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jbcarmody.bsky.social
Bryan Carmody
@jbcarmody.bsky.social
2.3K followers 140 following 130 posts
The Sheriff of Sodium | Pediatric nephrologist | EVMS associate professor | APD | Husband | Dad | Virginian | Advocate for medical trainees and common sense
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jbcarmody.bsky.social
OpenEvidence has revenue of $50 million.

But investors value it at $6.1 BILLION.

So… a couple of questions for the “AI won’t replace doctors!” crowd:

What do you think OE’s long-term monetization pathway looks like?

And what do investors expect to happen that could justify this valuation?
Screenshot of OpenEvidence investment prospectus, noting revenue of $50,000,000 with valuation of $6,100,000,000.
October 30, 2025 at 12:13 AM
jbcarmody.bsky.social
Another year, another increase in USMLE Step 2 CK performance.

Notice how the distribution shifts rightward every year.
Graphic demonstrating the distribution of USMLE Step 2 CK scores in four eras: 2013-2016, 2016-2019, 2019-2022, and 2022-2025. Each year, the distribution shifts slightly rightward and becomes slightly more compressed.
October 14, 2025 at 3:17 PM
jbcarmody.bsky.social
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...
The $100,000 H-1B Visa: Winners & Losers Edition
Last week, President Trump signed a proclamation requiring a $100,000 fee for all new H-1B visas. (For anyone unaware, the H-1B program allows American companies to employ skilled foreign workers w…
thesheriffofsodium.com
September 24, 2025 at 5:31 PM
jbcarmody.bsky.social
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...
The Applicant’s Guide to Strategic Preference Signaling
Whenever I discuss preference signaling on social media, one of the first replies is always “Wait – what’s that?” In the olden days, when an applicant was interested in a particular residency…
thesheriffofsodium.com
September 11, 2025 at 12:53 AM
jbcarmody.bsky.social
Preference signaling in the 2026 Match
Number of preference signals allowed, by specialty, in the 2025-2026 residency application cycle. Some specialties like orthopaedic surgery and urology allow 30 signals; others like pediatrics and emergency medicine only allow 5. Some specialties like dermatology, anesthesiology, radiology, and internal medicine have both gold and silver signals.
September 3, 2025 at 11:15 PM
jbcarmody.bsky.social
Let the residency application Bot Wars commence.

May the odds be ever in your favor.

