MedPod Today: Residency Application Updates; Doc Discipline; Vacation and Burnout

The following is a transcript of the podcast episode:

Rachael Robertson: Hey everybody. Welcome to MedPod Today, the podcast series where MedPage Today reporters share deeper insight into the week’s biggest healthcare stories. I’m your host, Rachael Robertson.

I’m kicking off today’s episode with some updates on residency application prices and other changes to the process. Then, Kristina Fiore will talk about a doctor who got disciplined for spewing COVID misinformation. After that, Michael DePeau-Wilson tells us about a new study that found doctors especially should actually relax on their vacations. But first, Kristina will host this first segment.

Kristina Fiore: Applying to residency is a high-stakes process for everyone involved. Last year, the ob/gyn specialty announced it was developing its own residency application system. And already this year, we’ve learned new updates about the ob/gyn system and the Electronic Residency Application Service. Rachael is here to tell us more about these changes to both residency application processes.

So Rachael, ob/gyn announced the changes first, so let’s start there. What’s new?

Robertson: So the new system is called ResidencyCAS and it will be used in the 2024-2025 season. I had an exclusive interview with AnnaMarie Connolly, who is the chief of education and academic affairs at the American College of Obstetricians and Gynecologists, a.k.a. ACOG. And she told me that ResidencyCAS is a single digital platform for applications, interviews, and reviewing the status of both applications and interviews. Basically, it’s an online hub for applicants and program directors. And through ResidencyCAS, applicants and programs can highlight more of what makes them unique and special, which ACOG refers to as part of their “holistic review” process.

Connolly told me that in the past decade, the average number of applications has doubled from 36 to about 70 per person, and the sheer number of applications are a burden to programs and applicants alike. They’re hoping that the features of ResidencyCAS will help applicants and programs find better matches and then reduce the overall number of applications to a more manageable level.

ResidencyCAS is also cheaper than the current application system. The first 18 applications are just $99. Connolly said that this bundle lines up with the maximum number of program signals that applicants have to express increased interest in a program. The signals are also something that helps reduce the number of applications.

Fiore: So ERAS also has some updates, right? What’s changing there?

Robertson: Yep, so then less than 2 weeks after ob/gyn detailed their updates, the Association of American Medical Colleges announced changes to ERAS. Historically, the price of ERAS applications has only increased a little each year to keep up with inflation. And remember, ERAS has a bunch of specialties housed within the platform while ResidencyCAS just has ob/gyn. But starting next application season, ERAS pricing structure will be simplified into just two tiers rather than their usual four. So the first 30 applications will be $11 each and each application above 31 will be $30 each. Thirty is the maximum number of program signals that any program has. So basically all applicants can use all of their signals while still being in the lower price tier.

And for a lot of applicants, this new price structure will be cheaper, though that isn’t the case for everybody. So for instance, ob/gyn applicants who also apply to another specialty will have less cost burden from applying to multiple specialties in multiple application systems, since the cost for ERAS will be cheaper for them. Late last year, AAMC also expanded their Fee Assistance Program, which gives qualifying applicants an automatic 60% discount.

Fiore: So it sounds like both groups had similar goals here: reduce the cost to the applicants and reduce the number of applications.

Robertson: Those were definitely common themes in my conversations. The AAMC told me that previous research had found a point of “diminishing returns” — basically around application 30 or 35, applying to more programs didn’t also increase most applicants’ likelihood of matching into residency.

I spoke with Bryan Carmody, who frequently shares his analysis of residency and Match data online. He emphasized to me that while lower costs for most applicants is a good thing, cost isn’t actually the number one driver of mass applications. Basically, the cost of not matching into residency will always be higher than the price of applications. He told me, “If you want applicants to apply to fewer programs, what you should do is you should set a larger number of signals.” He said this would devalue applications above the signaling limit. We’ll have to see how these changes play out for both systems once they take effect, and there’s more details about some of the other intricacies on our website.

Fiore: That’s great. Rachael, thank you so much.

Robertson: Thanks, Kristina. Time to switch roles.

Okay, here we go. During the pandemic, there was a lot of talk about medical boards disciplining doctors who spread misinformation around COVID-19. To date, few doctors have been formally disciplined by their boards for this reason, but that’s not the case for Dr. Ryan Cole. Earlier this month, the medical commission in Washington state restricted Cole’s license for spreading COVID misinformation and failing to meet the standard of care for patients during the pandemic.

