Increasing Applicant Cost is Associated with Match Success in Neurosurgery Residency Applications.

Abstract

The financial burden of applying to neurosurgical residency is not well defined in the setting of recent changes such as STEP1 pass/fail and signaling. Rising application costs may create economic barriers that influence outcomes. This study examines the relationship between cost and matching. We analyzed 276 U.S. MD applicants submitting 1044 applications through the Texas STAR database (cycles 2019-2025; virtual 2021-2023 excluded). Costs included application, interview, and other fees. Outcomes were matching, interview offer, and interview count. Multivariable logistic regression modeled match and interview receipt; linear regression assessed interview number; ANOVA tested cost trends. Mean total cost was $12,864.46, consisting of $1611.46 in application fees, $6574.95 in interview-expenses, and $4308.72 in other costs. Matched applicants spent slightly less overall than unmatched applicants ($11,566.67 vs. $12,964.91; P = 0.041), though interview expenses were higher among matched applicants ($5940.00 vs. $6624.10; P = 0.125). Total costs increased significantly across the study period, rising from $11,301.04 in 2019 to $12,901.34 in 2025 (P < 0.001), driven by increasing interview expenses ($6490.36 → $6838.84; P < 0.001). In adjusted models, higher total cost was associated with increased odds of matching (odds ratio=1.12; 95% CI 1.05-1.19; P < 0.001). Total cost was not associated with receiving an interview (odds ratio=1.02; P = 0.17). Applicant costs and interview patterns varied significantly across geographic regions (P < 0.001). Applying to more programs was inversely associated with both match and interview odds but produced only a small increase in interview count. Higher spending is associated with increased match odds without increasing interview likelihood. More applications yield small interview gains but unsuccessful match outcomes.