This survey study provides informative perspectives about the January 2021 Urology match, which was conducted in the heart of the COVID-19 pandemic with restricted access to externships and via virtual interviews. The authors report that most responders, both candidates and program directors (PDs), were satisfied with their match outcomes. Nearly all candidates and PDs were strongly in favor of expanding future opportunities for in-person externships. These externships allow candidates to visit another program, build relationships and assess potential fit, and obtain reference letters, and they are particularly important for candidates who do not have a Urology department at their home institution. On the other hand, both resident candidates and PDs were ambivalent about whether interviews should remain virtual vs returning to an in-person format. The authors recommend virtual interviews in future match cycles to reduce the financial burden placed on candidates and to make the process more equitable.
There are other recent developments in the Urology match process that will need consideration moving forward. These relate to the transition of USMLE Step 1 reporting to a pass/fail format, the robust increase in the number of candidates leading to a hypercompetitive environment, and the substantial costs associated with the entire process. Many candidates are now applying to an exorbitant number of programs, with the average being 82 based on recent AUA match statistics, and most programs are overloaded with candidates. At our center, we now have 6 faculty each cancel a day of clinic to ensure that every candidate's application is independently reviewed at least twice. Our goal is to be as fair as possible and to make sure that we are not missing any hidden gems. Removal of the UMSLE Step 1 score will mandate an even more time-consuming review process. This year candidates were allowed to signal strong interest to 5 programs. Perhaps there should also be a secondary signaling process whereby each candidate would also designate their top 30 programs, which would mitigate against the shotgun approach that is currently in practice. This would allow the programs to focus their efforts if they so desire and would likely help candidates, at least those who are realistic and sensible with their designations. Candidates who are not quite as strong might find this advantageous as they would then have some programs taking a good look at them, which might not occur otherwise. Candidates could and likely would apply to more than their 30 designated programs, but at least this would help inform programs about which candidates are most interested. Secondary signaling might also mitigate against “interview hoarding” among the top applicants, who generally are not at risk for an unsuccessful match. This would likely lead to a more equitable distribution of invites among qualified candidates.
Many future candidates will also likely want to pursue multiple externships (>2-3) to optimize match prospects. This, along with the arduous and time-consuming interview process, could compromise their general medical education and leave us with interns who are thrilled to be in our programs, but may not be optimally prepared to help take care of patients. Of course, the sensible, hard-working, and well-mentored candidate will make sure that they are taking enough challenging non-urologic rotations to ensure that they are adequately prepared. Nevertheless, perhaps there should be a limit on the number of Urology externships that candidates can take, or the length of the externships could be reduced.
Regarding in-person interviews, it is difficult to deny their potential value and perhaps there could be a process whereby each candidate would review their list of program invites and select 3 for in-person interviews. All their other interviews would be virtual. The programs would then schedule 1 or 2 days for in-person interviews and the remainder would be virtual. This would allow the candidates to learn as much as possible about the programs that they are most interested in without substantially increasing the total costs of the process.
We applaud the Society of Academic Urology (SAU) for their efforts to meet the challenges related to the pandemic and to make the match as fair as possible. In particular, the SAU's stance against second look visits has been very helpful for supporting an equitable process and limiting costs for the candidates.