The Impact of the COVID-19 Pandemic on the Cost of the Urology Application Process

To review the self-reported costs of urology residency applications from 2019 to 2023 and examine the impact of Society of Academic Urologists (SAU) policy changes made during the COVID-19 pandemic on these costs.

Data from the Texas Seeking Transparency in Applications to Residency (STAR) survey were used to evaluate costs incurred by fourth-year urology residency applicants from U.S. medical schools. Outcomes included median total cost (mTC), interview costs, application fees, and other associated costs, alongside the number of interviews offered and match outcomes. Cost comparisons among surgical specialties were made. Simple linear regression was used to identify cost drivers and cost-outcome correlations.

Between 2019 and 2023, 522 urology residency applicants responded to the survey. The adoption of virtual interviews and discontinuation of in-person away rotations in the 2020-21 cycle led to a 79% reduction in mTC and a 92% reduction in interview costs. Key cost drivers were the number of away rotations and number of applications submitted. Each incremental away rotation is associated increased cost of $1490. In the 2020-21 cycle, urology applicants spent on average $2000 more than their general surgery counterparts. Urology shared the position of most expensive surgical specialty with thoracic surgery and ophthalmology in the 2021-22 match cycle.

Pandemic-related policy changes significantly reduced the costs of urology residency applications, helping to reduce socio-economic barriers. The critical role of away rotations in securing match success, along with their associated costs, highlights equity concerns for students from institutions without home urology programs.