So, Kristina, first of all, who is Ryan Cole? What do we know about him?

Fiore: So Ryan Cole is a pathologist based in Idaho, although he also holds a license in Washington state. He’s made claims that COVID vaccines can cause cancer or autoimmune disease. He’s spoken at events hosted by America’s Frontline Doctors. And he’s also appeared in a viral documentary called “Died Suddenly,” which claims COVID shots were connected to the sudden onset of cancer, among other claims like this.

Robertson: Okay, so what sanctions does he face in Washington state then?

Fiore: The Board found that Cole made false or misleading statements about the pandemic, about COVID vaccines, and about the effectiveness of masks. It also said that he failed to meet the standard of care in treating four patients via telemedicine and that included prescribing drugs such as ivermectin that aren’t indicated for a COVID infection.

The board limited his practice in Washington to pathology — so he can’t practice primary care there and he can’t prescribe medications to patients there. He also has to complete medical education courses on COVID, pulmonary and respiratory diseases, medical record keeping, and telehealth — within 6 months. And then within 9 months, he has to write a 1,000-word paper on “professionalism, truthfulness, and honesty in medicine.” And he also has to pay a $5,000 fine to the commission.

Robertson: Okay, but Cole is based in Idaho. Does he still have his license there?

Fiore: Yes, he does. It’s active and it has no actions against it.

Robertson: Yikes. Thank you, Kristina, for that update.

Fiore: Thanks, Rachael.

Robertson: Our final story takes a look at a new study that shows that certain vacation habits are associated with higher rates of burnout among physicians. The study surveyed a nationally representative cohort of more than 3,000 physicians. It asked them questions about their annual vacation practices, how many vacation days they take, and whether they fully unplug from work during those days off. And Michael DePeau-Wilson is here to tell us more about that.

So, Michael, I’m sure our listeners are dying to know, what are the habits that lead to more burnout?

Michael DePeau-Wilson: Hi, Rachael. Well, first of all, the study showed that almost 60% of physicians took less than 15 days or 3 weeks of vacation time over the previous year. It also found that 70% reported working during a typical vacation day, which included patient care-related tasks and answering messages in their electronic health record system. And both of those habits, I guess we can call them habits, were associated with more burnout, according to the authors.

Now notably, they also found that the amount of time spent working during a typical vacation day was associated with an increasingly higher rate of burnout as well. So the more physicians check their EHR inbox, the worse the outcomes.

Robertson: Wow, so more than two-thirds of physicians are working on their vacation days. That doesn’t even sound like a vacation at all! What did the author say about why those habits are causing burnout?

DePeau-Wilson: Right, well, the authors told me that they wanted to conduct this study in the first place because anecdotally, they witnessed many physicians choosing not to take their full allotment of vacation days, or working while they were away. And as they started analyzing the data for this study, they found that 63% of physicians reported feeling symptoms of burnout, which is in the ballpark of the percentage of physicians who engaged in those habits that we just discussed. So as the study shows, those two things appear to be connected.

Robertson: Got it. So then what did the authors hope to accomplish by showing these numbers?

DePeau-Wilson: Well, it turns out that there is another side to that coin. So the authors were able to show that physicians who took more than 15 vacation days a year had a lower risk of experiencing burnout. In fact, they found that physicians who took more than 20 days in a given year had about a 41% lower risk of burnout overall. They also found that physicians who arranged to have full inbox coverage of their EHR had much lower rates of burnout as well.

So the good news is that taking more vacation time and getting full coverage so that you can unplug from work while you’re on vacation seems to have a big impact on reducing those symptoms of burnout.

Robertson: So moral of the story, take your vacation!

DePeau-Wilson: Exactly.

Robertson: Thanks, Michael.

DePeau-Wilson: Thanks, Rachael.

Robertson: And that’s it for today. If you like what you heard, leave us a review on Apple or Spotify, or wherever you listen to podcasts — and hit subscribe if you haven’t already. See you again in 2 weeks.

This episode was hosted and produced by me, Rachael Robertson. Sound engineering by Greg Laub. Our guests were MedPage Today reporters Rachael Robertson, Kristina Fiore, and Michael DePeau-Wilson. Links to their stories are in the show notes.

MedPod Today is a production of MedPage Today. For more information about the show, check out medpagetoday.com/podcasts.

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