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The Medical Residency Application Process: Privilege Gets the Placement

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Justine Cameron
May 2, 2021

While medical schools are attempting to diversify their student bodies, the requirements of medical school strongly favor wealthy, white students. I fear that bringing in diverse students but not supporting their diverse needs post-acceptance does not help address the broader concern: diverse representation among physicians in America. If changes aren’t made to the structure and financial burden of the application to the residency process, we will not see the population of economically and racially diverse students carry forward to residency or beyond. 

Often I see discussed the hurdles that non-wealthy and non-white students face when applying to medical school; this is written about heavily and often pointed to as a main reason for lack of diversity among medical students. This is certainly a valid concern, but it speaks to the first of what will be many challenges a socioeconomically disadvantaged student will face in medical school. Once admitted, students are often disheartened to learn of numerous financial barriers they will face; in particular, the residency application process. While this is functionally something students won’t do until their final year of medical school, there are plenty of exams and experiences along the way that are critical to the success of an applicant to residency programs. 

Students pursuing a MD degree must complete two United States Medical Licensing Examination (USMLE) Step exams prior to completing medical school. The first is known as being critically important to a student’s residency application. Both exams cost upwards of $1,000 each. Prior to the pandemic, there was a third exam students were required to complete, which was only offered in five cities in the United States. Thankfully, the USMLE announced they were discontinuing the exam, and with that, made a large step in the right direction of creating a residency application process that is reasonable for students who are unable to comfortably afford such large expenses. 

The largest burden, financially, comes in a student’s final year of medical school. It is (at minimum) two major costs; “Away/audition rotations,” and the in-person interviews for residency. During their final year, a student is required to complete all of their graduation requirements and take electives in the specialization/field of interest. 

In an effort to experience a day in the life at their preferred locations for residency, students apply to complete away/audition rotations, which give students a month-long experience in the hospital of their choosing. The process to apply to these experiences is cumbersome, expensive and highly competitive. Students often apply to these away/audition rotations all over the country, which means if selected, the student is required to travel to said location, pay for a month of housing (often not provided by the university), pay the registration fees for that elective and any other fees associated with the experience. I’ve seen students do as many as four or five away rotations; that certainly can’t be cheap. There are scholarships at some institutions which offset the cost of these experiences for students who are underrepresented in medicine. This is a great initiative, and one that I would suggest all medical schools consider developing if they haven’t already.

The other major expense is the cost of interviewing. Once students have paid to simply apply to each of their programs of interest, the programs then review the applicants to determine who they would like to invite on-site for a residency interview. Paying to apply to more programs casts your net wider, and naturally, we see financially well-off students advantaged in this process. If a student is selected to attend an interview, they must travel to that location for what is often a full-day interview experience. Again, we see the costs of flights, boarding and more quickly adding up.

Because the residency application process is so competitive, it’s essential for students to partake in as many interviews as they can or are offered, with the hope that these programs will rank the student highly come the time for the Nobel prize-winning resident matching algorithm to work its match magic. Being unable to partake in these experiences limits one’s exposure to programs, and lessens the likelihood that a student will match to residency. One significantly positive outcome related to the pandemic is that most of the 2020-2021 residency application process was conducted remotely, sparing these students the thousands of dollars spent in travel and therefore providing a student the ability to partake in an interview if selected.

My hope is that the changes that had to be made with regard to individuals’ safety during the pandemic may soon be permanent staples for the residency application process. As a higher education administrator, what I saw this year was a fairer experience for students who do not have the financial privileges of your, “Typical medical student.” I sincerely hope that in the future these financial institutional barriers will continue to lessen and eventually diminish, allowing for a financially and culturally diverse body of physicians. 


Author: Justine Cameron earned her master’s in public policy and graduate certificate in educational policy from UMass Dartmouth. Her professional interests include higher education, educational policy, teaching, public education administration, and student affairs. Justine is a Class of 2020 ASPA Founders Fellow. She can be reached at [email protected]

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