ADA Boycott Follows Meeting Scandal; Lawsuits Fly in Residency Application Space

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 insights into the week’s biggest healthcare stories. I’m your host, Rachael Robertson.

This week, we are talking with Kristen Monaco about the boycott of the American Diabetes Association following a scandal at this year’s conference. Then, Kristina Fiore and I will tell you about two lawsuits that paint different pictures of the competitiveness of the residency application landscape.

In the latest update, as part of a months-long saga, members of the American Diabetes Association (ADA) have launched a boycott against the organization. The reason for the boycott? Members have condemned the leadership’s actions in the aftermath of five researchers being removed by police from its annual meeting in June. Kristen Monaco is here to tell us all about it.

So, Kristen, can you explain the events that have led up to the boycott.

Kristen Monaco: Yes. To understand the current boycott, we actually need to rewind to June when the ADA’s annual meeting took place in New Orleans. At the meeting, Steven Kahn, MBChB, who is currently the editor-in-chief of Diabetes Care, the ADA’s flagship journal, and four other well-known researchers were ejected from the meeting by police.

This happened as they handed out printed copies of an editorial outside the hall where the meeting’s keynote address was given by an NIH official. The editorial was co-authored by Kahn and published in Diabetes Care back in April. In it, the editorial was critical of the Trump administration’s funding cuts to biomedical research. Since this happened, there has been quite a bit of backlash following how the ADA has handled the incident leading to the current boycott.

Robertson: So, how many people are involved in this boycott?

Monaco: As of Friday, Sept. 11, after being up for less than 2 days, the boycott had gathered over 400 signatures, including some big names. The list included past ADA presidents, award winners, Scientific Sessions committee members, journal editors, and individuals who are affected by diabetes.

In the letter addressed to the board, the boycott notice said that in the months after the researchers were removed from the meeting, the ADA had offered “shifting justifications,” no real apology, and despite the CEO’s promise, no truly independent review of the events.

Robertson: Okay, so hundreds of people have signed on to this boycott. By doing so, what are they actually agreeing to?

Monaco: Signees of the boycott have pledged to suspend all ADA-related activities. This includes not planning or attending any meetings led by ADA leadership or the board, including next year’s scientific sessions. Signees will also not participate in board-led activities regarding the investigation of the meetings, events, or the report generated by the so-called independent committee. Signees have also pledged to not engage in any other ADA operations, and this includes presentations, fundraisers, grant reviews, manuscript submissions and reviews, journal management, including Diabetes Care, and position statements.

Kahn told MedPage Today that manuscripts submitted to Diabetes Care will not be handled until the boycott is over. However, the ADA disputed this and said that the journal is “continuing with regular publication and processes, including accepting submissions.” But if there is a disruption at the journal, this could lead to delays in the dissemination of some critical research.

Robertson: Well, I know you will be covering this story like you have from the beginning. Thanks so much, Kristen.

Monaco: Thank you, Rachael.

Robertson: Lawsuits are flying over applying to residency, and they paint different pictures of the competitive landscape. In one, a physician alleges that the Association of American Medical Colleges, or the AAMC, their residency application system is a monopoly that’s gouging doctors. In another, an AAMC partner sues a doctor for alleged anti-competitive practices.

But let’s start with the first scenario. Kristina Fiore is here with me in the studio, and she wrote the first story about Kaitlin Buhrke, DO’s, lawsuit against the AAMC. So, Kristina, can you tell us about it?

Kristina Fiore: Sure. So, Kaitlin Buhrke is a wound care physician in Phoenix who is alleging that AAMC’s electronic residency application service, or ERAS, has very little competition and charges way too much. Burke herself paid almost $1,700 to apply to residency, which is a lot of money for a medical school student.

Her lawsuit alleges that AAMC “violated federal antitrust law to gouge residency and fellowship applicants attempting to follow their dreams,” and it can do this because there’s very little competition. There are only two competing systems: ResidencyCAS and SF Match, and they make a much smaller piece of the application service pie.

Now, ERAS is AAMC’s single biggest piece of revenue, at about $120 million per year. Is it taking advantage of doctors? We’re gonna have to see how the case turns out.

I will say that the law firm representing Buhrke brought a similar suit against AAMC last year, alleging its medical school application system was also overcharging students, and it did the same for the law school application process. Now, a motion to dismiss the other AAMC case was completed in December 2025, but that case is still pending. So this is likely going to take some time to work its way through the courts.

Now, the suit that you covered, Rachael, paints a very different picture of the competitive landscape of residency application services. So tell us about yours.

Robertson: Yeah. So the second lawsuit was launched by Thalamus, which is a software company that works really closely with the AAMC and ERAS. They sued Maya Hammoud, MD, MBA, who is an ob/gyn, and they also sued Liaison International, which is the company behind ResidencyCAS, which is the software that’s used by ob/gyn and emergency medicine. This lawsuit claims that the defendants “engaged in a coordinated effort to unfairly compete in the residency application market through anticompetitive means.”

It details how, leading up to the 2020/2021 application cycle, Thalamus partnered with Hammoud, the American Medical Association, and the Association of Professors of Gynecology and Obstetrics on a pilot project for which Hammoud was the principal investigator, and in that role she had full access to Thalamus’s products. This agreement prohibited Hammoud and the others from using Thalamus’s information to build a similar product. And then in 2022, Thalamus and Liaison entered into an agreement. Liaison leaders said that they did not plan to enter the graduate medical education space and didn’t have any similar products. Then a year later, ob/gyn announced its switch to ResidencyCAS.

For years, Thalamus/AAMC was the only major player in the graduate medical education software market, and now ResidencyCAS is one of the biggest threats to its market share. While in the case you described, it positions the AAMC as a monopoly, in the case I wrote about, Thalamus is poised more as an underdog. Though ultimately, the suit I covered boils down to a commercial dispute over allegedly violating a non-compete and using access to proprietary information to launch a competing product.

Both of us spoke with Bryan Carmody, MD, MPH, who runs a popular medical education blog about both of these lawsuits, and he had some interesting takeaways.

Fiore: He did. What I found most interesting was his take on whether competition has improved ERAS, and he thinks that it has. So, in that sense, there is competition, and it’s working like it should. At the same time, he’s also a bit wary that the AAMC/Thalamus lawsuit is there to deter other doctors from creating further competition and further innovation. So it’s all a weird and complicated dance, and it will be very interesting to follow along and to see how all these lawsuits play out.

Robertson: It really will. Thanks for coming on the podcast, Kristina.

Fiore: Thanks, Rachael.

Robertson: Things are still quite bad on the measles front. Last week there were 157 cases, and the week before had 235 — one of the worst weeks this year for measles. The bulk of cases are still in Pennsylvania, which had 99 cases last week and 117 the week before. Check out our interactive measles map for a more detailed breakdown of how measles has been spreading. We update it at the top of each week.

And that is it for today. If you like what you heard, leave us a review wherever you listen to podcasts, and hit subscribe if you haven’t already. We’ll see you again soon.

This episode was hosted and produced by me, Rachael Robertson. Sound engineering by Greg Laub. Theme music by Palomar. Our guests were MedPage Today reporters Kristen Monaco, Kristina Fiore, and Rachael Robertson. Links to our 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.