key: cord-0021214-h6od3pfz authors: Tabakin, Alexandra L.; Gupta, Nikhil K. title: AUTHOR REPLY date: 2021-08-11 journal: Urology DOI: 10.1016/j.urology.2021.01.015 sha: 8d10ae5d2c4f95ad69fdc172199d23cf5a9645e7 doc_id: 21214 cord_uid: h6od3pfz nan 16. Koo K, Cone EB. When more is less: the burden of increasing urology residency applications. J Urol. Urology Resident Interview costs (fees and travel) have been "under the radar" and infrequently considered in the urology resident selection process. In 2008 an interview expense questionnaire was submitted to 287 applicants in the 2006 urology match. The median cost of the interview process was $4000. Personal loans paid for 60% of overall interview expenses. 1 A different survey in 2015 determined that 173 respondents spent a median of $7000 for the urology match and on-site interviews. Applicants attended a mean of 14 interviews. Seventy nine percent were asked to return for a second look interview. Of the respondents 66% did not receive any financial aid and only 28% believed their financial aid departments provided adequate financial planning. Of those surveyed 20% indicated that their financial situation limited the number of interviews. 2 Tabakin et al in their current study of 64 of 242 (26%) urology residents noted the median cost per applicant for the 2019-2020 Match was $9725. 3 Average travel costs ranged from $2000 to $ 3000 per applicant. The authors conjectured "these high costs not only contribute to student debt but also may deter applicants from entering the field of urology." What can be done to decrease this additional financial burden? In 1994, the Canadian urology residency training programs designed the "Canadian Urology Fair"−a single-site (Toronto, Ont.), 1-day fair to conduct the personal interview portion of the residency selection process. An analysis of 2001 Urology resident applicant noted that expense to attend Canadian Urology Fair was significantly lower than estimated expense of on-site interviews. Financial costs to urology programs were not significantly greater than on-site interviews. 4 This concept can be applied to a one site Resident Fair at the annual AUA meeting. Alternately, regional medical centers i.e., greater NY, Boston, LA, etc. can designate uniform time visits and thus decrease multiple trips to the same region. During the COVID, Web based Interviews have decreased resident expense. In the future (after COVID) resident application expense can be lessened by virtual interviews. In 2018, approximately 75% of medical students required loans, and their average debt at graduation was $200,000". 5 Urology should recruit a diverse group of the "best and brightest." Further financial encumbrance should not limit this selection. Financial and educational costs of the residency interview process for urology applicants Survey of applicant experience and cost in the urology match: opportunities for reform The financial burden of applying to urology residency in 2020 Canadian Urology Program D. The Canadian Urology Fair: a model for minimizing the financial and academic costs of the residency selection process The cost, price, and debt of medical education We would like to thank the editorial authors for their reply. The COVID-19 pandemic undoubtedly caused many changes in the application process for the American Urological Association (AUA) 2020-2021 Match, namely the near elimination of costs associated with visiting student rotations and travel for interviews. With the lack of opportunities for in-person clinical education, several urology programs created virtual away rotations and other remote clinical learning experiences. While not perfect substitutes, these opportunities may afford more applicants a chance to explore urology in an affordable manner. Future studies should aim to determine if these cost-friendly alternatives could be improved upon and effectively utilized to make urology a more inclusive field for subsequent application cycles. Alexandra L. Tabakin Financial burden and the year 2020 have become virtually synonymous. The timing of this publication, the investigation into the debt incurred for urology residency application, is tragically ironic amidst our global pandemic. The authors report their