I’ve never had a virtual interview for any position, but the distance interview may soon be the norm. I wish the option had been around when I was an applicant for med school and residency.

As a college senior, I didn’t have a lot of money and my class schedule wasn’t exactly flexible. Fortunately, two of the schools that invited me for an interview were in-state, and one was right on campus where I already was.

Nashville was a decent road trip; I would repeat the trip to Vanderbilt for a residency interview four years later and continue on to Tampa. I called the folks in Gainesville to let them know I was in the area, but they didn’t have an interview slot for me yet. A month or so later, I flew back to Florida and eventually became a Gator Sedator.

Thankfully, most of the programs put me up in a hotel and fed me a good meal, but the logistics and cost of travel was a challenge in those days. Two decades later, the virtual interview promises to make life a bit easier for our future doctors. But can you really get a good feel for a program or school and its people via a Zoom call?

This post was written by Dr. Michelle Finkel, the founder of Insider Medical Admissions. We have no financial relationship.

The Virtual Interview for Medical School and Residency Will Save Everyone a Bundle of Money

Unintended Consequences

There are three Starbucks near my house: One has outdoor space with an ocean view, one has a highly sophisticated drive-through window, and one has indoor seating in a mall. The first two have been busy lately. The last one recently closed.

“Unintended consequences” is a sociologic term referring to outcomes of a purposeful action that are not foreseen. While COVID-19 was not an intentional phenomenon, we have observed many unintended consequences of the virus – medical, psychological, educational, environmental, and fiscal.

The thrust of the unintended consequences notion is that the repercussions would have seemed haphazard if someone had tried to predict them: A Starbucks with a drive-through window thrives, but one in a mall becomes defunct. Most COVID-19 unintended consequences are very bad or even tragic; a small fraction are positive.

COVID’s impact on medical school and residency interviews has been decisively beneficial for the majority of applicants – particularly for their wallets.

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The Cost of Medical School and Residency Interviews

For many years, medical school and residency applicants have been expending large amounts of money on interviews. Candidates purchase plane and train tickets and pay for hotels. They might need to buy professional attire and pay for food on their many interview trips as well.

Coordinating the timing of interviews can help mitigate the high costs, but synchronizing interviews at institutions in the same geographic location can be a challenge. Because of limited available interview slots, one medical school candidate I advised last year could not match the timing of his West Coast interviews, so he scheduled two back-to-back cross-country flights.

Some candidates are forced to spend down precious savings, take on high-interest credit card debt, or borrow from family members to interview at the convenience of the programs at which they hope to Match. Added to the exploding expense of a medical education, interview costs have an impact in creating medical graduates with a negative net worth.

Medical school applicants who have sufficient financial need can qualify for the Association of American Medical Colleges® (AAMC) Fee Assistance Program (FAP), but even those pre-meds who are approved for the FAP do not receive financial support for interview costs. The FAP does not exist for residency applicants at all.

Interview Expenses Are a Zero-Sum Game for Programs

The financial burden of in-person interviews is not levied only on the applicants, although they are certainly most vulnerable. Medical institutions also pay handsomely for their interview days in an effort to welcome and charm competitive candidates.

When I was an Assistant Residency Director, we invited applicants to an event at a restaurant the night before the interview and fed them lunch on the day they visited. Faculty who conducted interviews, including me, were treated to a meal as we discussed applications.

While institutions may have different offerings, their interview costs persist for months throughout the cycle. The money going toward wooing applicants and showing appreciation for faculty work could instead be funneled toward competing priorities like funding more scholarships or further enhancing medical education.

COVID-Prompted Virtual Interviews

This application cycle, things will be drastically different: Because of COVID-19 health risks, the AAMC has wisely recommended that all medical school and residency interviews be conducted virtually. (Currently, there is no version of the AAMC virtual interview recommendations tailored to fellowship applicants.) Formats may vary, but interviews for medical school and residency will not be in-person.

Peculiarly, interview modifications necessary to keep medical school and residency interviewees and faculty safer from COVID-19 might facilitate a more efficient, less costly interview season. Try as she might, Pandora won’t be able to shut this open box: Once virtual interviews become a validated alternative to in-person interviews, they should stay.

College students have optional interviews, and many law schools do not offer them at all. There is an argument to be made that virtual interviews alone – with in-person sessions late in the application season for admitted/Matched students – could work. In this case, medical schools and residencies could offer something akin to what colleges call “prospective freshman” visits.

