Your ERAS headshot is the first thing program directors see when they open your application. Not your Step scores. Not your personal statement. Your face.

It shows up on the ERAS dashboard, on composite sheets during ranking discussions, and in interview files. A professional photo signals competence and attention to detail. A bad one raises questions about both.

This guide covers the exact technical specs from the AAMC, what to wear, what backgrounds work, common mistakes that get photos rejected, and how to get a compliant headshot without overspending.

What are ERAS headshot requirements?

ERAS requires photos in JPEG or PNG format, 2.5x3.5 inches at 150 DPI minimum (or 5x5 square as of 2025), under 150 KB file size. The photo must show head and shoulders in business professional attire against a neutral light gray or off-white background. No white coats, no casual clothing, no environmental backgrounds. International Medical Graduates upload through MyIntealth (ECFMG) which transfers to ERAS.

The 2025 update added a square 5x5 inch crop option alongside the traditional portrait format. The square format allows higher resolution uploads while staying under the 150 KB limit. If your photographer offers both, choose the square crop for better quality.

Can I use an AI headshot for ERAS?

Yes, AI headshots are acceptable for ERAS applications as long as they meet the AAMC's technical specifications (correct dimensions, under 150 KB, JPEG or PNG) and look professionally realistic. The photo must be indistinguishable from a studio headshot. Tools like Narkis.ai generate ERAS-compliant photos with proper lighting, neutral backgrounds, and business professional framing at a fraction of traditional photography costs.

The critical test is whether a program director would recognize you from the photo when you walk into the interview room. If the AI headshot looks like you in professional attire, it works. Over-retouched or unrealistic AI photos that don't match your actual appearance create trust issues during interviews.

Official ERAS Photo Specifications

The AAMC sets specific requirements for photos uploaded through MyERAS. Here are the current specs:

International Medical Graduates upload through MyIntealth (ECFMG), which transfers the image to ERAS. Formatting errors at this stage can delay your application, so verify specs before submitting.

The 2025 update added a square 5x5 inch crop option alongside the traditional 2.5x3.5 portrait format. The square format allows higher resolution uploads. If your photographer offers both, go with the square crop.

What to Wear

Residency interviews call for business professional attire. Your headshot should match.

Men:

• Suit jacket in navy, charcoal, or black
• Collared dress shirt in white or light blue
• Tie in a solid color or simple pattern
• No white coat. It blends into light backgrounds and looks presumptuous before you've matched

Women:

• Blazer or structured top in a solid, neutral color
• Avoid busy patterns. They compete with your face at small display sizes
• Simple jewelry only. Nothing that catches light or distracts
• No white coat for the same reasons above

Everyone:

• Press everything. Wrinkles photograph worse than they look in person
• Get a fresh haircut 5-7 days before the photo. Not the day of. Fresh cuts look too sharp in photos.
• Minimal makeup. Enough to reduce shine under studio lights, not enough to look done up
• Glasses are fine if you wear them daily. Ask the photographer about anti-glare positioning

Background and Lighting

Background: Neutral light gray or off-white. This is effectively a requirement, not a suggestion. Solid backgrounds reproduce cleanly at any size and don't distract from your face. Avoid:

• Pure white (washes out under flash)
• Dark backgrounds (too dramatic for a medical application)
• Environmental settings (bookshelves, offices). These aren't casual headshots
• Gradients (they compress poorly and look dated). Learn more about international headshot standards.

Lighting: Soft, even lighting from slightly above and in front. The goal is no harsh shadows under the nose or chin. Studio lighting with a softbox or umbrella achieves this.

Natural window light works if it's diffused. Direct sunlight does not.

Expression and Posing

You're applying to take care of patients. Your expression should communicate competence and approachability.

• Slight, genuine smile. Not a grin, not a flat stare. The kind of expression that says "I'm capable and I won't make this more stressful than it needs to be."
• Direct eye contact with the camera. You're looking at program directors. Meet their eyes.
• Slight head turn (about 15-20 degrees from center). This adds dimension without looking like you're avoiding the camera.
• Relaxed shoulders. Tension in the jaw and shoulders is visible in headshots and reads as nervous.
• Head and shoulders framing. Tight enough that your face fills most of the frame, loose enough that your jacket collar is visible.

