ArticlePDF Available

Not a Cheap Investment: Estimating the Cost of the 2017 to 2018 Ophthalmology Residency Match to the Applicant and Program

Authors:

Abstract

Purpose To estimate the cost of the match process for all ophthalmology applicants and the departmental costs at the University of Kentucky during the 2017 to 2018 match cycle. Design Financial analysis. Methods Using the available national match statistics for the 2017 to 2018 ophthalmology residency match and the mean of all residency interview costs available in the literature, the estimated mean and total match costs were calculated for all applicants, including application fees and interviews. Program costs were estimated based on direct interview costs, lost productivity, and fixed costs. Results Of 625 applicants, 475 matched into an ophthalmology residency position in 2017 to 2018. The mean estimated cost was US$6,613 for matched applicants, and all applicants spent US$4,646,950 on the match in aggregate. Our department spent an estimated US$179,327 over four interview days with 12 faculty volunteers, or an average of US$3,736 per each of 48 interviewed applicants. Conclusions and Relevance Matching into an ophthalmology residency position is expensive not only for the applicant but also the program. Reforms to the process would likely be beneficial to both parties.
Not a Cheap Investment: Estimating the Cost of
the 2017 to 2018 Ophthalmology Residency
Match to the Applicant and Program
Daniel B. Moore, MD1
1Department of Ophthalmology and Visual Sciences, University of
Kentucky, Lexington, Kentucky
J Acad Ophthalmol 2018;10:e158e162.
Address for correspondence Daniel B. Moore, MD, Department of
Ophthalmology and Visual Sciences, Univer sity of Kentucky, 110 Conn
Terrace, Suite 550, Lexington, KY 40508
(e-mail: daniel.b.moore@uky.edu).
In 2017, 18,261 students graduated from U.S. medical
schools1with a mean debt of US$190,694.2Both of these
gures are continuing to rise year over year, and educa-
tional debt remains a central concern in addressing physi-
cian workforce diversity in geographic location and
specialty.3Medical students have additionally raised con-
cerns about the cost of the residency interview process,
indicating that the expenses are overly burdensome and
that nancial considerations inuence their decision to
attend interviews.4
This past match cycle, 689 U.S. and international appli-
cants competed for 475 ophthalmology residency positions.
Over the past decade, the number of positions offered has
slightly increased from 458 in 2009, whereas the number of
applications has actually decreased from 767. Despite this,
the competitiveness of the match, as measured by percent
matching, has not changed. What has increased substan-
tially, however, is the number of applications per applicant:
from 41 in 2004, to 50 in 2009, and up to 73 and 69 for the
average matched and unmatched applicants in 2018, respec-
tively. Matched and unmatched applicants also attended an
average of 12 and 4 interviews, respectively.5
Data regarding the nancial burden of the match processfor
applicants are limited but suggest signicant expense for this
cost-conscious population.3,615 The goal of this study is to
provide a reasonable estimate of the cost associated with the
Keywords
ophthalmology
residency match
residency interviews
residency application
cost
medical student
Abstract Purpose To estimate the cost of the match process for all ophthalmology applicants
and the departmental costs at the University of Kentucky during the 2017 to 2018
match cycle.
Design Financial analysis.
Methods Using the available national match statistics for the 2017 to 2018 ophthal-
mology residency match and the mean of all residency interview costs available in the
literature, the estimated mean and total match costs were calculated for all applicants,
including application fees and interviews. Program costs were estimated based on
direct interview costs, lost productivity, and xed costs.
Results Of 625 applicants, 475 matched into an ophthalmology residency position in
2017 to 2018. The mean estimated cost was US$6,613 for matched applicants, and all
applicants spent US$4,646,950 on the match in aggregate. Our department spent an
estimated US$179,327 over four interview days with 12 faculty volunteers, or an
average of US$3,736 per each of 48 interviewed applicants.
Conclusions and Relevance Matching into an ophthalmology residency position is
expensive not only for the applicant but also the program. Reforms to the process
would likely be benecial to both parties.
received
September 7, 2018
accepted after revision
October 11, 2018
DOI https://doi.org/
10.1055/s-0038-1675846.
ISSN 2475-4757.
Copyright © 2018 by Thieme Medical
Publishers, Inc., 333 Seventh Avenue,
New York, NY 10001, USA.
Tel: +1(212) 584-4662.
Research Article
THIEME
e158
ophthalmology residency match process for both applicants
and programs using available national and local data.
Materials and Methods
The numbers ofregistrants, participants, rank listsubmissions,
and matched and unmatched applicants for the 2017 to 2018
ophthalmology residency match cycle were obtained from the
publicly accessible Association of University Professors of
Ophthalmology (AUPO) and San Francisco (SF) Match Sum-
mary Report.5The mean number of applications and inter-
views for matched and unmatched applicants were also
obtained using the same dataset. Application fees for the SF
Match Residency Matching Services were used to determine
the mean application cost for matched and unmatched appli-
cants.16 Existing literature was used to estimate the applicant
cost per interview3,615; the mean of these reports was used.
Program costs were calculated from interview costs for
each of four half-day interview sessions at the University of
Kentucky during the 2017 to 2018 ophthalmology residency
match cycle. A total of 48 applicants were interviewed for
four positions. Clinical productivity was based on the scal
year 2017 to 2018 mean half-day collections and xed
overhead for the 12 faculties that participated in each of
the interviews. Fixed costs were based upon the same faculty
and scal year and included the sum of the Deans overhead
cost, faculty and personnel salaries and fringes covered by
the department, and other xed expenses.
All costs were in 2017 U.S. dollars and converted when
necessary using the consumer price index data for urban
consumers.
Results
There were a total of 735 registrants, 689 participants, and
625 rank lists submitted for 475 available positions in the
2017 to 2018 ophthalmology residency match. The mean
number of applications was 73 for the 475 applicants that
matched and 69 for the 150 that went unmatched. The
application cost for the mean applicant was US$1,665 and
US$1,525 for matched and unmatched applicants, respec-
tively, for a total estimated application fee of US$1,082,125
for the 625 applicants that submitted rank lists (Table 1).
Eleven surveys were conducted between 2006 and 2016,
providing estimates of applicant cost per residency inter-
view, with a mean of US$404 (range: US$306US$522)
(Table 2). The mean number of interview invites was 12
and 4 for matched and unmatched ophthalmology applicants
during the 2017 to 2018 match, respectively. Presuming
applicants attended all invited interviews, the mean cost
for interviews was US$4,848 and US$1,616, and the total cost
of applications and interviews was US$6,613 and US$3,241,
respectively. Based on these mean data, the total match cost
for all 625 applicants was US$4,646,950 (Table 2).