However, some might say that medical school and residency are different. There is a larger volume of applicants to both college and law school compared to medical school. And we physicians like to think that character is critical to upholding medical professionalism’s mandate that we put our patients’ interests before our own.

She’s Just Not That Into You

So, even if one were to argue that a purely virtual interview process for medical school and residency is inadequate, remote interviews could be a way to make the admissions process more efficient and economically palatable for years to come: Schools and residency programs could readily hold virtual interviews as a first round in the selection process, later inviting only those who make the cut for in-person interviews. Like speed dating, virtual interviews would help to screen out the suboptimal candidates.

Not only would this save applicants and institutions money, it would also help candidates who have overlapping responsibilities. Medical students applying to residency, in particular, can have it tough, as they continue rotations while trying to get to interviews.

One otolaryngology residency candidate I mentored had to skip an interview at a desirable program because he had already taken off too many days from his clerkship and had to choose between attending the interview and receiving a failing evaluation for the clerkship. Presumably, the timing of a virtual interview would be more accommodating than the rigid, in-person interview dates students grappled with in past cycles.

Having Big Brother Watching May Promote Better Interviewer Behavior

There are other important advantages to virtual interviews: They might mitigate some of the inequalities in the application process. While gender and race will still be distinguishable in remote interviews, it will be harder for the rare faculty member who wants to slip in an illegal question (“Do you plan to get pregnant during residency?”) to do so.

In an era of cheap technology, where law enforcement and bicycle helmets can easily be outfitted with video cameras, it would be relatively simple for an applicant to record a virtual session unbeknownst to the interviewer. In the past, what happened in the room between faculty member and candidate followed the logic of what happens in Vegas stays in Vegas.

With remote interviews, rogue faculty interviewers can no longer safely assume (as Lin-Manuel Miranda might put it) no one else was in the room where it happened.

Investing in Better Strategy Instead of In-Person Interview

One advantage of not paying for travel, lodging, and food for multiple in-person medical school or residency interviews is that the money can instead be put toward improving a candidate’s application strategy by applying to more institutions.

Medical students apply through a centralized system called the American Medical College Application Service, or AMCAS®. The AMCAS processing fee for 2021 is $170 and includes just one medical school designation; additional schools cost $41 each.

The residency equivalent of AMCAS is the Electronic Residency Application System, or ERAS®. Applying to 10 programs or fewer in the same specialty costs $99; 11-20 programs is an additional $16 each, and the price continues to increase with 21 to 30 programs and 30+.

There is also an $80 cost for United States Medical Licensing Examination (USMLE®) or Comprehensive Osteopathic Medical Licensing Examination (COMLEX®) transcripts.

Of course, throwing a very wide net and applying haphazardly without consideration of an applicant’s candidacy is not effective; the AAMC points out that there is a point of diminishing returns on the number of residency applications submitted. But, on the whole, putting $16 towards applying to one more residency program is a better strategy than spending it on an overpriced airport burrito during a snowstorm while trapped at O’Hare.

As a professional medical school and residency advisor, I would also argue that putting funds toward solid, expert help with written materials and mock interview support from an experienced advisor is a better use of resources than spending it on flights, hotels, and restaurants. This is especially true for those applicants who do not have any skilled, accessible mentorship available to guide them through a flawed admissions process.

The Best Way to Predict the Future is to Choose It

I consider myself a realist, and few who know me would accuse me of viewing the world through rose-colored glasses. In my assessment, COVID-19 has been an unmitigated disaster, and my stomach turns a little when someone tries to highlight silver linings for a disease that is killing hundreds of thousands of people globally.

The unintended consequences of the virus, though, need to be examined to see if some of the lessons we learn might lead to better, more efficient, fairer systems going forward. In this case, virtual medical school and residency interviews introduced as an adaptation to COVID might just be the equivalent of the Starbucks with outdoor seating and an ocean view.

And I’ll trust that if you are reading Physician on Fire you won’t blow your savings on a grande frap.

Dr. Michelle Finkel is a board-certified emergency physician and the founder of Insider Medical Admissions, where she provides advising services, editing, and virtual interview practice for residency, medical school, fellowship, post-baccalaureate, and dental school applicants.

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Have you taken part in a virtual interview? What are the advantages and disadvantages that you see?