Money Matters: Anticipated Expense of In-Person Obstetrics and Gynecology Fellowship Interviews Has Greater Impact for Underrepresented in Medicine and Women Applicants

Background: Much of the expense of pursuing subspecialty training in obstetrics and gynecology (ObGyn) is due to in-person fellowship interviews. Although interviews were converted to a virtual platform for the 2020 fellowship interview season in response to the COVID-19 pandemic, candidates anticipated in-person interview expenses at the time of their application. It is unknown whether financial considerations influenced candidates' decision to pursue fellowship training. This study aimed to evaluate the financial impact of anticipated in-person fellowship interviews among applicants of ObGyn subspecialties. Materials and Methods: This was a planned secondary analysis of a survey administered during the 2020 interview season to evaluate the effectiveness of virtual ObGyn fellowship subspecialty interviews in creating a rank list. Information was obtained about anticipated and actual interview costs, the need for securing additional funding and whether financial considerations influenced the decision to apply for fellowship. Results: In total, 158 participants enrolled in the 2020 National Resident Matching Program for ObGyn fellowship programs (48%) completed the web-based survey. Women and Black fellowship applicants were more likely than men (p = 0.044) and White applicants (p = 0.014) to endorse a need to secure additional funding for in-person fellowship interviews. In addition, Hispanic and Black applicants were more likely than White applicants to report that the financial impact of fellowship interviews influenced the decision to apply "somewhat"or "to a great extent"(p = 0.025 and p < 0.001, respectively). Conclusions: The costs of applying to ObGyn fellowship programs may disproportionately affect women and underrepresented in medicine applicants. By reducing a financial barrier, virtual interviews may help promote greater gender and racial and ethnic diversity in ObGyn subspecialty pursuit.