About

Brian T Antono is an Assistant Professor in the Department of Family Medicine and Community Health at Duke University. He is also a Core Faculty Member at the Duke-Margolis Institute for Health Policy. His professional role involves teaching, research, and community health initiatives within the Duke University School of Medicine. His work focuses on advancing family medicine and community health through academic and policy engagement, contributing to the education of medical students and health professionals, and participating in health policy research and scholarship.

Research topics

• Family medicine
• Medicine
• Political Science
• Sociology
• Law
• Biology
• Mathematics
• Library science
• Media studies
• Gerontology
• Medical education
• Psychology

Selected publications

• Office-Based Strategies to Combat Antimicrobial Resistance.

  PubMed · 2022-01-25 · 1 citations

  article1st authorCorresponding

  The goal is not simply to avoid antibiotics but to use them in a judicious manner. Here are 10 steps family physicians, practices, and leaders can take.

  Publisher

• The Price of Fear: An Ethical Dilemma Underscored in a Virtual Residency Interview Season

  Journal of Graduate Medical Education · 2021 · 13 citations

  1st authorCorresponding
  • Medical education
  • Psychology
  • Family medicine

  In May 2020, the Coalition for Physician Accountability recommended that all residency programs pivot to virtual interviews for the 2020–2021 season.1 This kept more than 45 000 applicants from traveling cross-country during a pandemic, aiding social distancing efforts. Additionally, it removed travel costs, granting applicants the opportunity to assess more programs. With opportunity and human nature, however, comes the risk of an arms race, where a more open residency market compounds pressure on students to apply to more programs. The residency application process has gone down a behavioral economics rabbit hole, where fear and uncertainty are unnecessarily driving up applications, despite evidence of no benefit to applicants or programs. In what follows, we contextualize the growing problem of application inflation, describe contributing drivers including those introduced by virtual interviews, raise concerns about a conflict of interest for the application steward, and discuss potential solutions.For the past decade, applications to residency programs via the Electronic Residency Application Service (ERAS) grew steadily.2 In 2019, US senior medical students averaged 64.9 applications, nearly twice as many as in 2009 (87% increase; Figure 1). That same year, international medical graduates (IMGs) submitted 136.5 applications on average, a 44% increase from 2009. Such application inflation might make sense if it improved the chance of matching, but it has not.3,4 US seniors have consistently matched at a 92% to 95% rate for decades despite the rise in applications, and Match rates for IMGs only improved by 15% over the past 10 years, reaching 59% by 2019.5 While application growth has yielded little benefit, it has multiplied student costs. Adjusted for inflation, US seniors spent an average of $1,409 on ERAS fees in 2019 (149% increase since 2009; Figure 1), while IMGs spent an average of $3,281 (39% increase since 2009).2,6,7 These substantial increases in application costs translate into substantial revenue for the Association of American Medical Colleges (AAMC) which manages ERAS. Form 990 filings with the Internal Revenue Service show that ERAS fees are the AAMC's largest single revenue stream, which has doubled between 2009 and 2019 ($47.6 million to $94.2 million; 98% increase; Figure 2).8A shift to a virtual interview season may escalate senior medical students' fear of not matching.9 Loss of away electives and usual opportunities for signaling interest and developing advocates may also increase concern and applications. For programs, the existing application inflation was already burdensome, and a COVID-19-related surge will likely exacerbate challenges to evaluate candidates holistically.9 Specifically, programs may depend more on “easy-to-measure” benchmarks like test scores to stratify applicants, favoring high-scoring candidates. Indeed, previous years have shown that a small minority of applicants already receive a majority of interview offers. In 2016, an estimated 2.6% of family medicine applicants received 22% of total interview slots.10 Traditionally, these applicants are limited by travel costs and logistics, thereby allowing other applicants to receive offers. However, a virtual season removes most of these limitations. Without any intervention, the risk of unfilled residency positions in the initial Match increases as programs disproportionately interview the same subset of applicants.Application inflation is likely driven by several factors working in unison. Peer pressure and conformity disposition are potent drivers of human behaviors, meaning students whose peers increase their applications are likely to do the same.11 A survey of internal