Program costs are presented in Table 3. The estimated
cost for each of the four interview dates was US$44,832, with
a total cost of US$179,327 for the match cycle, and an average
of US$3,736 spent on each of 48 applicants interviewed.
Discussion
The medical residency match is based upon a market algo-
rithm designed by Alvin Roth, leading to a Nobel Prize in
Economics in 2012 shared jointly with Lloyd Shapley for the
theory of stable allocations and the practice of market
design.17 Despite the accolade, the medical matching pro-
cess is the only professional training organization currently
using this system.18 Because of the competitive nature of the
match, applicants are applying to an increasing number of
programs. The costs associated with this process have the
propensity to be detrimental to the most nan cially strained,
with one pointed comment in an applicant survey stating:
This is the glass ceiling. It is set up to make economic
minorities fail.4Furthermore, applicants from rural pro-
grams may have to travel longer distances and incur even
greater costs.10 A survey of 2006 Urology resident applicants
found that those attending no rtheastern medical schools had
signicantly lower interview costs than other regions of the
country.6This, in part, may be why ophthalmology appli-
cants are signicantly more likely to match in the same
geographic region as their medical school.19 These ndings
raise concerns about not only the match process for the
applicants but also the programs that seek to select the most
desirable candidates from a diverse geographic pool.
This study and calculations provide further validation of
the costs. The mean matched ophthalmology applicant spent
an estimated US$6,613 on the match, whereas the mean
unmatched applicant spent roughly half that amount.
Although it may initially be reassuring that unmatched
applicants spent less, one reason that applicants are willing
to spend, increasingly, so much on the match is the tremen-
dous opportunity cost of going unmatched. The estimated
total cost of US$4,646,950 for all applicants that submitted
rank lists are similar to prior studies of US$3,228,556 for
urology,10 US$3,358,584 for otolaryngology,20 US$3,557,410
for neurosurgery,9and US$20,177,666 for emergency
Table 1 Estimated 2017 to 2018 match costs for ophthalmology
residency applicants
Mean
matched
applicant,
N¼475
Mean
unmatched
applicant,
N¼150
Total c ost
for all
applicants,
N¼625
Number of
applications
submitted
73 69
Tot a l
application
fees
US$1,765 US$1,625 US$1,082,125
Number of
interviews
12 4
Cost for
interviews
US$4,848 US$1,616 US$3,564,825
Tot a l
match
costs
US$6,613 US$3,241 US$4,646,950
Journal of Academic Ophthalmology Vol. 10 No. 1/2018
Cost Estimation of the Match Process for Ophthalmology Applicants Moore e159
medicine3applicants per match cycle. Similarly, we found
that resident interviews produced a substantial cost to our
department: US$179,327 in total or US$3,736 per applicant
interviewed. A comparable estimation of program costs for
resident interviews of a single plastic surgery residency that
interviewed 53 applicants found the total cost was US
$151,277 and the cost per applicant was US$2,854.21 A
survey of 82 emergency medicine program directors esti-
mated that the cost was US$214,845 per program per year
and US$47,910,292 for all emergency medicine programs in
an interview season.3
What changes could be made to potentially improve this
process? Video conference interviews for ophthalmology
resident applications have been trialed at the University of
Arizona,22 although there are some potential trade-offs with
this approach.23 Particularly in large urban areas, programs
can coordinate the scheduling of interview dates, as was
done in Chicago for emergency medicine applicants with
signicant cost savings and a favorable applicant review.24
Specialty societies and other national organizations could
negotiate special interview rates with national airlines and
hotel chains, and grassroots efforts by medical schools and
residency programs may provide more affordable housing
and travel options for applicants.3A recent publication
regarding the surgical fellowship match suggested using a
variation on the deferred acceptance matching algorithm
currently used to have an interview matchthat precedes
the standard fellowship match. After applications have been
submitted and reviewed, both applicants and programs
would create rank lists to ll a more limited number of
interview spots. Therefore, both parties theoretically inter-
view preferentially with fewer required interviews.25
Another option that would benet both applicants and
programs is to limit the number of applications an individual
can submit. Applying the game theory model of prisoners
dilemma to the urology match, Weissbart et al26 determined
that not only is allowing unlimited applications inefcient,
but it is also nancially burdensome for both applicants and
programs. In their estimation, applicants could collectively
save up to US$613,000 and program directors individually
1,639 minutes per match cycle with an application limit of
30. Using similar logic, an application limit could be set for
the ophthalmology residency match. Based on match data
from the past 2 years, the number of interview invites does
not increase signicantly for applicants beyond 40 applica-
tions,5,27 and such a cap would result in an estimated savings
of US$825,875 for the 625 applicants that submitted rank
lists this past match cycle. Using the previous estimate of
5 minutes spent reviewing each application,26 the mean of
Table 2 Mean estimated applicant cost per resident interview in the current literature
Study population Response
rate (%)
Mean cost
a
(in U.S. dollars)
All 468 urology applicants in 2006661 401
b
All 367 plastic surgery residency applicants in 2006738 522
All 194 applicants to a single plastic surgery residency program in 2012865 463
All 202 rst year neurosurgery residents in 2015 (2014 match cycle)964 485
An estimated 525 applicants to 18 urology residency programs in 201410 33 517
1,091 applicants to 4 orthopaedic residency programs in 201511 37 335
All 1,425 applicants to emergency medicine that were members
of the emergency medicine resident association in 2016313 344
All 81 residency applicants to a single emergency medicine program in 201612 81 331
All 195 applicants from the University of Kansas School of Medicine in 201613 84 306
All 61 applicants from the University of South Dakota School of Medicine in 201614 68 404
All 370 otolaryngology residency applicants in 201615 49 340
b
Overall mean cost 404
a
Adjusted for ination and presented in 2017 U.S. dollars.
b
Median cost reported.
