1. Abstract References Methods Introduction Results Conclusions Figures/Graphs Emergency Medicine residency interviews are an important, yet costly process for programs and applicants. We sought to determine the total economic burden of this process. We are hopeful our results may start the conversation on ways to reduce costs of …. Abstract Click headings to further view content The National Residency Match Program (NRMP) or The Match TM is an increasingly competitive and stressful process for fourth year medical students intending to further their training. Of the many components of this process, interviews…. 82/204 EM PDs completed the survey $224,712 per program to conduct their interview season 80% of EM ….. IRB-approved, piloted email surveys were sent to accredited (ACGME and AOA) EM Program Directors and senior medical student members of EMRA. Participants were surveyed in August 2015. During the most recent Emergency…. Emergency Medicine residency interviews are an important, yet costly process for programs and applicants. We sought to determine the total economic burden of this process. We are hopeful our results may start the conversation on ways to reduce costs of the interview process. The total economic impact of the EM interview season is unknown. We calculated the total dollars spent by EM residency programs and estimated dollars to be spent by senior medical students. EM residency programs and applicants appear to spend as much as $70 million per cycle on the application interview process. This amount serves as a significant contributor to growing …. 1.National Resident Matching Program, Results and Data: 2015 Main Residency Match®. National…. Jeffrey Van Dermark MD, David Wald DO, John Corker MD, David Reid DO The Departments of Emergency Medicine at University of Texas Southwestern Medical Center and Lewis Katz School of Medicine at Temple University Financial Implications of the EM Interview Process

2. Abstract References Methods Introduction Results Conclusions Figures/Graphs Emergency Medicine residency interviews are an important, yet costly process for programs and applicants. We sought to determine the total economic burden of this process. We are hopeful our results may start the conversation on ways to reduce costs of …. Introduction Click headings to further view content The National Residency Match Program (NRMP) or The Match TM is an increasingly competitive and stressful process for fourth year medical students intending to further their training. Of the many components of this process, interviews…. 82/204 EM PDs completed the survey $224,712 per program to conduct their interview season 80% of EM ….. IRB-approved, piloted email surveys were sent to accredited (ACGME and AOA) EM Program Directors and senior medical student members of EMRA. Participants were surveyed in August 2015. During the most recent Emergency…. The National Residency Match Program (NRMP) or The Match TM is an increasingly competitive and stressful process for fourth year medical students intending to further their training. Of the many components of this process, interviews represent the most sensitive evaluative factor for both applicants and residency programs. Applicants cite residency interviews and their personal interactions with other residents among their most important considerations influencing their rank list for residency choice. These interviews are expensive high stake ventures for applicants and for residency programs. The average US medical school graduate holds nearly $180,000 in medical school debt, while the average total four year medical school cost of attendance is over $240,000. Emergency Medicine residency positions have become increasingly more competitive to obtain. This in part has driven up the number of applications students are advised to submit (and pay for on a per application basis) along with the number of interviews they are encouraged to seek (and finance). This rising debt burden serves as a primary impediment to national policy efforts to improve physician workforce diversity and mitigate shortages in primary care and certain geographic areas. Additionally, applicants state that this burden significantly impacts major life choices like when to start a family, buy a house, or fellowship decisions. Residency programs divert numerous hours and resources away from their educational mission toward a months-long, time and labor-intensive process of evaluating hundreds of students for each open residency position. Within the context of unsustainable national health care spending, largely funded by Medicare dollars, residency programs commit previously unknown total resources to the interview process. As residency program budgets continue to tighten, these vital federal funds are threatened on the budgetary chopping block year after year. To date, there is a paucity of data outlining the actual costs of this process. In this study, we strive to determine the true financial impact of the Emergency Medicine (EM) residency interview process and to use our findings to propose meaningful changes that may make this process more efficient and less burdensome for all involved. EM residency programs and applicants appear to spend as much as $70 million per cycle on the application interview process. This amount serves as a significant contributor to growing …. 1.National Resident Matching Program, Results and Data: 2015 Main Residency Match®. National… Jeffrey Van Dermark MD, David Wald DO, John Corker MD, David Reid DO The Departments of Emergency Medicine at University of Texas Southwestern Medical Center and Lewis Katz School of Medicine at Temple University Financial Implications of the EM Interview Process

