My iPhone screen illuminated. “What floor are you on? We are here!” glowed a text message from a medical student. I scanned my kitchen. Pizza was out, drinks were on the counter, and my laptop sat poised next to the TV screen.
“I’ll be right down!” I texted back.
Descending in the elevator, I couldn’t believe it was coming together. Months before that October night, the chair of orthopaedic surgery at my residency program had approached me with an idea. Many residency programs in our specialty had returned to in-person interviews; he wanted to calculate the carbon dioxide emissions that our department was avoiding by continuing virtual interviews. I dove enthusiastically into the question and found that our applicants would have burned the equivalent of 5,964 gallons of gasoline had we held in-person interviews for Match 2024.
We are only one small residency program, and that was a lot of gas. I began to wonder about the residency interview process at large. Sixteen of us gathered that night to answer an important question: How are U.S. residency programs interviewing their applicants? We knew that the AAMC had recommended virtual interviews in June 2024. However, many of us noticed some programs transition back to in-person interviews in the application season that followed. No group had published data about to what extent this transition was happening. So, while eating pizza in my living room, we divided almost 5,000 U.S. residency programs across 23 specialties among ourselves.
For four months, our team scoured program websites, poured through specialty databases when available, and emailed program coordinators to determine how each residency program was conducting interviews for the 2024–25 application season. Interview styles were categorized as virtual, hybrid, or in person. We threw in the towel after determining the interview format for 4,014 programs, about 83% of all included residencies. Our team found that while the majority (75%) of residency programs held virtual interviews, many surgical subspecialties returned to the in-person format for Match 2025. The highest percentages of in-person interviews were recorded in otolaryngology (86%), plastic surgery (85%), neurosurgery (85%), orthopaedic surgery (70%), and thoracic surgery (56%).
As we collected this data, I was attending my own pediatric orthopaedic surgery fellowship interviews. Despite capping myself at 10 interviews and choosing virtual whenever possible, I flew a lot. I flew from Portland to New York for less than one day. I flew to Phoenix, St. Louis, Atlanta, Salt Lake City, Sacramento, and Los Angeles to participate in interviews that lasted about four hours. On my flight to Atlanta, I read news articles about the Palisades Fire as it incinerated places I loved. My heart ached with guilt as the plane engines hummed.
Graduating in the medical school Class of 2021, I only knew virtual interviews before this process. For both residency and fellowship, I truly believe that I matched where I was meant to be. The series of 20-minute interviews felt quite similar whether virtual or in person. However, I will admit there was a human element to interviewing in person that helped me confidently rank my top three programs. A reassuring hand on my back from a faculty member who noticed I was nervous. Deeper-than-expected conversations over a couple beers. The gut feeling of being at home. For me, just a few times, it was worth burning the carbon.
Where do we go from here? There has been some optimization in the residency selection process with preference signaling and many specialties retaining the virtual format. Next, I hope leaders will continue to wean in-person interviews down to only what is meaningful for applicants. In Match 2025, most U.S. seniors (73% MD, 76% DO) matched into one of their top three ranked residency programs. What if applicants interviewed in person at their top three choices and virtually for the rest? This, combined with program caps of three in-person interviews per residency spot, could ensure that applicants are investing their time, money, and carbon in residencies where they have a high likelihood of matching.
With the COVID-19 pandemic in our wake, we have the opportunity to shape residency interviews to fit the time in which we live. In the words of economist Tim Jackson, I hope we take this opportunity as physicians and leaders in our communities to “dream of a better future … Cleaner air. Less traffic. Bluer skies. Fewer contrails. More time for each other. Less pressure to succeed. More kindness to strangers. Less noise. More connection with nature … Was it wrong to hope that some of this might prevail?”
Should residency programs reduce in-person interviews? Share in the comments.
