Rapidly Increasing Number and Cost of Residency Applications in Surgery

Abstract

Background Surgical specialties represent the most competitive residency positions to obtain, and applicants for these spots may apply to increasingly more programs in an attempt to match. We describe trends in residency applications across all surgical specialties from 2017 to 2021 application cycles. Materials and Methods This review of the 2017, 2018, 2019, 2020, and 2021 surgical residency application cycles used the American Association of Medical Colleges’ Electronic Residency Application Service (ERAS) databases. Data from a total of 72,171 applicants to United States surgical residencies during the study’s time period were included. The 2021 ERAS fee schedule was used to calculate the cost of applications. Results The number of applicants across the study interval remains unchanged. Trends suggest more women and underrepresented minorities in medicine are applying to surgical residencies today compared to 5 years ago. The mean number of applications per applicant increased 32.0% from 39.3 in 2017 to 51.8 in 2021, resulting in an increased application fee cost of $329 per applicant. Mean total cost for application fees alone in 2021 were $1211 per applicant. In 2021, the cost of applying to surgical residency for all applicants was over $26 million, a nearly $8 million increase from 2017. Conclusions There has been an increase in the number of applications per applicant in the past 5 residency application cycles. Increased applications create barriers and burdens for applicants, and residency program personnel. These rapid increases are unsustainable and require intervention, although a viable solution has yet to be elucidated.

The Evolving Plastic Surgery Applicant

“…Such pressures are only heightened in the wake of the United States Medical Licensing Examination (USMLE) Step 1 examination transitioning from a numeric score to pass/fail grading as students seek to distinguish themselves among a competitive applicant pool 42 . In light of these changes, programs have been forced to consider alternative methodologies of ranking applicants and looking to new metrics to differentiate students 5,43–46 . As plastic surgery applicants are evaluated, it is essential to consider how these metrics may exacerbate inequalities in the system.…”

“…The UIM students or those who come from institutions with no plastic surgery home programs may find it more challenging to develop a strong mentorship relationship and thus may be unable to access these opportunities 48 . During this same period, the number of applications per applicant and the total cost of applying to plastic surgery have dramatically increased, which again may disadvantage UIM applicants 44,50 . As plastic surgery training and the application process continues to evolve, we must be aware of the possible inequities it may foster and how it affects the future of our specialty.…”

The Modern Integrated Plastic Surgery Applicant Pays 150% More Than Their Counterparts Four Years Ago

“…This trend has been observed in other surgical fields such as orthopedic surgery, neurosurgery, otolaryngology, and urology. 30 In addition, the total number of applications increased by nearly half (45%). These findings suggest that there is a widespread instability in the current plastic surgery application process, which merits investigation to quell both the burden of time and cost associated with such high levels of applications.…”

Cost Analysis of High‐Signal Approach in Otolaryngology‐Head and Neck Surgery Residency

“…Programs could subsequently engage in holistic review which has been shown to diversify the pool of applicants selected for interviews. 1 Reducing the number of applications submitted would also be financially advantageous to the applicant-many of whom accrue significant debt during the residency application and recruitment process 2,12 and may decrease barriers for applicants from lower socioeconomic backgrounds.…”