December 16, 2021 – For medical school graduates seeking training in orthopedic surgery, applying to residency programs has become a hyper-competitive process. Typically, applicants send out more than 80 applications on average, and programs receive more than 120 applications per position. A new study finds that the COVID-19 pandemic had an unanticipated financial benefit for these trainees: reducing expenses associated with the residency application process, reports the Clinical Orthopaedics and Related Research® (CORR®), a publication of The Association of Bone and Joint Surgeons®. The journal is published in the Lippincott portfolio by Wolters Kluwer.
"In the coronavirus-19 interview year, the median expenditures of orthopaedic residency candidates were $5,000 lower than they were in the previous year," according to the new research, led by Afshin E. Razi, MD, of Maimonides Medical Center, Brooklyn, N.Y. The researchers believe their findings have implications for efforts to lower financial obstacles while continuing to attract a diverse pool of highly qualified applicants.
Greatest decreases in expenses for interviews and away rotations
For orthopaedic surgery residency applications, as for nearly every aspect of life, COVID-19 has changed things. The pandemic eliminated in-person interviews, as well as "away rotations": time spent at other institutions, outside the student's home medical school. Other aspects of the match process in general did not change, including programs' use of high-stakes examination scores, medical school grades, and letters of recommendation.
Dr. Razi and colleagues compared responses from 263 orthopaedic surgery residency applicants who successfully matched to programs in the Spring of 2020 before the emergence of COVID-19 with 258 applicants from the 2021 application year, when pandemic-related changes were in place. The two classes of applicants were asked to share information about the expenses associated with the application process.
Median total expenses decreased from $7,250 in the 2020 application year to $2,250 in 2021 – a dramatic $5,000 reduction in overall application costs. The greatest decreases were seen for away rotation costs, from $2,750 to $250; and interview expenses, from $2,250 to $75.
Applicants in the West region had the greatest savings: a median of $6,000. Although expenses decreased across regions, applicants in the Northeast had higher costs than those in the Southern and Central regions.
While the benefits of the financial savings are obvious, including supporting efforts to increase trainee diversity, which is a key priority for orthopaedic surgery as a specialty, the researchers note there are potential harms as well. For example, if applicants can’t make in-person visits for interviews and away rotations, they may try to compensate by applying to even more programs; the lower costs may also drive an increase in the number of programs candidates apply to.
in an Editorial Spotlight accompanying the new article, CORR® Senior Editor Montri D. Wongworawat, MD, applauds the "nearly 70 percent discount on application costs" reported in the new study. "On the other hand," he adds, "there are intangible benefits that can't be replaced by a virtual experience."
In a "Take 5" interview, Drs. Wongworawat and Razi – both residency program directors themselves – discuss the implications for strategies to control costs while achieving a fair application process. For example, Dr. Razi believes that with the recent introduction of a Universal Interview Offer Day will help "to promote a diverse, equitable, and inclusive environment and recruit those who may be an excellent fit for their program." He also notes that in-person rotations and interviews are likely to resume when the pandemic settles down.
In a separate email, Dr. Wongworawat states: "COVID-19 has driven us to be creative in our thinking. It took us out of the business as usual and forced us to seriously think about and act on the issues of cost, equity, fairness, and access. We've made moves, such as the Universal Offer Day...and the discussion is ongoing."
DOI: 10.1097/CORR.0000000000002042
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About CORR®
Devoted to disseminating new and important orthopaedic knowledge, Clinical Orthopaedics and Related Research® is a leading peer-reviewed orthopaedic journal and a publication of The Association of Bone and Joint Surgeons®. CORR® brings readers the latest clinical and basic research and informed opinions that shape today's orthopaedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system.
About the Association of Bone & Joint Surgeons®
The mission of The Association of Bone and Joint Surgeons® is to advance the science and practice of orthopaedic surgery by creating, evaluating, and disseminating new knowledge and by facilitating interaction among all orthopedic specialties. Founded in 1947 as the "American Bone and Joint Association," ABJS membership is offered by invitation only to orthopaedic surgeons who have been certified by the American Board of Orthopaedic Surgery.
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Clinical Orthopaedics and Related Research