Financial Burden of Emergency Medicine Residency Applications: Pre-, During, and Post-Pandemic

Introduction: Applying to emergency medicine (EM) residency programs is costly. In the past several years, the EM residency application process has undergone multiple changes in recommendations regarding away rotations and interview format, primarily but not solely driven by COVID-19 restrictions. To date, little is known about the financial impact of these changes on EM applicants. This study assesses recent trends and changes in the costs of the EM residency application. Methods: We analyzed EM applicant survey data from the Texas STAR (Seeking Transparency in Application to Residency) database from 2019–2024. Application cycles were grouped into three time periods: pre-pandemic (2019–2020), pandemic (2021–2022), and post-pandemic (2023–2024). Applicants’ self-reported data for application fees, away rotation costs, interview costs, and total expenses were analyzed. We conducted Kruskal-Wallis testing to evaluate differences in expense-related variables across the three time periods. We performed post-hoc analysis using the Dunn test if significant differences were detected. Results: This study included 3,495 EM applicants, which represents 8.4% of the total 41,497 Texas STAR survey respondents from 2019–2024. Average per-applicant total costs were $5,412, $2,076, and $3,156 in the pre-, during-, and post-pandemic application cycles. Self-reported total applicant expenses decreased between the pre-and pandemic period and increased from the pandemic and post-pandemic period (P <.01). Applicants had the lowest overall costs in 2021. Away rotation, second look, application costs, interview travel and lodging, and virtual interview costs all reached their lowest levels during the pandemic period (P <.01). In the post-pandemic period, travel and lodging costs were higher than pre-and during pandemic levels, while interview costs remained lower due to the continued use of virtual interviews (P <.01). Applicants from the Western Region of the US saw the highest total costs compared to the Northeast, which saw the lowest. Conclusion: The total expenses reported by medical students applying to EM residency programs were significantly reduced during the pandemic, compared to other years. Some expenses, notably away rotation and second look and application costs, have risen post-pandemic. To help reduce the financial burden of the EM residency process, the continued use of virtual interviews is an opportunity for cost savings.