COVID-19 Reduced Expenses for Med Students Applying to Ortho Residency Programs

    Applying to orthopedic surgery residency programs has become a hyper-competitive process for medical school graduates. Applicants send out more than 80 applications on average, and programs receive more than 120 applications per position.

    It’s also an expensive process. In that regard, COVID-19 had an unanticipated positive effect: For the 2021 residency match, the median expenses associated with the residency application process were reduced by $5000 compared with the previous match year, according to a study published online ahead of print by Clinical Orthopaedics and Related Research (CORR).

    These findings may have implications for efforts to lower financial obstacles while continuing to attract a diverse pool of highly qualified applicants, the researchers said.

    Decrease in Expenses for Interviews, Away Rotations

    Two of the most expensive aspects of the orthopaedic surgery residency application process – in-person interviews and away rotations – were eliminated for the 2021 residency match due to the COVID-19 pandemic. Other aspects of the match process in general did not change, including the use of high-stakes examination scores, medical school grades, and letters of recommendation.

    For the study, the researchers performed a retrospective, cross-sectional analysis of the 2020 and 2021 Texas Seeking Transparency in Application to Residency Dashboard database. They compared responses from 263 orthopaedic surgery residency applicants who successfully matched to programs in spring 2020 with 258 applicants from 2021, when pandemic-related changes were in place. The 2 classes of applicants were asked to share information about the expenses associated with the application process.

    Median total expenses decreased from $7250 in the 2020 application year to $2,250 in 2021 – a dramatic $5000 reduction in overall application costs. The greatest decreases were seen for away rotation costs, from $2750 to $250; and interview expenses, from $2250 to $75.

    Applicants in the West region had the greatest savings: a median of $6000. Although expenses decreased across regions, applicants in the Northeast had higher costs than those in the Southern and Central regions.

    Potential Downsides

    Although the benefits of the financial savings are obvious, including supporting efforts to increase trainee diversity – a key priority for orthopaedic surgery as a specialty – the researchers noted that 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 to which candidates apply.

    In an Editorial Spotlight accompanying the new article, CORR Senior Editor Montri D. Wongworawat, MD, applauded 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.”

    Benefits of Universal Interview Offer Day

    In a “Take 5” interview, Dr. Wongworawat from Loma Linda University Health in Loma Linda, California, and Afshin E. Razi, MD, of Maimonides Medical Center in Brooklyn, New York – 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 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 noted that in-person rotations and interviews are likely to resume when the pandemic subsides.

    In a separate email, Dr. Wongworawat stated that “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.”


    Gordon AM, Conway CA, Sheth BK, et al. How did coronavirus-19 impact the expenses for medical students applying to an orthopaedic surgery residency in 2020 to 2021? Clin Orthop Relat Res. 2021 Dec 16. doi: 10.1097/CORR.0000000000002042. Online ahead of print.