3. Abstract References Methods Introduction Results Conclusions Figures/Graphs Emergency Medicine residency interviews are an important, yet costly process for programs and applicants. We sought to determine the total economic burden of this process. We are hopeful our results may start the conversation on ways to reduce costs of …. Methods Click headings to further view content The National Residency Match Program (NRMP) or The Match TM is an increasingly competitive and stressful process for fourth year medical students intending to further their training. Of the many components of this process, interviews…. 82/204 EM PDs completed the survey $224,712 per program to conduct their interview season 80% of EM ….. IRB-approved, piloted email surveys were sent to accredited (ACGME and AOA) EM Program Directors and senior medical student members of EMRA. Participants were surveyed in August 2015. During the most recent Emergency…. IRB-approved, piloted email surveys were sent to accredited (ACGME and AOA) EM Program Directors and senior medical student members of EMRA. Participants were surveyed in August 2015. During the most recent Emergency Medicine interview season (2014-2015) Program Director’s questions included demographics of their program, estimated faculty, resident and administrative time spent both preparing and conducting interviews of senior medical student candidates for residency. Non salary expenses for pre-interview dinners, food, beverage, transportation and lodging were also queried. EMRA senior medical students questions included demographics and estimated dollars to be spent during the current (2015-2016) season. Categories of expenses included ERAS application fees, airfare and ground transportation, lodging, clothing, miscellaneous expenses. Results were reported using descriptive statistics. Financial data were correlated with national academic EM faculty and resident salary surveys and Bureau of Labor Statistics administrative assistant salaries. Hours spent preparing and conducting interviews were totaled and multiplied by average hourly rates for EM faculty, program directors, residents and administrative assistants. Non salary expenses were added to the salary costs. These calculations created the total amount of dollars spent by EM programs during the previous interview season. Senior medical students responses were averaged according to each expense category and then totaled. This total average cost of applying and interviewing was multiplied by the EM candidate pool total according to 2015-2016 ERAS numbers. These calculations created the total amount of dollars spent by EM candidates during the current interview season. EM residency programs and applicants appear to spend as much as $70 million per cycle on the application interview process. This amount serves as a significant contributor to growing …. 1.Blah 2.Blah 3.Blah and Blah.... Jeffrey Van Dermark MD, David Wald DO, John Corker MD, David Reid DO The Departments of Emergency Medicine at University of Texas Southwestern Medical Center and Lewis Katz School of Medicine at Temple University Financial Implications of the EM Interview Process

4. Results Conclusions Figures/Graphs Click headings to further view content Jeffrey Van Dermark MD, David Wald DO, John Corker MD, David Reid DO The Departments of Emergency Medicine at University of Texas Southwestern Medical Center and Lewis Katz School of Medicine at Temple University Financial Implications of the EM Interview Process References Introduction Methods

5. Abstract References Methods Introduction Results Conclusions Figures/Graphs Emergency Medicine residency interviews are an important, yet costly process for programs and applicants. We sought to determine the total economic burden of this process. We are hopeful our results may start the conversation on ways to reduce costs of …. Results Click headings to further view content The National Residency Match Program (NRMP) or The Match TM is an increasingly competitive and stressful process for fourth year medical students intending to further their training. Of the many components of this process, interviews…. 82/204 EM PDs completed the survey $224,712 per program to conduct their interview season 80% of EM ….. IRB-approved, piloted email surveys were sent to accredited (ACGME and AOA) EM Program Directors and senior medical student members of EMRA. Participants were surveyed in August 2015. During the most recent Emergency…. 82/204 EM PDs completed the survey $224,712 per program to conduct their interview season 80% of EM program costs were due to faculty hours. 213/1425 EM bound M4 students completed the survey $6,838 per student to interview at EM programs 63% of student costs were due to airfare and lodging. Loans and credit cards will be the top two methods of payments by students. Extrapolating total programs, hours, salaries and expenses, total student candidates with their expenses, the economic burden of an EM interview season is: $51,683,582 Program Cost $22,722,674 Student Cost EM residency programs and applicants appear to spend as much as $70 million per cycle on the application interview process. This amount serves as a significant contributor to growing …. 1.National Resident Matching Program, Results and Data: 2015 Main Residency Match®. National… Jeffrey Van Dermark MD, David Wald DO, John Corker MD, David Reid DO The Departments of Emergency Medicine at University of Texas Southwestern Medical Center and Lewis Katz School of Medicine at Temple University Financial Implications of the EM Interview Process