Table 3 Total estimated University of Kentucky Ophthalmology
program costs for 2017 to 2018 residency interviews
Category
a
Cost
(in U.S. dollars)
Meals
b
4,655
Supplies 528
Losses in faculty clinical productivity
c
89,952
Losses in clinic xed costs
d
84,192
Total program costs per interview 44,832
Total program costs per match cycle 179,327
Cost per applicant Interviewed 3,736
a
Interviews were conducted over four separate half-day weekday ses-
sions. A total of 12 faculties participated in each interview session and
48 applicants were interviewed.
b
Include applicant reception with
current residents, breakfast and lunch on the interview day, and a rank
list dinner for faculty following the nal interview.
c
Mean individual
faculty collections per half-day session multiplied by 12 faculties and 4
interview dates.
d
Mean faculty xed costs per half-day session multi-
plied by 12 faculties and 4 interview dates. Fixed costs include the sum
of the Deans overhead, faculty and personnel salaries and fringes
covered by the practice, and other xed expenses.
Journal of Academic Ophthalmology Vol. 10 No. 1/2018
Cost Estimation of the Match Process for Ophthalmology Applicants Mooree160
114 program directors par ticipating in the match would have
reviewed 176 fewer applications and saved 878 minutes or
14.6 hours of time with this limit. However, these potential
savings for applicants would have to come at the expense of
the sponsoring organization and beneciaries. As an exam-
ple, using the Electronic Residency Application Services
(ERAS) fee formula, 2015 fees for all student ERAS applica-
tions was US$72 million, representing approximately 40% of
the Association of American Medical Colleges operating
revenue for that year.3Using the tiered distribution fee
schedule from SF Match,16 an application limit of 40 would
cost each applicant US$410, for a total of US$256,250 for all
625 applicants in 2017 to 2018. With an estimated US
$1,082,125 in application fees, this limit would reduce
revenue by approximately 80%. It should be emphasized
this is an estimate based on mean application data, and
while exact nancial analysis is not possible, the loss to SF
Match and other beneciaries would be substantial if com-
pensatory changes were not made in the fee structure.
A restriction to the number of applications per applicant
poses several reasonable potential objections. For instance,
applicants may potentially be applying to an increasing
number of programs not to improve the probability of
matching but due to interest in a larger and broader range
of programs. Other concerns include the possibility that
applying to an unlimited number of programs improves
applicantshappiness and sense of control or that an appli-
cation limit would decrease competition. Weissbart et al26
presents a thorough analysis and refutation of these and
other objections. Regardless of where an application limit is
set, applicants would need sufcient information to make
educated decisions on where to selectively apply. Accord-
ingly, programs would need to provide information about
screening criteria and additional standards when reviewing
applications to allow applicants the opportunity to strate-
gically apply to a restricted number of programs.
There are several important limitations to this study. The
match dataset presents mean statistics; therefore, precise
measurements are not possible. The surveys used to esti-
mate interview costs have multiple inherent biases and are
not specic to ophthalmology. While we plan to obtain this
informationinthefuture,itisunlikelytoaltertheunder-
lying conclusion of this and other similar studies: the
interview process is expensive. In fact, this analysis likely
underestimates to true cost of matching for two reasons.
First, the cost of away rotations is not included. There is one
limited survey including ophthalmology that found appli-
cants completed a mean of 1.9 away rotations at a cost of US
$990 per rotation.28 Another study estimated a mean cost of
US$1,100 for emergency medicine applicants.12 Second,
these gures do not account for the separate cost to apply
and interview for preliminary year positions. There are no
existing data to estimate these costs, although the inde-
pendent matching process may soon be changing.29 This
analysis presumed that applicants attended all invited
interviews. While this is not likely the case, the mean of
12 interview invites is similar to the overall average of 10.91
ranked programs for all 27,424 successfully matched appli-
cants in the 2018 National Resident Matching Program.30
Lastly, the program costs are specic to our institution and
the interview year. The number of interview dates offered,
faculty involvement, and weekday versus weekend dates,
among other factors, vary widely. Collectively, these data
compel a broader examination of the costs associated with
the match process.
The AUPO and SF Match should be commended for
providing match statistics to the public for evaluation; these
data continue to be benecial for applicants and programs
alike. The trends in recent years, however, coupled with cost
analyses demonstrate the need for change. It is time to
reconsider the ophthalmology residency application and
interview process, primarily to aid not only our applicants
and future colleagues but also the programs themselves.
Conict of Interest
None.
References
1Barzansky B, Etzel SI. Medical schools in the United States, 2016-
2017. JAMA 2017;318(23):23602367
2Association of American Medical Colleges. Medical Student Edu-
cation: Debt, Costs, and Loan Repayment Fact Card. http://mem-
bers.aamc.org/iweb/upload/2017%20Debt%20Fact%20Card.pdf.
Accessed August 2018
3Van Dermark JT, Wald DA, Corker JR, Reid DG. Financial implica-
tions of the emergency medicine interview process. AEM Educ
Train 2017;1(01):6069
4Association of American Medical Colleges. Cost of Applying to
Residency Questionnaire Report. 2015. https://www.aamc.org/
download/430902/data/costofapplyingtoresidency.pdf. Accessed
August 2018
5Association of University Professors of Ophthalmology. SFMatch.
Ophthalmology Residency Match Summary Report 2018. https://
www.sfmatch.org/PDFFilesDisplay/Ophthalmology_Residency_-
Stats_2018.pdf. Accessed August 2018
6Kerfoot BP, Asher KP, McCullough DL. Financial and educational
costs of the residency interview process for urology applicants.
Urology 2008;71(06):990994
7Rogers CR, Gutowski KA, Munoz-Del Rio A, et al. In tegrated plastic
surgery residency applicant survey: characteristics of successful
applicants and feedback about the interview process. Plast
Reconstr Surg 2009;123(05):16071617
8Claiborne JR, Crantford JC, Swett KR, David LR. The plastic surgery
match: predicting success and improving the process. Ann Plast
Surg 2013;70(06):698703
9Agarwal N, Choi PA, Okonkwo DO, Barrow DL, Friedlander RM.