Common Mistakes That Get ERAS Photos Rejected

1. Wrong file size or format

The 150 KB limit catches people off guard. High-resolution studio photos often exceed this. Your photographer should provide a web-optimized version specifically for ERAS. If they don't know what ERAS is, send them the specs from this article.

2. Cropping too tight or too loose

Too tight cuts off the top of your head or your chin. Too loose includes your waist or the background dominates. Head and shoulders, centered, with a small margin above your head.

3. White coat in the photo

You haven't matched yet. Wearing a white coat in your application photo is like putting "Dr." in front of your name before graduation. Some program directors find it presumptuous. Others don't care. Why take the risk?

4. Selfies or phone photos

Even a good phone camera can't replicate studio lighting. Phone photos have visible noise, uneven lighting, and the lens distortion from arm's-length distance makes your nose look larger and your face narrower than reality. This is the one photo that represents you to hundreds of programs. A $75-150 headshot session is a rounding error in the cost of applying.

5. Outdated photos

If you look noticeably different from your photo during interviews, it creates an awkward moment and a subtle trust issue. Use a photo taken within the last 6 months.

6. Over-retouching

Light retouching is fine: evening skin tone, removing a temporary blemish, reducing under-eye shadows from studying. Heavy smoothing, jaw reshaping, or skin lightening creates an uncanny valley effect. Program directors will meet you on interview day. The photo should look like you.

7. Poor background choice

A textured wall, a bookshelf, or your living room. These immediately signal "I didn't take this seriously enough to go to a studio or find a plain background."

Upload Process

1. Log in to MyERAS through the AAMC portal
2. Navigate to Documents, then Photo
3. Upload your JPEG or PNG file (under 150 KB)
4. Preview the crop. ERAS will show you how the photo appears in the application
5. Verify the image is sharp and correctly framed after upload. The compression can sometimes degrade quality

For IMGs using ECFMG/MyIntealth: upload through that portal first. The image transfers to ERAS automatically. Double-check that it transferred correctly by verifying in MyERAS after the sync.

When to Get Your ERAS Headshot

ERAS applications typically open in early September, with most applicants submitting in the first two weeks. Don't wait until August to think about your photo.

Ideal timeline:

• June-July: Book and complete your headshot session
• August: Receive edited photos, resize for ERAS specs, test upload
• September: Submit with your application on day one

This timeline gives you margin for reshoots, retouching revisions, and the inevitable technical issues with MyERAS in the first week of the application cycle.

How Much Should an ERAS Headshot Cost?

Studio headshot sessions for medical residents typically run $75-250. The variation comes from location and whether retouching is included.

What's worth paying for:

• A photographer who specializes in headshot lighting. Portrait and wedding experience doesn't automatically translate.
• Retouching included in the price. Some photographers charge it separately.
• Digital delivery in multiple formats: full-res for printing and web-optimized for ERAS

What's not worth paying for:

• "Medical headshot specialists" charging $400+. The photo requirements are simple. Any competent headshot photographer can nail them
• Hair and makeup styling. Unless you want it, it's unnecessary for a medical application

AI Headshot Generators as an Alternative

AI headshot tools like Narkis.ai can produce ERAS-compliant photos from regular selfies. The technology has improved significantly: you get studio-quality lighting, neutral backgrounds, and professional framing without booking a session.

When AI headshots make sense for ERAS:

• You're in a rural area without access to a professional headshot photographer
• You need the photo quickly and can't schedule a session in time
• Budget is tight. AI headshots start at $27 compared to $75-250 for studio sessions.
• You want multiple versions with different attire and expressions without paying per-look fees

What to verify with AI headshots:

• The output matches ERAS dimensions (2.5x3.5 or 5x5 square)
• File size stays under 150 KB
• The photo looks like you. Not an idealized version, not a different person. You
• Background is solid neutral gray or off-white
• No artifacts or distortion in the face, hair, or clothing

The test is simple: would a program director recognize you from this photo when you walk into the interview room? If yes, it works. If you have to squint, reshoot.