Last week, the president issued a proclamation imposing a $100,000 fee on new H-1B visa applications. It’s generated lots of discussion - much of which isn’t grounded in facts or logic. So who really wins - and who loses - with the six-figure H-1B? thesheriffofsodium.com/2025/09/24/t...

On September 24, ERAS will open to programs. Which means applicants have only 2 weeks left to decide which programs to signal. And if you want to know how to allocate your signals in the most effective manner possible, I’ve got something for you: thesheriffofsodium.com/2025/09/10/t...

Preference signaling in the 2026 Match

Let the residency application Bot Wars commence. May the odds be ever in your favor. www.thalamusgme.com/blogs/thalam...

New episode of Bio(un)ethical is out now, with @jbcarmody.bsky.social! Bryan Carmody: Are doctor shortages real? We discuss: - Why people think there aren't enough doctors - Why many access problems reflect misallocation (vs shortages) - What models projecting shortages miss - AI (the 🐘 in the 🏥)

If you’ve got a few minutes during your next workout or commute, I’d love to challenge your faith in the “doctor shortage.” Check out the latest episode of Bio(un)ethical here (or on Apple Podcasts, Spotify, etc.): www.biounethical.com/episodes/epi...

Starting in July, the minimum passing score for the USMLE Step 2 CK exam will increase from 214–>218. (Recent first-time pass rates for US students have been ~98%, so this is not a surprising move.)

Given to me by a patient

Ever had a conversation like this?

In a news release filed under the category tag “Leadership”, the ACGME announced it will no longer enforce program and institutional standards related to diversity, equity, and inclusion. www.acgme.org/newsroom/202...

This week, the president issued an executive order targeting #MedEd accreditation. This is big news - and the intent, impact, and implications of this order all deserve scrutiny. So you know what that means. It’s time to break it down, Winners & Losers style. www.youtube.com/watch?v=XgHK...

New executive order targets the organizations that accredit medical schools and residency programs. Will this be the end of the LCME and ACGME? www.whitehouse.gov/presidential...

Today is Match Day. So you know what that means. It’s time to break things down, Winners & Losers™️ style. Match Day 2025: Winners & Losers Edition youtu.be/ckbO6ykf2f8

Today, residency applicants will find out whether they matched or not. But to find out where, they’ve gotta wait another 4 days. Need something to pass the time? Might I recommend a 6 part video series covering the past, present, and future of the Match? thesheriffofsodium.com/2022/03/17/t...

DOs as a percentage of licensed physicians, by state: 1. Oklahoma - 22% 2. Michigan- 20% 3t. Iowa, Maine - 18% 5t. Idaho, Nevada, W. Virginia, Pennsylvania, Delaware - 16% . . . 46t. Georgia, Connecticut - 8% 48t. Louisiana, Maryland - 6% 50. Massachusetts - 5% 51. DC - 4%

Why an applicant would use a pseudonym to send a complaining email, 9 days before rank lists were due, to a residency program at which they’d done an away rotation and a research project (and at which they were ranked highly) is beyond me. But anyhow, now they’re on PubMed.

Sad - but unsurprising news. (Last year, I covered what happened to the surgery residency program after the hospital got involved with Bartholomew Banks.) Death of a Program: The ACGME vs. Private Equity youtu.be/MqYUFy87UMM

Why don’t residents earn more money? How did resident salaries get standardized? And how much do hospitals receive to train residents, anyhow? Your questions, answered Following The Money: A Primer on Resident Physician Compensation youtu.be/0WhxiuD4Rb8

We may be getting a new medical school in California… The University of Silicon Andhra School of Medicine

Resident physician salaries rise only at the rate of inflation - completely untethered to any other market force. The median PGY-1 salary for current residents is $65,100… which is ~$48,000 in 2012 dollars in case you wanted to plot it on the graphic below.

Starting today at noon, Match applicants can begin submitting their rank order lists. But before you do… here’s what residency applicants consistently overvalue - and what they consistently undervalue - when picking a program. Rank Order List: Buyers and Sellers Edition youtu.be/rDtlD1BH0Yw

New data on the primacy of signaling in the residency application process. Note the massive drop-off in interview rate for signaled/non-signaled applications, especially in ‘big signaling’ specialties. Deciding where to signal is *the* new high stakes meta-game in residency selection.

