Presentation Authors: Jorge Whitley, Byron Joyner, Kathleen Kieran*, Seattle, WA
Introduction: Increasing diversity is a goal of many urology training programs. Failure to recruit and retain more underrepresented minority applicants(URM) has been attributed to a â€œpipelineâ€ issue, although it is unclear where in the â€œpipelineâ€ this discrepancy is most pronounced. We wondered whether the structure of residency interview schedules favors non-URM applicants since many medical schools with high proportions of URMs are not located in urban centers with airport hubs. We compared the financial and temporal costs of residency interviews at 17 top residency programs for 22 theoretical applicants: 11 at medical schools with the student body >20% URM (HURM), and 11 others at randomly selected medical schools with the student body < 15% URM (LURM). We hypothesized that costs for applicants from HURM schools would have travel costs at least 20% greater than applicants from LURM schools.
Methods: We compared the financial and temporal costs of residency interviews at 17 top residency programs for 22 theoretical applicants: 11 at HURM medical schools, and 11 others at randomly selected LURM medical schools.
Results: The median costs of travel, meals, and lodging, to 17 interviews was $9189 (range: $7201.60-13,702.59) for applicants from HURM schools and $9035 (range: $6698.48-$11966.83) for applicants from LURM institutions (p=0.81). Overall travel time from HURM and LURM schools was similar (median 173.33 vs 161.18 hours, p=0.63).
Conclusions: We were surprised to find that, in the 2017-2018 urology interview season, temporal and financial costs to applicants from HURM and LURM institutions were similar. While absolute cost and time considerations may not account for differences in URM representation in top-tier residency programs, URM students are known to carry disproportionately higher debt than non-URM students, and so cost considerations may in fact differentially affect URM applicants. Our data raise concern that factors other than time and money strongly influence how URM applicants decide to pursue postgraduate medical training. Undergraduate and graduate medical education leaders must continue to investigate real and potential barriers to the recruitment and retention of URM applicants to urology residency programs.