medicine residents suggested these factors increase ERAS applications.12 A similar effect evolved for Advanced Placement (AP) examinations in high school where indirect peer pressure and conforming behavior have escalated AP class enrollments with some concerning effects.13Beyond peer pressure, behavioral economic drivers, particularly fear of not matching, lead most students to “over-apply, overaccept.”14 These are frequently stoked by claims that medical school expansion will limit residency options for students, a fear echoed by deans.15 This is despite AAMC data showing stagnant Match rates for over a decade.16Economic factors may also play a role. While application and interview costs continue to grow, even a generous $10,000 application budget pales in comparison to the rising debt medical students now face—more than $200,000 on average.17 Faced with the fear of not matching, students may simply consider this a “drop in the bucket” compared to the overall cost of a medical degree.Finally, a review of application rates to medical schools, graduate schools, and law schools did not reveal the application inflation seen with ERAS, suggesting application inflation is not an environmental phenomenon.18–20This season's virtual shift is one of necessity. While the health benefits of this temporary change are welcome, the potential surge in applications is not. A recent publication called for a timely response by graduate medical education stakeholders to “both mitigate the immediate effects of COVID-19 on the residency selection process and improve this system more broadly.”9 Heeding this call, obstetrics and gynecology leadership organizations proposed specialty-wide changes.21 In particular, programs were urged to release interview offers in a standardized window and to limit offers based on available slots.22 In otolaryngology, applicants can now send tokens to 5 programs to signal their interest to interview and overcome the “noise” of application saturation.23 Previous proposals like mission-driven recruitment were not implemented this season but may prove beneficial for future seasons.24More broadly, the AAMC has the capacity to curb the burden on students and programs by making decades of ERAS data available, empowering students to make better-informed decisions on which programs to apply. Currently, AAMC data are available to applicants via the Apply Smart and Residency Explorer tools.25,26 Apply Smart attempts to show the point of diminishing returns where more applications do not translate to a greater likelihood of matching, but its flawed assumptions need repair.27 Similarly, Residency Explorer compares an applicant's metrics with those of matched residents at programs of interest, but stops short of providing actionable data for applicants to reasonably estimate their likelihood of an interview offer or a match. Addressing the flaws of these tools would be a meaningful step to guide application choices based on probable fit rather than peer anecdotes and fear of not matching.There have also been calls for limiting residency applications for several years without serious consideration by stakeholders.3,12,28 With ERAS now representing more than 40% of the AAMC's total revenue, any systemic change like limiting applications will have economic implications: In 2019, if applications had been capped at 20 per student, ERAS revenue would have decreased from $94 million to $11 million. The potent conflict between AAMC's economic interests and students' best interests should be addressed and may require a neutral third party to administer ERAS.A virtual 2020–2021 Match season was an important decision for student health. However, a real risk of that decision may be escalation of the prior decade's growth in non-beneficial ERAS applications, enhancing an existing ethical dilemma. There are strong ethical reasons to provide students with information to reduce fears of not matching, and of limiting the number of ERAS applications. An examination of current policies and their effects on underrepresented applicants is also needed. At the time of writing, the effect of COVID-19 on student application rates leading up to the 2021 Match remained unknown. However, the likelihood of another dynamic season ahead presents perfect timing to test previously recommended strategies and policies.

  PublisherOA PDFDOI

• Physician Employment Eclipses Practice Ownership: The Ongoing Trend and Its Effect on Family Medicine.

  PubMed · 2021-10-01 · 1 citations

  article

  In 2016, for the first time, less than one-half of practicing physicians had an ownership stake in their own practices. The most recent American Medical Association Physician Practice Benchmark Survey reveals that this trend continues. More physicians are identifying as employees instead of owners, with family physicians being the second most likely specialty to be employed. This trend has significant implications for reimbursement and practice patterns, and potential impacts on physician burnout if scope is limited by employers.