Should you tell your favorite program you’re ranking them #1? What about your backups? Should you tell them that, too? Or just say you’re ranking them VERY highly? Or should you just say nothing at all? Gimme a few minutes, and all your LOI questions will be answered… youtu.be/qTCuzYE7v5Q

Congratulations to Thalamus on the capital raise… …but why is the AAMC putting money into this? How do they envision they’ll achieve a return on their investment? Do we really need the AAMC to become a player in the physician recruitment game? thalamusgme.com/thalamus-rai...

BREAKING NEWS: A federal judge has *dismissed* the class action lawsuit filed by two Nepali physicians alleging that the NBME unlawfully discriminated against them when invaliding their USMLE scores in last year’s cheating scandal.

Prescription Bot will see you now. www.congress.gov/bill/119th-c...

Articles like this absolutely wear me out. It comes SO close to acknowledging the real issues - then parrots back the same platitudes. Do we really just need more doctors? Or do we need a system that incentivizes doctors to practice in the ways/areas we need - instead of doing the very opposite?

absolutely incredible drop from @jbcarmody.bsky.social a must-watch for all physicians and trainees or anyone interested in healthcare systems issues 🫥 youtube.com/watch?v=gIHR...

The total number of medical school applicants declined again last year, reaching the lowest number since 2017. (Meanwhile, the number of matriculants hit an all time high.)

Yes and no. The NRMP Charting Outcomes reports show match rates by number of contiguous ranks submitted (which is a reasonable surrogate for interview number, since most applicants rank all programs at which they interviewed. e.g., here, for international medical graduates in general surgery:

Word of advice for residents considering their first job offers: It’s priced in. Nobody’s getting money for free. If Job X is paying 25% more than Job Y… there’s a reason for it.

Ask and ye shall receive

Announcement from the NBME today: There will be no increase to the USMLE Step 1 minimum passing score. (at least, not yet)

Percentage of available positions that filled in yesterday’s fellowship match.

If you’re a med student looking for someone to follow re ERAS / applying / Match info, @jbcarmody.bsky.social has a ton of interesting info generally.

Fun fact: Although scientific journals have existed in some form since the 1600s, external peer review only became standard in the 1970s. (So yeah… Einstein’s theories, Watson & Crick’s double helix, penicillin, insulin, etc. - all published without helpful comments from Reviewer 2.)

My take: The skills required to be a good resident and those required to pass the boards are overlapping… but distinct. At-risk residents *require* drilling with MCQs.

The top 20 most common passwords 🤦‍♂️

“It is not hard to see why disease so severe that it rewrites the laws of homeostasis would have increased rates of devastating outcomes.”

This is why I urge medical students to choose their specialty based on what they think they'll love doing - not what they think they'll earn, which may change with the stroke of a pen. https://www.washingtonpost.com/health/2024/11/21/rfk-physician-payments/

Very excited to be in Chicago for Grand Rounds at Lurie Children's Hospital tomorrow Be there (if you can)

Every now and again I peruse the state board's disciplinary notices. And every now and again, I see one that truly makes my jaw drop. (CW - sexual misconduct)

New data on medical student debt from the AAMC: Average educational debt is up 2% to $205,000. …but that's for students who incur debt. Nowadays, 29% of students don't. Meanwhile, 23% of graduates owe >$300,000. (In other words, more debt is being heaped upon a smaller proportion of students.)

Aw jeez, not this again. According to this consultant, hospitals now *lose* an average of $304,312 per physician per year. 🤦🏻‍♂️ Guess it's time for another thread on budgetary gerrymandering.

An applicant’s ranking is determined on their interview day. Here’s my advice for putting your best foot forward. Advice for the Residency Interview youtu.be/ZbV8Y3D27Tw

It’s January. Time to answer your questions like: should I send a letter of intent? Should I send more than 1? What about a letter of interest? And what should I do if a program says they’re ranking me VERY highly? Mailbag: Letters of Intent and Post-Interview Communication youtu.be/qTCuzYE7v5Q

Last year, I predicted that there would be a LOT of unfilled pediatric residency positions in this year’s match… and there is absolutely nothing in the preliminary application data to convince me otherwise.

Big changes may be coming to the internal medicine residency application process next year: The AAIM has proposed: -increasing preference signals from 7 to 15 -tiered signaling (3 gold, 12 silver) -an interview cap -no interviews until November 1