Is Signaling the Solution? Curbing Excess Volumes and Costs of Urology Residency Applications With Large-Volume...

Rising annual volumes of urology residency applications have increased applicants' expenses and program faculty's time costs. A "large-volume" preference signaling initiative that was introduced in the 2024 residency match, in which applicants may "signal" their interest in up to 30 programs, has the potential to reduce excess application volumes. We aimed to characterize changes in urology residency application volumes and model the financial impact to residency applicants and programs following implementation of large-volume preference signaling.

Using public data from the Association of American Medical Colleges and American Urological Association, we analyzed urology residency application and interview volumes during 2013 to 2024 and modeled preinterview costs during 2017 to 2024. To model applicants' costs, we calculated submission fees for the total applicant pool annually. For program costs, we assumed that submitted applications undergo 2 rounds of faculty screening and that large-volume preference signaling permits programs to halve the initial screening pool. All costs were adjusted for inflation.

From 2013 to 2023, the average number of applications submitted per applicant increased by 66% (53 to 83 applications). In 2024, large-volume preference signaling decreased submitted applications by 25% to 66 per applicant, while average interviews given by programs and taken by applicants remained unchanged. In the cost model, large-volume preference signaling resulted in applicants' average submission costs decreasing by 31% per applicant and programs' review costs decreasing by 25% per program. The total cost of application submission and review decreased by 26% from $3.05 million to $2.25 million, corresponding to a per-vacancy cost of $5,836, the lowest cost observed during the study period.

Implementation of large-volume preference signaling resulted in markedly decreased urology residency application volumes and program review time, resulting in substantially lower total costs of the submission and review process.