Comparison of cost changes due to the COVID-19 pandemic for Dermatology residency applications in the USA.

We performed a cost estimation of dermatology residency applications prior to COVID-19 pandemic restrictions (2016-2020) and during the COVID-19 pandemic (2021) and surveyed dermatology programme directors to assess the impact of virtual interviews. We found that COVID-19 virtual interviews significantly reduced the cost of applications. We understand that the changes forced by the pandemic were challenging and not ideal; however, the online aspect of interviews provided a way for applicants to save a significant amount of money.

Dear Editor,

The financial burden placed on medical students in the USA includes not only school tuition costs, but also residency application costs. A previous survey study found that some medical students took loans of up to US$7000 for the interview process alone, while others took extreme cost‐saving measures, such as opting to sleep in restaurants. In 2014, matched applicants paid an average US$11 324 for dermatology residency applications, with costs consistently rising (Table 1). , We believe COVID‐19 restrictions may have reduced application costs because of virtual interviews being used and away rotations being discouraged.

Table 1

Estimation of residency application costs 2016–2021.

Parameter	Year of application
	2016	2017	2018	2019	2020	2021
Total applicants (US MD seniors), n	619	651	651	701	797	734
Mean applications submitted per applicant, n	63	69	69	68	66	67
Mean cost of application fees per applicant	1225	1393	1413	1407	1355	1441
Mean number of interviews accepted, n	7.44	7.53	7.87	8.00	8.45	8.30
Estimated overall interview cost, USD a	3769	3908	4169	4303	4658	153 b
Estimated cost of one away rotation, USD a	2169	2224	2270	2305	2362	0
Mean total cost of application, USD c	7309	7679	8007	8180	8541	1759

MD, Medical Doctor.

Estimated costs adjusted to account for inflation.

Estimated cost of internet for online interviews.

Average total application cost is equal to the sum of applications, fees, interviews and away‐rotation costs.

We performed a cost estimation for US medical school seniors applying for Dermatology residency before and during the COVID‐19 pandemic. Application costs pre‐COVID‐19 (2016–2020) included fees for the Electronic Residency Application Service (ERAS), National Resident Matching Program (NRMP) and US Medical Licensing Exam (USMLE), away‐rotation costs, and travel costs to interviews. The Consumer Price Index Inflation Calculator from the US Bureau of Labor Statistics was used to calculate inflation each year. Away‐rotation costs were based on a rotation of 1 month, accounting for the mean cost of living and adjusted for inflation. Application costs during the COVID‐19 pandemic (2021) included only application fees and internet costs, as there were no away rotations or in‐person interviews. Additionally, we surveyed dermatology programme directors to compare the effect of virtual and in‐person interviews.

Without COVID‐19 restrictions, we projected the average application cost for dermatology residency to be $8476 per applicant (Fig. 1). With COVID‐19 restrictions, we estimated the average application cost to be $1759 per applicant. The transition to virtual interviews saved each applicant almost $6882. While these savings are substantial, the importance of nonvirtual away rotations remain critical in medical education and residency placement. If away rotations return to in‐person and interviews remain virtual, the estimated application cost would be $4154 (including one away rotation), saving applicants around $4322. In a survey of 27 programme directors, 70% were either very or extremely willing to participate in online interviews again in the future. When the programme directors were asked about their overall impression of online interviews, 86% stated that they were very to extremely satisfied. Although they were mostly satisfied with online interviews, 52% of the programme directors agreed that in‐person interviews were better to achieve a more holistic view of the applicant. Furthermore, 81% of the programme directors also agreed that in‐person interviews allowed for the most realistic impression of the programme.

Figure 1

Estimated costs of US Dermatology residency applications. Dashed line represents estimated costs without COVID‐19 restrictions, including away rotations and in‐person interviews.

Based on our calculations, COVID‐19 restrictions led to significant savings in application costs to dermatology residency. It is important to acknowledge the limitations that virtual interviews pose for both the applicant and the programme directors. However, it is also critical to consider that virtual interviews may alleviate the cost burden on medical students. It could be beneficial to have the option of virtual interviews in the future to decrease financial barriers in the application process.