Author – Linda Katirji, EM Resident at University of Kentucky Emergency Medicine, on behalf of the CORD EM Student Advising Task Force

As medical students apply to more and more programs each year the cost of the match for students and programs has skyrocketed. Interview season places a significant financial burden on medical students, many of which have already accrued hundreds of thousands of dollars in students loans. Additionally, the interview process is costly for EM programs, particularly expensive in terms of faculty, resident, and administrative hours. For programs and students alike, the personal interactions that take place at interviews are one of the most important factors in making a rank list and the most expensive part of an application cycle. Most involved in this process acknowledge that this is an issue, however realistic solutions for reducing this burden have not materialized.

Recently, Van Dermark et. al published a study in Academic Emergency Medicine which outlined the average cost of interview season for students and programs (“The Financial Implications of the Emergency Medicine Interview Process”).  Although costs of the application cycle for students have been studied before (see AAMC’s Costs of Applying to Residency Questionnaire Report, a survey of 959 students applying to all specialties), this is the first paper to review the entire economy of an EM interview cycle, including costs for residency programs themselves.

The numbers are shocking

They found that programs spent a mean of greater than $210,000 per interview cycle per year, taking into account direct costs (lodging, food/beverages, etc) and indirect costs (faculty/administrative/resident time). About 85% of this was PD and EM faculty time spent selecting and conducting interviews. The total cost to fill each PGY-1 spot was $25,796, based on their estimate of total economic expenditures for EM programs.

The average cost per medical student for an interview cycle was about $5000; 67% of that cost was due to transportation and lodging. This cost is about 10% of the salary the student will be making in their PGY-1 year.

What to do?

The authors suggest several possible solutions.  The initial ERAS applications are a significant expense and students would benefit from reducing the number of applications they make in ERAS (average of 7 interviews declined per student in this study).  Making better use of advising resources to narrow the list of programs they apply to without hurting their chances of matching.  Curtailing over-application would benefit residency programs as well by saving them program director and faculty time currently expended reviewing applications from students with minimal genuine interest.

Additional measures suggested include attempts by applicants to consolidate travel costs by “clustering” multiple interviews in areas with a dense population of residency programs.  Medical schools and residency programs can help with student costs by continuing to foster efforts to have local students and residents host visiting applicants.

Improving technology could also be leveraged, as with conducting remote interviews by video or improving the applicant screening methods used, something being explored with the new Standardized Video Interview.

This paper shines a light on the monetary burden the application cycle places on both students and residency programs.  You can and should read the full paper here.

We look forward to seeing your thoughts on solutions in the comments below.