Financial burden associated with the residency match in neuro-
logical surgery. J Neurosurg 2017;126(01):184190
10 Nikonow TN, Lyon TD, Jackman SV, Averch TD. Survey of applicant
experience and cost in the urology match: opportunities for
reform. J Urol 2015;194(04):10631067
11 Camp CL, Sousa PL, Hanssen AD, et al. The cost of getting into
orthopedic residency: analysis of applicant demographics,
expenditures, and the value of away rotations. J Surg Ed 2016;
73(05):886891
12 Blackshaw AM, Watson SC, Bush JS. The cost and burden of the
residency match in emergency medicine. West J Emerg Med
2017;18(01):169173
13 Walling A, Nilsen K, Callaway P, et al. Student expenses in
residency interviewing. Kans J Med 2017;10(03):115
Journal of Academic Ophthalmology Vol. 10 No. 1/2018
Cost Estimation of the Match Process for Ophthalmology Applicants Moore e161
14 Chang PS, Rezkalla J, Beard M. An analysis of the nancial
burden associated with the residency match at the University
of South Dakota Sanford School of Medicine. S D Med 2018;71
(02):6669
15 Cabrera-Mufy C, Chang CWD, Puscas L. Current interview trail
metrics in the otolar yngology match. Otolaryngol Head Neck Sur g
2017;156(06):10971103
16 SF Match Residency and Fellowship Matching Services. Central
Application Services Application and Distribution Fees. https://
sfmatch.org/SpecialtyInsideAll.aspx?id=6&typ=2&name=Ophthal-
mology#. Accessed August 2018
17 The Nobel Prize Organization. The Sveriges Riksbank Prize in
Economic Sciences in Memory of Alfred Nobel 2012. https://www.
nobelprize.org/prizes/economics/2012/summary. Accessed August
2018
18 Black CC. Examination of the residency interview process for aca-
demic pathology departments:how to make the most of a resource-
heavy process. Acad Pathol 2016;3(03):2374289515623551
19 Loh AR, Joseph D, Keenan JD, Lietman TM, Naseri A. Predictors of
matching in an ophthalmology residency program. Ophthalmol-
ogy 2013;120(04):865870
20 Polacco MA, Lally J, Walls A, Harrold LR, Malekzadeh S, Chen EY.
Digging into debt: the nancial burden associated with the
otolaryngology match. Otolar yngol Head Neck Surg 2017;156
(06):10911096
21 Susarla SM, Swanson EW, Slezak S, Lifchez SD, Redett RJ. The
perception and costs of the interview process for plastic surgery
residency programs: can the process be streamlined? Plast
Reconstr Surg 2017;139(01):302e309e
22 Pasadhika S, Altenbernd T, Ober RR, Harvey EM, Miller JM.
Residency interview video conferencing. Ophthalmology 2012;
119(02):426426.e5
23 Shah SK, Arora S, Skipper B, Kalishman S, Timm TC, Smith AY.
Randomized evaluation of a web based interview process for
urology resident selection. J Urol 2012;187(04):13801384
24 Shappell E, Fant A, Schnapp B, et al. A novel collaboration to
reduce the travel-related cost of residency interviewing. West J
Emerg Med 2017;18(03):539543
25 Melcher ML, Ashlagi I, Wapnir I. Matching for fellowship inter-
views. JAMA 2018;320(16):16391640
26 Weissbart SJ, Hall SJ, Fultz BR, Stock JA. The urology match as a
prisoners dilemma: a game theor y perspective. Urology 2013;82
(04):791797
27 Association of University Professors of Ophthalmology. SFMatch.
Ophthalmology Residency Match Summary Report 2017. https://
www.sfmatch.org/PDFFilesDisplay/Ophthalmology_Residency_-
Stats_2017.pdf. Accessed August 2018
28 Winterton M, Ahn J, Bernstein J. The prevalence and cost of medical
student visiting rotations. BMC Med Educ 2016;16(01):291
29 ACGME Program Requirements for Graduate Medical Education in
Ophthalmology. https://www.acgme.org/Portals/0/PFAssets/Revie-
wandComment/240_Ophthalmology_2018-08-06_R&C.pdf.
Accessed August 2018
30 National Resident Matching Program. Impact on Length of Rank
Order List on Match Results: 20022018 Main Residency Match.
http://www.nrmp.org/wp-content/uploads/2018/03/Impact-of-
Length-of-Rank-Order-List-on-Match-Results-2018-Main-Match.
pdf. Accessed August 2018
Journal of Academic Ophthalmology Vol. 10 No. 1/2018
Cost Estimation of the Match Process for Ophthalmology Applicants Mooree162
... Since 2011, the number of applications submitted per applicant has risen from 52 in 2011 to 80 in 2021. 1 Increased applications have led to greater financial and logistical burden for applicants and administrative burden for residency programs. 2 Furthermore, the steady rise in applications submitted per applicant has not yielded improved match outcomes, with the percentage of applicants matching at one of their top three ranked residency programs slightly declining in each of the past 3 years. 1 There have been several studies that have examined the various factors that contribute to a successful match into an ophthalmology residency program. ...
... The FREIDA database provided a list of 123 ophthalmology residency programs. 9 Of these, 110 were included in this study based on inclusion criteria (1) availability of a roster of ophthalmology residents from the graduating classes of 2021, 2022, and 2023 (obtained from the program Web site or email inquiry to the residency program) and (2) available data on residents' medical school attended and medical degree earned. If a listing of medical schools attended was unavailable or incomplete on a residency program Web site, Google searches and social media accounts (Doximity, Twitter, and Instagram) were used to identify a given resident's medical school attended. ...
... This broad-based approach to the application cycle is extremely costly to applicants, with a recent analysis indicating that the average cost of the application cycle for an ophthalmology applicant is approximately $7,000. 2 The increased volume of applications also makes it difficult for ophthalmology residency programs to decide which candidates to extend an interview invitation. Once programs sift through candidate applications, hosting interviews is also expensive for residency programs, with one program estimating costs for the 2017 to 2018 residency application cycle to be nearly $180,000 when accounting for meals, supplies, losses in faculty clinical productivity, and losses in clinic fixed costs. 2 As such, there is a need for information that will allow both ophthalmology applicants and residency programs to become more efficient and to better allocate resources during the match process. ...
Article
Full-text available
Introduction The ophthalmology residency match remains competitive. Several prior studies have examined various factors that contribute to a successful match into an ophthalmology residency program; however, the role of geographic location in the ophthalmology residency match process is unclear. The purpose of our study was to evaluate geographic trends in the ophthalmology residency match and to determine whether geographic trends vary based on program level factors such as program rank or funding source and/or applicant factors such as year of training, gender, and medical degree earned. Specifically, we assessed associations with residents training at the residency program affiliated with their medical school and/or within the same geographic region as their medical school, using data obtained through publicly available sources and residency program surveys. Methods We used the American Medical Association's Fellowship and Residency Electronic Interactive Database database to identify accredited ophthalmology residency programs. Residency program Web sites and email inquiries were used to collect demographic and geographic information for residents in the graduating classes of 2021 to 2023. Statistical analysis included χ2 testing and multivariate logistic regression. Results In total, 1,378 residents were included from 110 ophthalmology residency programs and 218 medical schools. Residents who matched at the residency program affiliated with their medical school (18%) were evenly distributed among the Midwest, Northeast, South, and West regions (p = 0.2236). Residency programs in the West (31.7%) matched fewer regional medical students compared with programs in the South (61.2%), Midwest (57.4%), and Northeast (58.4%) (p
... Of course, application fees represent just a fraction of the total costs applicants incur. Attending in-person interviews can exceed $10,000 for competitive specialties [17][18][19][20]. As applicants have applied to more programs, they have also attended more interviews: the median number of interviews completed by a successful applicant has increased from 10 to 13 over the past decade [21,22]. ...
