Total Financial Burden of Increasing Urology Residency Applications on Applicants and Programs

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INTRODUCTION: The annual volume of urology residency applications continues to rise. Previous studies have assessed applicants’ expenses without accounting for the time cost borne by program faculty. We modeled the total financial burden incurred by applicants during submission and program faculty during review. METHODS: For applicant costs, we calculated application submission fees and assessed the applicant pool by year. For program costs, we assumed applications receive a 10-minute screening review by 1 reviewer, and a subset of applications receives a 30-minute full review by 2 reviewers. We extrapolated per-program salary costs to 143 US programs. RESULTS: Average per-applicant applications increased 57% during 2013 to 2022, from 53 to 83 (Figure). Corresponding submission fees rose 67%, from $1,157 to $1,937 per applicant. However, average interviews given by programs and taken by applicants remained relatively static (Figure). In the total cost model for 2017 to 2022, total applicant submission costs rose from $0.7M to $1.2M. Average applications received per program increased 42% (236 to 349 applications), increasing faculty review time by 27% (113 to 144 hours). Extrapolated to all US programs, total program costs rose from $1.6M to $2M. Thus, total costs increased from $2.3M to $3.2M, corresponding to a rise in per-vacancy costs of 22%, more than twice the rate of inflation in the same period. CONCLUSION: Increasing application volumes have resulted in substantially higher total financial costs of the submission and review process. Efforts to control the time cost of faculty review may lead to reliance on suboptimal screening strategies.Figure