Introduction: Application for a residency position in neurosurgery is a highly competitive process. However, the process is an expensive one that places significant financial burden on applicants. In this study, we aimed to quantify expenses incurred by first year neurosurgery residents who matched in 2014.

Methods: A ten question survey was distributed in partnership with the Society of Neurological Surgeons to all first year neurosurgery residents in the United States. The survey asked respondents about the number of sub-internships, interviews, and second looks attended and the resultant costs, the type of program match, preferences for sub-internship interviews, and suggestions for changes they would like to see in the application process. In addition to compiling overall results, we examined the data for differences in cost when stratifying for region of the respondent’s medical school or whether the respondent had contact with the program they matched to prior to the interview process (matched to home or sub-internship program).

Results: The survey had a 64.4% response rate. The mean total expenses for all components of the application process were $10,255 with interview costs comprising the majority of the expenses (69.5%). No difference in number of sub-internships, interviews, or second looks attended, or their individual and total costs, were seen for applicants from different regions of the United States. Respondents who matched to their home or sub-internship program attended fewer interviews (13.5 versus 16.4, p = 0.0023) but had the same overall costs (mean $9,774 versus $10,566, p = 0.58).

Conclusions: Securing a residency position in neurosurgery is a costly process for applicants. No differences are seen when stratifying by region of medical school attended or contact with a program prior to interviewing. Interview costs comprise the majority of expenses for applicants, and changes to the application process are needed to control costs incurred by applicants.

Patient Care: Costs associated with the residency match in Neurological Surgery are substantial. Identifying these costs and the factors contributing them may lead to changes improving the financial burden to applicants and encouraging more pursue advanced training in Neurosurgery. Ultimately, this will lead to a larger work force to provide continued support for patients suffering from neurological conditions requiring surgical intervention.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of the costs associated with applying for the residency match in Neurological Surgery 2) Discuss, in small groups, methods to improve financial burden to applicants.

References: 1. Association of American Medical Colleges: How Do I... Pay for Medical School? Washington, DC: Association of American Medical Colleges, 2013 (https://www.aamc.org/students/aspiring/paying/283080/pay-med-school.html)[Accessed February 17, 2015] 2. Claiborne JR, Crantford JC, Swett KR, David LR: The Plastic Surgery Match: Predicting Success and Improving the Process. Annals of plastic surgery 70:698-703, 2013 3. Kerfoot BP, Asher KP, McCullough DL: Financial and Educational Costs of the Residency Interview Process for Urology Applicants. Urology 71:990-994, 2008 4. Lieber BA, Wilson TA, Bell RS, Ashley Jr WW, Barrow DL, Wolfe SQ: Gauging the feasibility of cost-sharing and medical student interest groups to reduce interview costs. Neurosurgical focus 37:E11, 2014 5. Marasa LH, Pittman TA: Factors neurosurgery candidates use when choosing a residency program. J Neurosurg 120:167-172, 2014 6. National Resident Matching Program: Charting Outcomes in the Match, 2009. Washington, DC: National Resident Matching Program, 2009 7. National Resident Matching Program: Charting Outcomes in the Match, 2014. Washington, DC: National Resident Matching Program, 2014 8. National Resident Matching Program: Results and Data: 2014 Main Residency Match. Washington, DC: National Resident Matching Program, 2014 9. Rogers CR, Gutowski KA, Munoz-Del Rio A, Larson DL, Edwards M, Hansen JE, et al: Integrated plastic surgery residency applicant survey: characteristics of successful applicants and feedback about the interview process. Plastic and reconstructive surgery 123:1607-1617, 2009 10. Society for Neurological Surgeons: Information for Residency Applicants. Indianapolis, IN: Society for Neurological Surgeons, 2014 (https://www.societyns.org/match_information.html) [Accessed February 17, 2015] 11. U.S. News & World Report: Best Medical Schools: Research. Washington, DC: U.S. News & World Report, 2014 (http://grad-schools.usnews.rankingsandreviews.com/best-graduate-schools/top-medical-schools/research-rankings?int=98fd08) [Accessed February 17, 2015]