... As applicants have applied to more programs, they have also attended more interviews: the median number of interviews completed by a successful applicant has increased from 10 to 13 over the past decade [21,22]. These interviews are expensive: one program estimated the cost of lost faculty clinical productivity at $3,736 per interviewee [19]. Many programs may not have the capacity to interview more applicants. ...
Article
Over the past decade, the number of residency applications submitted per applicant has nearly doubled. This epidemic of "Application Fever" is expensive for applicants, burdensome for programs, and ultimately does not improve overall Match outcomes. In this review, we discuss the phenomenon of Application Fever, with a focus on contributing factors and costs of this behavior. Application Fever has its origins in the early 1990s. At that time, the number of residency applicants began to outpace the number of available positions. Because an applicant who applies to more residency programs has a greater probability of securing a residency position than an otherwise equivalent applicant who applies to fewer, "overapplication" became a dominant strategy and residency applicants began to apply to more residency programs each year. This trend was enhanced and enabled by the introduction of the Electronic Residency Application Service (ERAS). Although Application Fever is a rational decision for applicants, it imposes a substantial evaluative burden on program directors and necessitates the use of convenience screening metrics. We then briefly review potential solutions, including informational strategies, application limits, and marketplace incentives to reduce application numbers. Although a fixed cap on applications would reduce application numbers and facilitate a holistic selection process, greater transparency from residency programs regarding their selection criteria would be required to help applicants choose where to apply. To improve the residency application process for programs and applicants alike, we call upon the medical community to further study Application Fever and carefully consider solutions, including fixed application caps.
... Every year, applicants inevitably pay more in application fees, and PDs and their admissions committees must devote more time and resources to screening applications (12,13). A recent study estimated that lost faculty productivity leads to $3736 of lost revenue per interviewee (14). ...
... Part of this debt arises from the cost of attendance, but multiple hidden expenses associated with medical training, including residency application fees and expenses incurred on the interview trail, also add to this number. For applicants across all specialties, the cost of applying to programs through the Electronic Residency Application Service (ERAS) does not include other significant costs such as travel or lodging (23)(24)(25)(26). ...
Article
Full-text available
Rationale and Objectives The recent completion of the inaugural virtual interview season has triggered calls for the permanency of virtual interviews in the radiology resident selection process. We designed a study to assess the inaugural 2020-2021 virtual interview season and inform the anticipated debate on the future of radiology residency interviews. Materials and Methods Forty-four and 39-question survey instruments developed for program directors (PDs) and applicants, respectively, were distributed through the Radiology Residency Education Research Alliance to measure the demographics, experiences with technology, attitudes toward the virtual interview season and attitudes about proposed changes to the interview process. Comparisons were made between demographics and survey queries. Results PD and applicant response rates were 74% (25/34) and 45% (84/186), respectively. Eighty percent (20/25) of PDs and 76% (64/84) of applicants described the virtual interview season as excellent or very good. Sixty percent of PDs agreed or strongly agreed with the statement “The benefits of the virtual interview season outweighed the drawbacks,” while 24% disagreed or strongly disagreed, and 16% were neutral. Among applicants, 80% agreed or strongly agreed, 10% disagreed or strongly disagreed, and 10% were neutral toward the same statement. Ninety-two percent of PDs noted that their rank order list performed the same or better than in years prior. Both PDs and applicants identified applicant equity and wellness as major benefits of virtual interviews, while identifying over-application and interview hoarding as significant detriments. Conclusion The virtual interview provides an adequate substitute for the conventional in-person residency interview, with real and perceived benefits to applicant wellness, equity, and financial well-being. The downsides of virtual interviews, namely over-application and interview hoarding, have workable solutions.
... Residency applicants today submit many more applications than those in the past [1][2][3]. This is expensive for applicants, burdensome for residency program directors, and does not improve overall Match rates [1,[4][5][6][7][8]. However, for applicants to sensibly apply to fewer programs, they must have access to high-quality information to help them select programs at which their application will be competitive. ...
Article
Background Today's residency applicants submit more applications than those in the past. To facilitate holistic review, many program directors have encouraged applicants to submit fewer applications. However, whether programs provide sufficient information to help applicants determine where to apply is unclear. Objective To evaluate the frequency of missing information on residency program websites and in the Fellowship and Residency Electronic Interactive Database (FREIDA). Methods We used FREIDA to identify all categorical pediatric residency programs in the United States. We noted the presence of information programs reported in each FREIDA data field. We compared information available on the program website for consistency with the information in FREIDA and additionally searched for current resident information and any description of the qualities of applicants/residents desired on the program website. Results Two hundred and eleven pediatric residency programs were included in FREIDA. Approximately 25% of programs did not include basic information such as number of first year residents, salary, work hours, or consideration of applicants requiring work visas. Over half of programs did not report minimum licensing examination scores required for interview consideration. Discrepancies between information on program websites and FREIDA related to work visas occurred in 6-8% of programs. While 88% of program websites included information on current residents, only 17% included any description of the applicant attributes sought by the program. Conclusions Many pediatric residency programs do not provide much of the information that applicants need to help determine if a program is a good fit or whether their application is competitive.
Article
Introduction Residency programs have historically used numerical Step 1 scores to screen applicants, making it a career-defining, high-stakes examination. Step 1 scores will be reported as pass/fail starting in January 2022, fundamentally reshaping the residency application review process. This review aimed to identify opinions of physicians and medical students about the new format, identify arguments in support of or against the change, and determine the implications of this change on the residency selection process. Methods A comprehensive PubMed review was performed in May 2021 to identify articles that discussed the new Step 1 format. Non-English and duplicate articles were excluded. Data collected from each article included publication year, specialty, subjects, and key findings. Results A total of 81 articles were included, 26 of which discussed the impact of the new format within surgical fields (32.1%). Remaining articles discussed the implications within the medical community as a whole (n = 33, 40.7%) and nonsurgical fields (n = 22, 27.2%). Studies suggest Program Directors will rely on Step 2 Clinical Knowledge (CK) scores, medical school reputation, applicant familiarity, Dean's letters, recommendation letters, and research in lieu of numerical Step 1 scores. In addition, concerns have been raised that the new format will disadvantage international, osteopathic, and minority applicants while increasing stress surrounding Step 2 CK. Conclusions Within the medical community, there are concerns that Step 2 CK will be used to substitute Step 1 and that resident diversity will diminish due to the new Step 1 format. Holistic candidate consideration will be increasingly important.
