Doctor Sues Over Residency Application System

A physician is bringing antitrust claims against the Association of American Medical Colleges (AAMC) for what she alleges is a monopoly over the residency application process that’s gouging doctors.

Kaitlin Buhrke, DO, a general surgeon in Phoenix, filed the proposed class-action lawsuit in August, claiming that AAMC’s Electronic Residency Application Service (ERAS) has very little competition and charges applicants too much.

“AAMC has violated federal antitrust law to gouge residency and fellowship applicants attempting to follow their dreams, [make] better lives for themselves and their families, and make a difference for patients and their communities,” the complaint stated.

Hilgers PLLC, the Dallas law firm representing Buhrke, filed a similar suit against AAMC last year, alleging its medical school application service, AMCAS, was overcharging students. It made similar allegations against the law school application process.

In an emailed statement, AAMC said that while it “cannot comment on ongoing litigation, we remain committed to a fair, secure, and efficient application process for all residency and fellowship applicants and will vigorously defend this lawsuit.”

The current complaint alleges that AAMC makes a substantial part of its income from ERAS fees — about $120 million annually, from about 64,000 applicants.

Applicants often apply to dozens of programs in order to have a better shot at ensuring a residency position, at an average cost of about $1,800 per person. Buhrke submitted 81 applications through ERAS, paying $1,691 in total, according to the complaint.

The vast majority of physicians use ERAS to apply, as it has only two competitors: ResidencyCAS for ob/gyn and emergency medicine, and SF Match for ophthalmology and plastic surgery.

AAMC also took an equity stake in competitor Thalamus so that it wouldn’t be a threat to its monopoly, the complaint alleged.

Bryan Carmody, MD, MPH, of Eastern Virginia Medical School in Norfolk, who runs a popular blog on medical education, noted that ERAS is indeed the single biggest piece of AAMC’s revenue.

Carmody said he hasn’t seen a case like this one in recent history. A case involving pharmacy residents that was recently dismissed went farther than the ERAS suit. It alleged that hospitals and an accrediting organization violated antitrust law by using their match program to keep pharmacy residents’ salaries low and prevent them from moving between programs.

The pharmacy suit was closer to one that was filed more than two decades ago. In Jung v. AAMC, a group of doctors alleged that the National Resident Matching Program (NRMP) kept salaries low and pushed severe working conditions on residents.

That case was ultimately dismissed because AAMC was able to do an end-run around antitrust law, getting Congress to write an antitrust exemption for the match into a pension funding bill in 2004, according to a post by Carmody.

More than two decades later, that exemption has received renewed scrutiny, with a House Judiciary subcommittee holding a hearing in May 2025 questioning it. While some witnesses said the exemption restricts physician wages and mobility, others argued that scrapping it could result in disorder and inequity in residency placement.

The House Judiciary Committee issued a report this past March, charging that the match operates as a monopoly that harms residents, impedes access to care, and constrains the growth of America’s physician workforce. “The Match’s anticompetitive conduct is currently shielded from scrutiny by a special-interest antitrust exemption that allows it to harm the public while avoiding judicial oversight,” the committee said in its press release announcing the report.

It’s not clear that the report will set in motion any changes to the match’s antitrust exemption, nor is it clear that Buhrke’s case against ERAS will proceed. Legal experts said AAMC will likely move to dismiss the case, but given that courts in Washington, D.C., are backed up, it could take time to move through that process.

Indeed, the motion to dismiss the case against AAMC’s medical school application process was completed in December 2025, but it is still pending.