  Publisher

• How effective is direct acting antiviral therapy in curing chronic hepatitis C among individuals who actively inject drugs?

  Evidence-Based Practice · 2020-04-01

  article

  Jackson, Troy MD; Antono, Brian MD; Grandy, Rebecca PharmD; Smith, Eric MD; Hulkower, Stephen MD; Stigleman, Sue MLSAuthor Information

  PublisherDOI

• Telehealth, Rural America, and the Digital Divide

  Journal of Ambulatory Care Management · 2020 · 61 citations

  Senior authorCorresponding
  • Political Science
  • Sociology
  • Library science

  Professor of Family Medicine Georgetown University School of Medicine Washington, District of Columbia (Dr Mishori); and Robert L. Phillips Jr. Health Policy Fellow The Robert Graham Center Washington, District of Columbia and Georgetown University School of Medicine Washington, District of Columbia (Dr Antono). Correspondence: Ranit Mishori, MD, MHS, FAAFP, Georgetown University School of Medicine, Family Medicine, Pre-clinical GB-01D, 3900 Reservoir Rd. NW, Washington, DC 20007 ([email protected]) Drs Mishori and Antono have no conflicts of interest.

  PublisherDOI

• PENGARUH STRATEGI GALLERY WALK TERHADAP MOTIVASI DAN HASIL BELAJAR PESERTA DIDIK PADA MATA PELAJARAN SEJARAH DI SMA NEGERI 1 INDRALAYA UTARA

  2019-06-27

  dissertation1st authorCorresponding

  This research is titled “Effect of Gallery Walk Strategy on Student Motivation and Learning Outcomes in Historical Subjects at SMA Negeri 1 Indralaya Utara”. The formulation of the problem in this paper is whether there is an effect of the Gallery Walk Strategy on the Motivation of Learning and Learning Outcomes of Students in Historical Subjects at SMA Negeri 1 Indralaya Utara. While the purpose of this study is to see whether there is an effect of the gallery walk strategy on learning motivation and student learning outcomes on historical subjects in SMA Negeri 1 Indralaya Utara. The sample in this study was class XI Natural Sciences namely class XI IPA 2 as the experimental class and class XI IPA 1 as the control class using random sampling. Data collection techniques in this study were using questionnaires/questionnaires and tests/questions. The data analysis technique used in this study is the data normality test, data homogeneity test, and two-way annava test with a significance level with a real level (α = 0.05). Based on the results of data analysis from three existing problem formulas, the FA = 115.62 > 3.93 (Significant) results, FB = 54.54> 3.93 (Significant), FAB = 5.61> 3.93 (Significant). Thus it can be concluded that the Gallery Walk strategy influences learning motivation and student learning outcomes on historical subjects in SMA Negeri 1 Indralaya Utara. Keywords: Gallery Walk Strategy, Learning Motivation, Learning Outcomes, Students, North Indralaya 1 Public High School.

  Publisher

• Tu1970 Probiotic VSL#3 Promotes Eubiosis and Protects Against Radiation Colitis

  Gastroenterology · 2013-05-01

  articleOpen access
  PublisherOA PDFDOI

Frequent coauthors

• J Willis

  3 shared

• Ranit Mishori

  Georgetown University

  3 shared

• Andrew Bazemore

  3 shared

• John M. Westfall

  3 shared

• Robert L. Phillips

  National Academy of Medicine

  3 shared

• Yalda Jabbarpour

  2 shared

• Julie Hyppolite

  Center For Policy Research

  2 shared

• Stephen Petterson

  George Washington University

  2 shared

Education

• MD, School of Medicine

  UNC Health Care System

  2016

• MPH

  University of North Carolina at Chapel Hill Gillings School of Global Public Health

  2015