Cost of the Otolaryngology Residency Application Process: Comparison With Other Specialties and Equity Implications

Abstract

Objective This study aims to assess trends in applicant-reported costs of the otolaryngology residency application process between 2019 and 2021 and evaluate the impact of application costs on number of interview offers. Study Design Cross-sectional study. Setting US allopathic and osteopathic medical schools. Methods Survey data from applicants were obtained from the Texas STAR database (Seeking Transparency in Application to Residency) for the years 2019 to 2021. Outcomes included total cost, interview cost, other costs, application fees, and number of interview offers. Simple and multivariable linear regression was used to identify novel predictors of cost and assess the correlation between cost and interview offers. Results Among 363 otolaryngology applicants, there was a 74% reduction in total costs and a 97% reduction in interview costs in the 2021 cycle vs the 2020 cycle. Significant predictors of total cost among otolaryngology applicants included the number of away rotations ( P < .01), the number of research experiences ( P = .04), and couples matching ( P < .01). During the 2019 and 2020 application cycles, there was a significant association between applicant-reported total spending and number of otolaryngology interview offers ( P < .01), which was not present during the 2021 cycle ( P = .35). Conclusion Number of otolaryngology interview offers appears to be directly correlated with applicant-reported total costs regardless of number of applications or interviews attended, which may be a source of inequality in the application process. There was a drastic reduction in total costs, interview costs, and other costs during the COVID-19 pandemic, which was likely driven by virtual interviewing and the absence of away rotations.

Association of Virtual Away Rotations With Residency Applicant Outcomes in Otolaryngology

“…Although virtual away rotations cannot reproduce all aspects of the in‐person experience, they offer a more affordable and more equitable alternative. In a recent cost analysis of the otolaryngology residency application process, we found an average decrease in spending of $5669 per applicant in the 2020 to 2021 application cycle, presumably due to a lack of in‐person away rotations and interviews that year 23 . Both applicants and programs have emphasized the ability for virtual away rotations to help level the playing field for applicants from economically disadvantaged backgrounds, those without a home program, those who identify as URiM, and those who are IMG 3,24,25 .…”

“…In a recent cost analysis of the otolaryngology residency application process, we found an average decrease in spending of $5669 per applicant in the 2020 to 2021 application cycle, presumably due to a lack of in-person away rotations and interviews that year. 23 Both applicants and programs have emphasized the ability for virtual away rotations to help level the playing field for applicants from economically disadvantaged backgrounds, those without a home program, those who identify as URiM, and those who are IMG. 3,24,25 Our findings suggest that virtual away rotations might help applicants with interviewing and matching at a program of interest if virtual rotations are offered.…”

Matching into competitive surgical residencies: predictors of success

“…Costs associated with residency applications and away rotations in surgical subspecialities have been investigated in the literature and evidence shows that the costs for applying to certain surgical subspecialties is higher than other subspecialties [ 13 , 16 , 20 , 29 , 30 ]. Specifically, Gordon et al used the Texas STAR database to compare the costs of students applying to competitive surgical residencies, and the authors found application costs to vary depending on subspeciality and geographic region [ 20 ].…”

“…The Texas STAR survey response rate averages 40% (unable to calculate for 2017, 47% in 2018, 38% in 2019, 47% in 2020). Several prior studies have utilized this database to evaluate applicant characteristics, expenditures, and success with matching into a surgical residency [ 13–21 ].…”

Does Geographic Region of Away Rotations Predict Otolaryngology Match Outcomes?

“…Prepandemic data suggest that otolaryngology applicants who complete away rotations might improve their match outcomes at programs where they spent time; 32.7% of applicants matched to the program where they completed an away rotation, and 48.8% of applicants who ranked a program where they completed an away rotation first on their rank list matched there 5 . However, away rotations incur costs estimated at $1600 to and $2500, 6,7 which might deter economically disadvantaged applicants from participating 8‐12 …”