Article
Objective This study aimed to investigate emerging trends and increasing costs in the National Residency Matching Program (NRMP) and San Francisco Residency and Fellowship Match Services (SF Match) associated with the current applicant/program Gale–Shapley-type matching algorithms. Design A longitudinal observational study of behavioral trends in national residency matching systems with modeling of match results with alternative parameters. Patients and Methods We analyzed publicly available data from the SF Match and NRMP websites from 1985 to 2020 for trends in the total number of applicants and available positions, as well the average number of applications and interviews per applicant for multiple specialties. To understand these trends and the algorithms' effect on the residency programs and applicants, we analyzed anonymized rank list and match data for ophthalmology from the SF Match between 2011 and 2019. Match results using current match parameters, as well as under conditions in which applicant and/or program rank lists were truncated with finalized rank lists, were analyzed. Results Both the number of applications and length of programs' rank lists have increased steadily throughout residency programs, particularly those with competitive specialties. Capping student rank lists at seven programs, or less than 80% of the average 8.9 programs currently ranked, results in a 0.71% decrease in the total number of positions filled. Similarly, capping program rank lists at seven applicants per spot, or less than 60% of the average 11.5 applicants ranked per spot, results in a 5% decrease in the total number of positions filled. Conclusion While the number of ophthalmology positions in the United States has increased only modestly, the number of applications under consideration has increased substantially over the past two decades. The current study suggests that both programs and applicants rank more choices than are required for a nearly complete and stable match, creating excess cost and work for both applicants and programs. “Stable-marriage” type algorithms induce applicants and programs to rank as many counterparties as possible to maximize individual chances of optimizing the match.
Article
Background In the setting of the COVID-19 pandemic, residency programs implemented videoconferencing “virtual” interviews for the 2020 to 2021 match cycle. There is limited published information on virtual ophthalmology residency interviews. Objective The study aimed (1) to assess applicant, selection committee member, and resident opinions of technical quality, communication quality, and ability to assess applicant or program “fit” during virtual interviews; (2) to determine which interview format—in-person or virtual—each party would prefer in the future; and (3) to survey which residency resources applicants found helpful. Design Surveys were sent to applicants, selection committee members, and residents to assess the above objectives for the 2020 to 2021 match cycle virtual interviews at the Moran Eye Center, University of Utah. Setting This study was conducted in a single residency program interview season from 2020 to 2021. Participants Forty applicants, eight committee members, and seven residents who participated in the virtual interview process were surveyed. Intervention or Exposure Prior to interviews, various avenues were implemented to connect with applicants. A videoconferencing software was utilized for interviews. Applicants and selection committee members met in one-on-one or small group interviews. Residents communicated with applicants in a large group setting between interviews. Main Outcome and Measure The study aims to survey the participants as stated in the objectives. There was no planned outcome for this quality improvement study. Results Survey response rate was 98.2% (54/55). All parties rated the technical components as good or very good. Applicants and selection committee members rated communication as overall good or very good, although residents thought communication was very poor. A total of 92.3% applicants, 75% selection committee members, and 0% residents were reported that they were able to appropriately assess fit of the program with the applicant. However, 46.3% respondents preferred in-person interviews in the future. Popular applicant resources were resident-produced videos (82.1%), conversations with residents (46.2%), and a gift bag (43.6%). Conclusion and Relevance Overall, the technical components of the interview were successful. Small, structured group interactions led to better communication and assessment of fit. There were variable opinions regarding future interview format preference between in-person, virtual, or choice. Amid the COVID-19 pandemic, connecting with applicants via various means can optimize the match process.
Article
Background The coronavirus disease 2019 pandemic has significantly impacted medical education, notably the mandate for all residency programs to implement virtual (rather than in-person) residency interviews. Understanding residency applicants' perceptions and approach to this novel virtual interview season will be beneficial as potential future interview formats are considered. Objective The aim of this study was to examine perceptions of the 2020 to 2021 ophthalmology residency match applicants regarding the virtual interview season prior to the start of the interview season. Patients and Methods Ophthalmology residency applicants during the 2020 to 2021 cycle were invited to complete the survey between October 20 and 29, 2020. Respondent demographic information, perceived importance of various application details in a normal versus virtual interview season, strengths and limitations of virtual interviews, and preferences for optimal virtual interview format were obtained. Results There were 337 survey respondents, with at least 50% of the survey completed by 190 applicants (56%). Of these, 73% of respondents applied to more than 60 ophthalmology residency programs, and 78% felt that the evaluation of candidates would be impacted by the virtual interview format. Regardless of interview format, United States Medical Licensing Examination Step 1 score and letters of recommendation were perceived to be the two most important factors related to matching at an applicant's top ranked programs. The primary limitation of a virtual interview season was the inability to experience a program's culture in person, while largest strength was cost savings. Conclusion The ophthalmology residency match is a competitive process made potentially more complex by a novel virtual interview format. A detailed postcycle analysis will be important to optimize future interview seasons.
Article
Full-text available
Purpose Given ophthalmology residency programs are transitioning to include the internship year, either through “joint” or “integrated” 4-year programs, we set out to identify applicant preferences regarding the match and their experiences with two residency application systems: (1) the Central Application Service (CAS) and (2) the Electronic Residency Application Service (ERAS). Design This study is designed as a retrospective repeated cross-sectional survey. Methods A 15-question online survey was sent to 196 and 461 applicants to the 2019 and 2020 ophthalmology match cycles, respectively. Questions from the survey assessed user experiences with specific components of both application services and evaluated preferences regarding the future of the ophthalmology match. Results Responses were received from 208 (32%) applicants. A majority of users had positive experiences with both application services; for CAS, 162 (78%) applicants had a positive experience, compared with 111 (53%) for ERAS. When compared directly, applicants favored the CAS (60%) to ERAS (21%). Furthermore, 108 (52%) respondents stated that they would prefer ophthalmology continue to use both the CAS and ERAS, while 47 (23%) respondents indicated a desire for the CAS to become the only application system for both matches. Conclusion Although half of all respondents prefer that both the CAS and ERAS systems are utilized for the match process, many express a desire for a single matching program. As ophthalmology residency programs move to joint and integrated 4-year programs, the complexity of matching will increase. Further evaluation of applicant preferences during this transition phase is needed as applicants are required to apply to a variety of different joint and integrated internship and ophthalmology programs.