6. Abstract References Methods Introduction Results Conclusions Figures/Graphs Emergency Medicine residency interviews are an important, yet costly process for programs and applicants. We sought to determine the total economic burden of this process. We are hopeful our results may start the conversation on ways to reduce costs of …. Conclusions Click headings to further view content The National Residency Match Program (NRMP) or The Match TM is an increasingly competitive and stressful process for fourth year medical students intending to further their training. Of the many components of this process, interviews…. 82/204 EM PDs completed the survey $224,712 per program to conduct their interview season 80% of EM ….. IRB-approved, piloted email surveys were sent to accredited (ACGME and AOA) EM Program Directors and senior medical student members of EMRA. Participants were surveyed in August 2015. During the most recent Emergency…. EM residency programs and applicants appear to spend as much as $70 million per cycle on the application interview process. This amount serves as a significant contributor to growing indebtedness for medical school graduates, and ever tightening budgets for residency programs. The application and interview cycle also requires valuable time and resources that could be alternatively used to enhance medical students’ fourth year of training as well as the educational mission of residency programs. It appears that EM residency programs may save the most money and resources by finding ways to become more efficient with the number of faculty hours dedicated to this process. In addition, applicants may be able to significantly reduce their costs by participating in centralized or regionalized, multi-program interview days to save on transportation, lodging and other travel-related expenses. Finally, since applicants are funding the majority of their costs via loan or credit card, there may be private business opportunities for banks or other lenders to offer specialized, low-interest loans and credit cards just for this purpose. It should also be noted that we did not include estimated costs associated with “audition” rotations completed outside of applicants’ home institutions. These month- long “away rotations” can often play a significant role in the evaluative process for both programs and applicants, and are universally expensive. Finally, some of the M4 survey responders indicated that their initial survey estimates included shared costs with a significant other with whom they would be couples-matching, thus potentially inflating projected costs for the individual applicant. Further study, over longer periods of time, into the actual costs of this process for programs and applicants will be required in order to better understand trends and more accurately assess the efficacy of future cost-saving interventions. EM residency programs and applicants appear to spend as much as $70 million per cycle on the application interview process. This amount serves as a significant contributor to growing …. 1.National Resident Matching Program, Results and Data: 2015 Main Residency Match®. National… Jeffrey Van Dermark MD, David Wald DO, John Corker MD, David Reid DO The Departments of Emergency Medicine at University of Texas Southwestern Medical Center and Lewis Katz School of Medicine at Temple University Financial Implications of the EM Interview Process

7. Abstract References Methods Introduction Results Conclusions Figures/Graphs Emergency Medicine residency interviews are an important, yet costly process for programs and applicants. We sought to determine the total economic burden of this process. We are hopeful our results may start the conversation on ways to reduce costs of …. Selected References Click headings to further view content The National Residency Match Program (NRMP) or The Match TM is an increasingly competitive and stressful process for fourth year medical students intending to further their training. Of the many components of this process, interviews…. 82/204 EM PDs completed the survey $224,712 per program to conduct their interview season 80% of EM ….. IRB-approved, piloted email surveys were sent to accredited (ACGME and AOA) EM Program Directors and senior medical student members of EMRA. Participants were surveyed in August 2015. During the most recent Emergency…. EM residency programs and applicants appear to spend as much as $70 million per cycle on the application interview process. This amount serves as a significant contributor to growing …. 1.National Resident Matching Program, Results and Data: 2015 Main Residency Match®. National… Jeffrey Van Dermark MD, David Wald DO, John Corker MD, David Reid DO The Departments of Emergency Medicine at University of Texas Southwestern Medical Center and Lewis Katz School of Medicine at Temple University Financial Implications of the EM Interview Process 1.National Resident Matching Program, Results and Data: 2015 Main Residency Match®. National Resident Matching Program, Washington, DC. 2015. 2.National Resident Matching Program, Data Release and Research Committee: Results of the 2014 NRMP Program Director Survey. National Resident Matching Program, Washington, DC. 2014. 3.2015 Medical School Graduation Questionnaire: All Schools Summary Report & Individual School Report. Association of American Medical Colleges, Washington, DC. 2015. 4.Tuition and Student Fees Reports. Association of American Medical Colleges, Washington, DC. 2015. http://services.aamc.org/tsfreports/ 5.Rohlfing, J et al. “Medical Student Debt and Major Life Choices Other than Specialty.” Medical Education Online 19 (2014): 10.3402/meo.v19.25603. PMC. Web. 14 Feb. 2016. 6.Iglehart, JK. Institute of Medicine Report on GME – A Call for Reform. N ENGL J MED 372;4 January 22, 2015. 7.Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2016-17 Edition, Secretaries and Administrative Assistants, on the Internet at http://www.bls.gov/ooh/office-and- administrative-support/secretaries-and-administrative-assistants.htm 8.Stern D and Associates:, 2014 National Emergency Medicine Salary Survey: Academic Report, American College of Emergency Physicians. 2014. 9.Kane L, Peckham C, Medscape Residents Salary & Debt Report 2014. Medscape/WebMD. New York, NY. 2014. 10.Turner J, Reid D. The Medical Student Survival Guide. Emergency Medicine Residents’ Association. 2015