology (~245).
With an increase in applicants over the past 3 years, 54% of IM PD’s responded by raising the bar for granting interview invitations. Others invited more applicants, added more interview days, or turned away applicants without ties to the program. Due to this increase in applicants, 46% of programs reported they are less likely to perform a “holistic” review of applicants. In the setting of increasing numbers of applicants, this survey based study demonstrates the persistent reliance on USMLE scores for evaluating candidates and a diminished ability to conduct a thorough review of applicants — Payal Dave MD & Ranita Sharma MD.