Exploring Barriers to the Inclusion of Underrepresented Minorities in Urology: The Temporal and Financial Costs of Residency Interviews

Abstract

ObjectiveTo investigate whether interview travel cost and time differed for urology residency applicants from medical schools with higher vs lower proportions of students from groups underrepresented in medicine (URiMs). MethodsWe identified 22 medical schools, 11 with <15% and 11 with >20% URiM students, and 17 “highly ranked” urology residency programs. We contacted the residency programs and requested interview dates, preferred lodging options, and institution-based cost-savings. We constructed interview itineraries for 22 hypothetical students (one from each school), and compared the total cost and time for travel to all 17 interviews. Total travel time and interview costs for the students at schools with <15% and >20% URiM were compared, with findings considered statistically significant at P <.05. ResultsEach student was able to attend all 17 interviews. The median total cost was similar for applicants from schools >20% URiM ($8074.80; range: $7027.60-$13702.59) and <15% URiM ($8764.60; range: $6698.48-$11966.83; P = .89). The median aggregate travel time for applicants from schools >20% URiM was 176.4 (range: 93.7-246.2) hours and for applicants from schools <15% URiM was 160.5 (range: 128.2-203.9) hours (P = .62). ConclusionFinancial and temporal costs were similar for applicants from medical schools with <15% or >20% URiM students. Thus, absolute cost considerations are unlikely to account for differences in URiM representation in urology. However, the relative impact of interview costs may be different for URiM students. Effective and durable engagement of URiM students in urology requires an introspective assessment of objective vs anecdotal barriers to recruiting and retaining URiM medical students.