www.thalamusgme.com/blogs/thalam...
Headline: Thalamus Acquires Medicratic to Accelerate AI-Powered Innovation in Medical Education and Transform Physician Workforce Intelligence SANTA CLARA, CA — July 30, 2025 — Thalamus, the leading platform for Graduate Medical Education (GME) and emerging physician recruitment solutions, announced today the acquisition of Medicratic, a healthcare technology company specializing in using Artificial Intelligence (AI) to improve the evaluation of medical residency and fellowship applications. This strategic acquisition expands Thalamus’s mission to ensure that the right doctor ends up at the right hospital to treat the right patients — from medical school through practice — using advanced technology and values-driven design thinking. “Thalamus and Medicratic were both born from an aspiration to transform the transition to residency for the betterment of applicants and programs,”said Jason Reminick, MD, MBA, MS, CEO and Founder of Thalamus. “This acquisition enhances the Thalamus platform to create a force multiplier for the future of medical education and physician workforce planning.”
July 30, 2025 at 4:58 PM
Reposted by Bryan Carmody
leahpierson.bsky.social
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 🏥)
July 19, 2025 at 3:42 PM
jbcarmody.bsky.social
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...
EPISODES | Bio(un)ethical
www.biounethical.com
July 14, 2025 at 11:33 PM
jbcarmody.bsky.social
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.)
Change to Step 2 CK Passing Standard Begins July 1, 2025. At its June 2025 meeting, the USMLE Management Committee conducted a review of the USMLE Step 2 Clinical Knowledge (CK) passing standard. Management Committee members include individuals with experience on state medical boards, medical school and residency program faculty from across the United States, practicing physicians, residents, and public members. The Committee decided that a four-point increase in the passing standard – used to determine a Pass or Fail outcome – will apply to Step 2 CK examinees testing on or after July 1, 2025. On the three-digit score scale, the passing standard will change from 214 to 218.
June 17, 2025 at 2:51 PM
jbcarmody.bsky.social
Given to me by a patient
Two aliens sit at a dinner table. One is using a salt shaker. Alien 1: Why sprinkle minerals before ingesting? Alien 2: I enjoy sprinkled minerals. Alien 1: But this could decrease your final revolution count. Alien 2: Perhaps I enjoy fewer revolutions and more minerals.
May 22, 2025 at 2:35 PM
jbcarmody.bsky.social
Ever had a conversation like this?
Nervous doctor, to administrator: c-c-could I get… Administrator: I’m afraid the budget is very tight… Administrator: The hospital is operating at a loss… (Doctor looks tired) Administrator: In fact, we’re losing money on you! Doctor is shriveled and dessicated
May 11, 2025 at 2:31 PM
jbcarmody.bsky.social
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...
ACGME Board Executive Committee Action. The ACGME… is suspending enforcement of these requirements (see specific program and institutional standards in following screenshots). The program, in partnership with a sponsoring institution, must engage in practices that focus on mission-driven, ongoing, systematic recruitment and retention of a diverse and inclusive workforce of residents, fellows (if present), faculty members, senior administrative staff members, and other relevant members of the academic community. The sponsoring institution, in partnership with each of its programs, must engage in practices that focus on ongoing, mission-driven, systematic recruitment and retention of a diverse and inclusive workforce of residents/fellows, faculty members, senior administrative staff members, and other relevant members of its GME community.
May 11, 2025 at 2:08 PM
jbcarmody.bsky.social
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...
Executive Order on Medical Accreditation: Winners & Losers Edition
YouTube video by Sheriff of Sodium
www.youtube.com
April 26, 2025 at 2:18 PM
jbcarmody.bsky.social
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...
Presidential actions - reforming accreditation to strengthen higher education; executive order, April 23, 2025 The Attorney General and the Secretary of Education, in consultation with the Secretary of Health and Human Services, shall investigate and take appropriate action to terminate unlawful discrimination by American medical schools or graduate medical education entities that is advanced by the Liaison Committee on Medical Education or the Accreditation Council for Graduate Medical Education or other accreditors of graduate medical education, including unlawful “diversity, equity, and inclusion” requirements under the guise of accreditation standards. The Secretary of Education shall also assess whether to suspend or terminate the Committee’s or the Accreditation Council’s status as an accrediting agency under Federal law or take other appropriate action to ensure lawful conduct by medical schools, graduate medical education programs, and other entities that receive Federal funding for medical education.
April 23, 2025 at 11:37 PM
jbcarmody.bsky.social
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
Match Day 2025: Winners & Losers Edition
YouTube video by Sheriff of Sodium
youtu.be
March 21, 2025 at 11:01 PM
jbcarmody.bsky.social
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...
The Match: The Movie
Over the past week, subscribers to the Sheriff of Sodium YouTube channel have been treated to a sprawling and expansive six-part video series on the Match – including the long-awaited Part 6,…
thesheriffofsodium.com
March 17, 2025 at 2:00 PM
jbcarmody.bsky.social
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%
March 15, 2025 at 1:44 PM
jbcarmody.bsky.social
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.
Screenshot of the first page of the article “To Catch a Catfish: A Cautionary Tale of Internet Unprofessionalism.” Full text link below. Figure from the linked article, showing rapid program leadership response to unusual email, resulting in unranking applicant in 4 days.
March 9, 2025 at 9:54 PM
jbcarmody.bsky.social
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
March 7, 2025 at 10:01 PM
jbcarmody.bsky.social
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
Following The Money: A Primer on Resident Physician Compensation
YouTube video by Sheriff of Sodium
youtu.be
February 25, 2025 at 2:08 AM
jbcarmody.bsky.social
We may be getting a new medical school in California…

The University of Silicon Andhra School of Medicine
Screenshot from the Liaison Committee on Medical Education website, noting applicant status for the proposed “University of Silicon Andhra School of Medicine” in the San Joaquin Valley.
February 12, 2025 at 11:18 PM
jbcarmody.bsky.social
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.
Graphic from the New England Journal of Medicine demonstrating the mean salary of a first-year resident from 1968 to 2012, with values standardized to 2012 dollars. All of the points on the graphic range from ~$41,000 to ~$54,000, with values after 1983 more tightly clustered between ~$45,000 and ~$52,000.
February 11, 2025 at 7:17 PM
jbcarmody.bsky.social
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
Rank Order List: Buyers and Sellers Edition
YouTube video by Sheriff of Sodium
youtu.be
February 3, 2025 at 1:25 PM
jbcarmody.bsky.social
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.
Graphic demonstrating the interview rate at the median program in each specialty for MD applicants who signaled or did not signal the program with their application. There is a significant drop off in interview rates for non-signaled applications. In less-competitive specialties with low signal numbers (e.g., pediatrics - 5), 83% of signaled applications yielded an interview, while 40% of non-signaled applications did. In more competitive specialties with high signal numbers (e.g., neurosurgery - 25), 31% of applicants who signaled received an interview, while 1% of non-signaled applicants did.
February 3, 2025 at 3:23 AM
jbcarmody.bsky.social
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
Mailbag: Letters of Intent and Post-Interview Communication
YouTube video by Sheriff of Sodium
youtu.be
February 1, 2025 at 4:44 PM