Walking through the hospital, I have recently been struck by the increasing frequency with which I have encountered hordes of well-dressed, anxious-appearing medical students. Their tired eyes and forlorn looks, juxtaposed against the unsettling uniformity of their attire, can only mean one thing: it's residency interviewing season.
An annual tradition beginning in fall and stretching deep into winter, residency interviews are a hallmark of the Match process by which fourth-year medical students secure residency positions to continue their training after graduation. As in other professions, the expectation for medical residency interviews is that medical students visit their prospective employers in-person. Unlike other professions, the prospective employers are often scattered throughout the United States, requiring medical students to travel extensively to complete the process.
There are obvious reasons to require interviews prior to Match Day. Interviews allow applicants and programs to get to know and evaluate one another in person. Without an interview, the nuances of both applicants and programs are reduced to applications and glossy recruiting brochures, respectively. When I applied to residency, I viewed interviews as fact-finding missions—opportunities for me to evaluate if programs were a "good fit" for my personality and style of learning.
That said, there are reasons to believe that the residency interviewing process has spiraled out of control. Faced with a variety of pressures, and the ultimate threat of not finding a residency position after graduation, medical students are going on too many interviews. As a result, they are spending far too much money on the process.
An October 2015 study in Academic Medicine examined and quantified aspects of the residency interviewing process. The study's authors surveyed 1,367 fourth-year medical students from 20 American M.D. granting medical schools. The authors found that the medical students in the sample applied to 36.4 programs on average. In some specialities, however, the numbers were considerably higher: students applying into Emergency Medicine, Radiology, and Surgery, for example, applied to 41.3, 41.8, and 58.2 programs on average, respectively. It is worth remembering that all of this is occurring as medical students are all trying to secure a single post-graduation residency spot.
Unsurprisingly, applying to such a high number of programs has appalling financial consequences. The students in the sample attended 12.3 interviews, on average (though this figure also differed significantly by specialty). With most individual interviews costing between $250 and $500 apiece, interview season literally cost each applicant thousands of dollars. In fact, 65.7 percent of the medical students in the sample reported that their interview costs totaled between $1,000 and $5,000. Over a fifth of the sample, or 20.3 percent, reported spending over $5,000 in the process.
These statistics are alarming. For one, according to the American Association of Medical Colleges, 75 percent of the graduating members of the class of 2017 had debt as a result of their medical educations. The mean debt of the group stood at $190,694. While it is true that most medical students go on to become high-earning members of society in the future, many still spend years working to pay off such astronomical sums. Given that student debt has been linked to poorer mental health, this is worrying, and raises the question of whether this current financial arrangement adds an undue mental health burden to the youngest physicians in our society. There is no credible reason that residency interviews should exacerbate this problem.
Moreover, America is in dire need of physicians. Becoming a doctor is, in some regards, already discouraging: the job requires an endless amount of training and has notoriously high burnout rates. Requiring its next generation of prospective physicians to pay exorbitantly high costs to interview at dozens of places to secure a job after graduation is yet another deterrent to entering the field. Why are we making life so difficult for the very people we need to fill some of the most important jobs of the future?
While the true solution to this problem will be complex, ultimately requiring a reduction in the number of interviews applicants go on, there are some possible remedies that would significantly alleviate much of the toxic financial stress residency interviews put on our poor medical students. For one, residency programs in close proximity could better coordinate with one another to allow medical students to complete multiple interviews on the same day. This would spare medical students the additional difficulties, and expenses, that come with having to take multiple trips in and out of the area to visit programs that, while geographically close, may hold their interview dates at different times.
Additionally, more programs could begin to offer remote video interviews as an equivalent alternative to in-person interviews. In the internet age, where information can be disseminated across the country with a keystroke, applicants no longer need to be physically present to acquire information about prospective residency programs. And video interviews would still allow programs to evaluate the "softer" personal qualities of applicants and how they respond under pressure.
Both of these changes would substantially reduce the costs of airfare for medical students, helping to slash their financial burdens during interview season. Airfare, as it turns out, accounts for the lion's share of applicants' costs during this trying time.
There has thankfully been an increasing recognition that interview season puts an unnecessary financial burden on medical students, which may affect them long after residency is over. But while there has been progress on this issue, any definitive solution will likely come too late for this year's crop of applicants. That is truly unfortunate.
Dr. Kunal Sindhu is a resident physician in New York City and a 2018-2019 Doximity Author. You can follow him on Twitter @sindhu_kunal.