By Justin D. Triemstra

Match day.

Those two words can bring back a fountain of emotions for physicians.  For some, excitement and thrill. For others, anxiety or sorrow. But for most, a significant financial burden during a time of limited income. A recent discussion with a fourth year medical student reminded me of this important, yet under-recognized dilemma. One that can affect the geographical diversity of residency classes and increase disparities for students coming from low resource settings.

Since 1952, The Match has placed medical students into residency training programs. In 2017, 43,157 registrants entered The Match with 31,757 filled positions. To obtain a filled position, many students attend a significant number of interviews with the mean number of interviews attended at 12 for matched applications in 2017.¹ Each interview adds to the financial burden for students with recent studies in Emergency Medicine reporting an estimated cost per trip to be about $350.^2,3 With an average number of interviews attended at 12, we estimate an average medical student will spend $4200 during interview season; a significant burden for a non-salaried trainee and a number that is likely much higher for a significant number of applicants.

In addition to applying for additional loans, I have heard personal accounts from fourth year medical students who pick up second jobs to pay for interview season. For example, one student drove for Uber while another acted as an electronic medical record consultant for a hospital transitioning to EMR. Although jobs like these can add income to a student’s bottom line, is this how we, as an academic community, would like our trainees spending their time during their last year of medical school? Wouldn’t their time be better utilized focusing on experiential learning opportunities like participating in global health trips, completing research projects, preparing for intern year, or focusing on wellness initiatives? Therefore, the question for medical educators in undergraduate medical education and graduate medical education remains: how can we as an academic medical community help ease the financial burden during this essential, yet high stress period of training?

There have been a variety of recent reports describing innovative and novel techniques at reducing the cost of interviews. One study looked at videoconferencing interviews to decrease the need and subsequent financial cost of travel for interviews.⁴ Although, they reported that the majority of trainees were satisfied, the impersonal nature and inability for the student or resident to visibly meet and tour the institution they will be spending the next 3-7 years of their life makes this model seem insufficient for generalizability. Another study looked at collaborating with programs within the same city to decrease the need for duplicate trips.² This innovative model is encouraging and should be considered for smaller specialties. However, it may be difficult to implement for larger training classes such as internal medicine and pediatrics.

I believe that we as an academic medical community need to continue to address this problem. Not only do these extensive costs add to the already increasing financial burden many medical students face, it also has the potential to limit geographical diversity of residency classes, decrease opportunities for students with limited resources, and potentially increase health disparities. Although a solution is not immediately clear, we should continue to explore avenues and alternatives in decreasing the cost of interview season so that students can focus solely on determining the best program for their next step of training in their career.

References:

• National Resident Matching Program, Annual Report: 2017. Washington, DC, 2017. http://www.nrmp.org/wp-content/uploads/2017/09/Applicant-Survey-Report-2017.pdf
• Shappell E, Fant A, Schnapp B, Craig JP, Ahn J, Babcock C, Gisondi MA (2017). A Novel Collaboration to Reduce the Travel-Related Cost of Residency Interviewing. West J Emerg Med 18(3):539-543.
• Blackshaw AM, Watson SC, Bush JS. The Cost and Burden of the Residency Match in Emergency Medicine (2017). West J Emerg Med 18(1):169-173.
• Healy WL and Bedair H. Videoconference Interviews for an Adult Reconstruction Fellowship: Lessons Learned (2017). J Bone Joint Surg Am 99(21):e114.

Justin D. Triemstra, MD, FAAP is an assistant professor of pediatrics and human development at Michigan State University College of Human Medicine and Helen DeVos Children’s Hospital.