Article
Full-text available
Background The student costs of residency interviewing are of increasing concern but limited current information is available. Updated, more detailed information would assist students and residency programs in decisions about residency selection. The study objective was to measure the expenses and time spent in residency interviewing by the 2016 graduating class of the University of Kansas School of Medicine and assess the impact of gender, regional campus location, and primary care application. Methods All 195 students who participated in the 2016 National Residency Matching Program (NRMP) received a 33 item questionnaire addressing interviewing activity, expenses incurred, time invested and related factors. Main measures were self-reported estimates of expenses and time spent interviewing. Descriptive analyses were applied to participant characteristics and responses. Multivariate analysis of variance (MANOVA) and chi-square tests compared students by gender, campus (main/regional), and primary care/other specialties. Analyses of variance (ANOVA) on the dependent variables provided follow-up tests on significant MANOVA results. Results A total of 163 students (84%) completed the survey. The average student reported 38 (1–124) applications, 16 (1–54) invitations, 11 (1–28) completed interviews, and spent $3,500 ($20–$12,000) and 26 (1–90) days interviewing. No significant differences were found by gender. After MANOVA and ANOVA analyses, non-primary care applicants reported significantly more applications, interviews, and expenditures, but less program financial support. Regional campus students reported significantly fewer invitations, interviews, and days interviewing, but equivalent costs when controlled for primary care application. Cost was a limiting factor in accepting interviews for 63% and time for 53% of study respondents. Conclusions Students reported investing significant time and money in interviewing. After controlling for other variables, primary care was associated with significantly lowered expenses. Regional campus location was associated with fewer interviews and less time interviewing. Gender had no significant impact on any aspect studied.
Article
Full-text available
Introduction Interviewing for residency is a complicated and often expensive endeavor. Literature has estimated interview costs of $4,000 to $15,000 per applicant, mostly attributable to travel and lodging. The authors sought to reduce these costs and improve the applicant interview experience by coordinating interview dates between two residency programs in Chicago, Illinois. Methods Two emergency medicine residency programs scheduled contiguous interview dates for the 2015–2016 interview season. We used a survey to assess applicant experiences interviewing in Chicago and attitudes regarding coordinated scheduling. Data on utilization of coordinated dates were obtained from interview scheduling software. The target group for this intervention consisted of applicants from medical schools outside Illinois who completed interviews at both programs. Results Of the 158 applicants invited to both programs, 84 (53%) responded to the survey. Scheduling data were available for all applicants. The total estimated cost savings for target applicants coordinating interview dates was $13,950. The majority of target applicants reported that this intervention increased the ease of scheduling (84%), made them less likely to cancel the interview (82%), and saved them money (71%). Conclusion Coordinated scheduling of interview dates was associated with significant estimated cost savings and was reviewed favorably by applicants across all measures of experience. Expanding use of this practice geographically and across specialties may further reduce the cost of interviewing for applicants.
Article
Full-text available
Introduction To obtain a residency match, medical students entering emergency medicine (EM) must complete away rotations, submit a number of lengthy applications, and travel to multiple programs to interview. The expenses incurred acquiring this residency position are burdensome, but there is little specialty-specific data estimating it. We sought to quantify the actual cost spent by medical students applying to EM residency programs by surveying students as they attended a residency interview. Methods Researchers created a 16-item survey, which asked about the time and monetary costs associated with the entire EM residency application process. Applicants chosen to interview for an EM residency position at our institution were invited to complete the survey during their interview day. Results In total, 66 out of a possible 81 residency applicants (an 81% response rate) completed our survey. The “average applicant” who interviewed at our residency program for the 2015–16 cycle completed 1.6 away, or “audition,” rotations, each costing an average of $1,065 to complete. This “average applicant” applied to 42.8 programs, and then attended 13.7 interviews. The cost of interviewing at our program averaged $342 and in total, an average of $8,312 would be spent in the pursuit of an EM residency. Conclusion Due to multiple factors, the costs of securing an EM residency spot can be expensive. By understanding the components that are driving this trend, we hope that the academic EM community can explore avenues to help curtail these costs.
Article
Full-text available
Background Performance on visiting rotations during the senior year of medical school is consistently cited by residency program directors as a critical factor in selecting residents. Nevertheless, the frequency with which visiting rotations are undertaken and the associated financial costs they impose have not been systematically examined. Method Under the auspices of the Electronic Residency Application Service, a survey was sent in March 2015 to all U.S. applicants for residency programs in the 2014-15 academic year. Students were asked how many visiting rotations they performed; the estimated cost of performing each rotation; their perception of their educational value and primary motivation for performing them; and the Match outcome of their residency application. ResultsThe survey was completed by 2817 applicants, yielding a response rate of 11.3 %. 1898 applicants (67.4 %) performed visiting rotations: 647 applicants (30.0 %) performed one; 640 (22.7 %) performed two; 322 (11.4 %) performed three; and 289 (10.3 %) reported four or more. When accounting for potential response bias, the true prevalence of away rotators was estimated to be 58.7 % of all fourth-year medical students (95 % CI 54.0–63.4 %). The mean number of rotations for participating students was 2.1. Most students performed rotations equally as an audition for residency placement and for education, with some of the more competitive subspecialties reporting more of an audition experience. The mean estimated cost for performing a single rotation was $958. Thirty-six percent of applicants reported matching at an institution where they had rotated, either their home institution or one at which a visiting rotation was performed. Conclusions Visiting rotations are prevalent, expensive, and only partly educational. As such, these rotations may impede optimal use of the senior year of medical school and limited student financial resources.
Article
Surgical fellowships have proliferated over the last 2 decades. Recent data suggest that the application process has become inefficient and costly, especially for candidates and programs in competitive surgical specialties.¹ Although the Accreditation Council for Graduate Medical Education (ACGME) accredits many programs, other organizations, such as the Foundation for Surgical Fellowships, the Society of Surgical Oncology, and the American Society of Transplantation, certify non-ACGME fellowships. Of 3354 graduating general surgery residents from 2009 to 2013 who responded to a survey by the American Board of Surgery, 74% (n = 2478) sought surgical specialty training.² Candidates for surgical fellowships are matched to programs following the “deferred acceptance” matching algorithm similar to the one used by the National Resident Matching Program (NRMP).³ This algorithm assigns each candidate to a program such that if an applicant ranked another program over the one to which they were assigned, then that program must have ranked all their assigned trainee(s) over this candidate.
