Medical Residency Interview Scheduling, Automated

The cumbersome process of scheduling interviews between medical residency programs and candidates usually involves a torrent of emails and phone calls between exasperated candidates and equally exasperated residency program directors. That may be about to change.

Scheduling interviews between residency applicants and medical education residency program coordinators is about to get easier, if one startup's promise to automate the process holds true.

Each summer, a bit of computer science commences which optimizes U.S. healthcare behind the scenes. The Electronic Residency Application Service (ERAS), operated by the Association of American Medical Colleges (AAMC), starts accepting fourth-year medical student applications for residency programs starting the following July. Candidates submit their transcripts, grades, letters of recommendation, personal statements, and an application fee, and hope for some good responses.

Invitations to interview follow from residency programs, and then a round of in-person interviews between residency programs and candidates. Then a second service, the National Residency Matching Program (NRMP), accepts the rankings of both the interviewers and the interviewed, and via an algorithm recognized with a 2012 Nobel Prize in Economics, produces the final matches, which are released on Match Day, usually the third Friday in March.

As wondrous as this process is, there has been a cumbersome productivity-drain and stress-inducing process in arranging those interviews. That is because ERAS produces a list of candidates for each residency program, which then invites potentially hundreds of candidates to choose from perhaps 20 potential interview dates, but it's left up to the prospective residents to arrange the actual dates and times of each interview.

Believe it or not, at least one residency program still uses the U.S. postal service to arrange the entire thing.
 
Mostly, administrative officials at each school are besieged by a flood of nearly-simultaneous emails and phone calls from hundreds of applicants trying to confirm their preferred dates and times. "We interview about a 170 to 200 people, so you get all those emails back, trying to get everybody scheduled in, so it's hundreds of emails and phone calls and stuff," says Amy Matenaer, anesthesiology medical education residency program coordinator at the Medical College of Wisconsin (MCW) in Milwaukee.

Clearly, there was a need to more efficiently match available times to candidates and interviewers, and even to establish waiting lists, since in the scrum of candidates trying to reach their most desired interviews, there was bound to be variations in interview demands based on the prestige of the residency program.

Last fall, MCW's anesthesiology program became one of a handful of residency programs which turned to Thalamus, a service open to all specialties, which charges programs a modest fee, $250 to $1000 per year, and in return offers an online interview reservation and scheduling system, including wait lists, not unlike some airline reservation systems.

Thalamus is the creation not of some venture capital-based startup, but of an exasperated residency candidate and an equally exasperated anesthesiology residency program director.

The service's founder and CEO Jason Reminick is that former residency candidate. He describes the problem: "It becomes this big email race… So everyone emails back as quickly as they can. They arbitrarily just pick a few dates. And then a coordinator on the other side is going email by email, filling out a date planner, filling out an Excel spreadsheet, a completely manual process until they hit a roadblock."
 
"The idea for this came when I actually got stuck in New York City during Hurricane Sandy, and several of my interviews were cancelled," he says.

After Reminick returned home to his medical school, the University of Rochester School of Medicine and Dentistry, and met with his mentor (and Thalamus co-founder and secretary), Suzanne Karan, MD, vice chair of education and residency program director for anesthesiology, she told him of her own frustrations with arranging interviews from the program side of the process.

"We sat down and came up with this idea of trying to hit it from all sides to make this one-shop stop for everyone." Reminick says. "I was completing a combined MD/MBA degree and I had one more course that I needed to complete for my business degree, so we decided that together we would write the business plan as part of that course, and Thalamus is what came of it."
 
"We're not so much reinventing the match process, but there's a byzantine process that precedes getting to the match that we are making into a more modern process," Karan says. She and Reminick used their network of residency program directors, interviewing physicians, administrators, and applicants who needed a solution for this problem. Last year, the Thalamus community included Stanford, Mount Sinai, and the University of Miami.

One beauty of Thalamus is that candidates can select interview dates that allow them to minimize the amount of cross-country travel during interview season by coordinating interviews within a particular geographical region, instead of just arbitrarily picking dates and then facing stiff travel costs and too much time in airports.

Then there is the waiting that is eliminated. Under the old email-and-phone call system, residency administrative personnel spend hours and hours thumbing through paper calendars or spreadsheets, and might respond to a candidate with an interview time three or four weeks later. Using Thalamus, they can reduce this process to under a minute.

In addition, Thalamus accommodates those students who are left without their most-preferred prospects at the end of the early round of interviews in January, says Michael Wadja MD, vice chair for education and residency program director for the NYU School of Medicine Department of Anesthesiology.

Trimming Fat from the System
"Some applicants are spending between $10,000 and $20,000 just on the interview process in terms of travel costs," says Reminick, who eventually chose Stanford University Hospital and Clinics/Lucile Packard Children's Hospital and just completed his second year of combined residency in pediatrics and anesthesiology there. Reminick cites an estimate from Forbes that the entire process wastes between $300 and $400 million.

Considering that medical residents don't exactly rake in the big bucks in terms of salary— another controversy entirely—anything that can cut costs of these programs is obviously good for those programs in light of widely reported physician shortages.

And those wait lists? Thalamus handles them automatically as interview candidates change their plans and interview slots open up. "They actually get an email saying this date just opened, would you like to move your date to here?" Matenaer says. "So it's more of an automated system, versus the manual going back and forth and everything like that."

"There's fat in the system, and some of the fat in the system is the administrative cost of running these residency programs," Karan says. "Being able to take a third of one person's job and cut it into minutes is a huge time and cost savings for our department. So I was thrilled, my chair was thrilled, and my other program director friends were thrilled."

Gaining Traction
Another Thalamus believer is Brian Tse, a 2015 UCLA Medical School graduate who began his anesthesia residency at Stanford last month.

"Several of the programs I interviewed at started to use Thalamus, which didn't take away the anxiety of emailing back ASAP, but did eliminate the lag time of emailing back in order to confirm dates," Tse says. "I started to look forward to those programs that sent out interview invitations through Thalamus and loved how simple the process is."
 
This fall, Thalamus continues to gain traction, much of it by word of mouth. There is also the possibility of integrating it with travel services, or even analyzing prior application data and telling applicants what their probability of matching at a particular program might be, Reminick says.

AAMC also deserves some credit for freely sharing necessary data with Thalamus and other programs while it works on enhancing ERAS' own capabilities in this regard. Such openness and cooperation is admirable, and could be better emulated throughout the healthcare IT field.