The Price of Fear: An Ethical Dilemma Underscored in a Virtual Residency Interview Season

In May 2020, the Coalition for Physician Accountability recommended that all residency programs pivot to virtual interviews for the 2020–2021 season. This kept more than 45 000 applicants from traveling cross-country during a pandemic, aiding social distancing efforts. Additionally, it removed travel costs, granting applicants the opportunity to assess more programs. With opportunity and human nature, however, comes the risk of an arms race, where a more open residency market compounds pressure on students to apply to more programs. The residency application process has gone down a behavioral economics rabbit hole, where fear and uncertainty are unnecessarily driving up applications, despite evidence of no benefit to applicants or programs. In what follows, we contextualize the growing problem of application inflation, describe contributing drivers including those introduced by virtual interviews, raise concerns about a conflict of interest for the application steward, and discuss potential solutions.