Article
Objective: The application process for residency positions is a costly endeavor. This study aims to quantify the financial expenses incurred by University of South Dakota Sanford School of Medicine (USD SSOM) class of 2016. Our hope is that this study will prepare future students of USD and other smaller programs for the financial burdens associated with the match. This data should be used to guide financial decision making by medical students from USD or by regional students from medical programs that desire to apply to residency programs not offered at their home institution. Methods: A 10-item online survey was administered in April of 2016 via the USD Sanford School of Medicine email listserv to the graduating MD class of 2016. The survey asked respondents about the number and cost of away-rotations completed, interviews attended, second-look days attended after the interview, preferences for interviewing during an away-rotation, the specialty the applicant matched into, and number on each applicant's rank list that he/she matched. Results: The survey had a 68.3 percent response rate. The mean number of away-rotations completed, interviews attended, and second-look days attended were 1.3, 12.1, and 0.1 per applicant respectively. The mean costs of attendance to away-rotations, interviews, and second-look days were $1,690.63, $4,881.88, and $24 per applicant, respectively. The total mean collective cost of away-rotations, interviews, and second-look days was $6,596.51 per applicant. Conclusions: The process of applying to residencies among the graduating MD class of 2016 is a costly endeavor. Attendance of interviews for residency positions is the most costly part of the residency application process. Although the financial burden associated with applying to residency programs is high, increasing competition for graduate medical education positions may only drive the cost further.
Article
Objectives To identify how applicants to otolaryngology residency determine how to apply to, interview with, and rank programs on the interview trail and to determine the extent of the financial burden of the otolaryngology interview trail. Study Design Web-based survey distributed in March and April 2016. Setting Otolaryngology residency applicants throughout the United States. Subjects and Methods Applicants to otolaryngology residency during the 2016 match cycle and current otolaryngology residents were surveyed. Results Median number of applications, interview offers, interviews attended, and programs ranked was not different during the 2016 match and the previous 5 match years. The most important factor affecting the number of applications was the need to apply widely to ensure sufficient interview offers. The most common reason for declining an interview offer was scheduling conflict. Applicants during the 2016 match spent a median of $5400 applying and interviewing for otolaryngology residency. Conclusions Median number of applications, interview offers, interviews attended, and programs ranked has not changed. The most cited reason for applying to many programs was to increase the chances of matching, but this is not statistically likely to increase match success. We advocate for continued attempts to make the otolaryngology match process more transparent for both applicants and resident selection committees, but recognize that applicants are likely to continue to overapply for otolaryngology residency positions.
Article
Objective To quantify the cost incurred during the match process for otolaryngology applicants, determine sources of expenditures, and highlight potential methods to alleviate financial burden of the match process. Study Design Cross-sectional. Study Setting Online survey. Subjects and Methods An electronic survey was sent via email to those who applied to the otolaryngology residency programs at Dartmouth-Hitchcock Medical Center and MedStar Georgetown University Hospital during the 2016 application cycle. Questions regarding demographics and experiences with the match were multiple choice, and questions regarding cost were open answer. Data were downloaded and analyzed on Excel and Minitab software. Results Twenty-eight percent of the total 370 applicants completed the survey. The mean cost of away rotations was $2500 (95% confidence interval [CI], $2224-$2776). With application fees and the cost of interviewing, the mean total cost of applying for the 2016 otolaryngology match was $6400 (95% CI, $5710-$7090), with a total range of $1200 to $20,000. Twenty-eight percent of students did not have sufficient funds for applying and interviewing despite seeking out additional monetary resources. Conclusion In 2016, otolaryngology applicants spent a mean of $8900 (95% CI, $7935-$9865) on away rotations, applications, and interviewing. Half of the applicants obtained additional funding to cover this cost, while 28% still did not have sufficient funding. Methods of decreasing cost may include instituting a cap on application number, videoconferencing interviews, regionalizing interviews, and adjusting the interview timeline.
Article
Background: Emergency medicine (EM) residency interviews are an important, yet costly process for programs and applicants. The total economic burden of the EM interviewing process is previously unstudied. Graduate medical education funding and student finances are both fragile shifting sources, which appear to fund most of these economic expenditures. Objectives: The total economic impact of the EM interview season is unknown. This study sought to calculate total dollars spent by EM residency programs and senior medical students (M4) during interview season. Potential solutions for reducing this burden will be outlined. Methods: Institutional review board-approved, piloted e-mail surveys were sent to accredited (Accreditation Council for Graduate Medical Education [ACGME] and American Osteopathic Association [AOA]) EM program directors (PDs) and M4 student members of EMRA. PDs were queried after the 2014-2015 interview season. PDs questions included demographics, estimated faculty, and resident and administrative time used, along with dollars spent during the 2014-2015 interview season. M4 questions included demographics and dollars spent during the 2015-2016 season. Results were reported using descriptive statistics. Financial data for EM programs were calculated with academic EM faculty, resident, and administrative assistant salaries along with reported hours used during the interview season. Results: A total of 82 of 223 EM PDs completed the survey, reporting an mean annual cost of $210,649.04 per program to review, screen, and interview applicants based on time spent by faculty, resident, and administrative assistants. A total of 84.6% of EM program costs were due to faculty hours. A total of 180 of 1,425 EM-bound M4 students completed the survey, reporting a mean annual estimate of US$5,065.44 per student to apply and interview. Seventy-two percent of estimated costs were due to airfare and lodging. Loans and credit cards were the top two methods of payments of these interview costs by students. Extrapolating the cost of EM personnel with hours spent, the economic burden of an interview season for EM programs is approximately US$46,974,735.92. M4 students spent US$19,724,823.40 for application fees and interview-related expenses. Conclusions: Emergency medicine residency programs and applicants appear to spend over US$66 million per cycle on the interview process. EM residency programs may save resources by reducing faculty hours associated with the interview process and leveraging administrative and resident resources. Creation of regional or national fixed interview locations may also be appropriate. Applicants may reduce travel costs by participating in video interviews, reducing program applications, and attending regionalized interview days. A full conversation among all specialties and organized medicine needs to take place to reform the systems in place to reduce the economic burden on students and residency programs.