The Cost of Connection: It Just Might Be Worth It

It has become well known that we are more disconnected as a species than ever, despite having countless ways to connect. On top of incessant exposure to social media, the ease of multi-tasking while on tumor board or in chart rounds is wildly tempting, contributing to our ever-shrinking attention spans and distractibility. That said, connecting electronically was foundational in how we weathered the height of the COVID-19 pandemic. On the other hand, one wonders whether that resource became too much of a crutch, one that we continue to need just to walk.

It’s no secret that the fallout from COVID has seemingly touched every aspect of life, including our connectivity. And while the ease of conferencing via Zoom has revolutionized how we meet, it has also impacted experiences that are meant to be deeply personable and are not replicated on Zoom. Resident interviews are a case in point.

It is true that virtual interviews have saved students thousands of dollars in travel and lodging costs, as well as countless hours waiting in TSA lines and changing in airport bathrooms. Certainly, it is not ideal to add a four-figure price tag to already exorbitant undergraduate and medical school debt. But that price also extends to intimate connections and new relationships, as well as formative encounters that challenge and influence perspectives and overall growth. Can you really put a price on that experience, that personal and professional development?

"In-person interviews enable students to explore the culture and environment of a program in the flesh, allowing them to get a “gut feel” for the program and visualize themselves as a resident there (or not)".

Certainly, with more organizational and preparatory adjustments, virtual interviews could become more personable and engaging for applicants.1 Maybe even with advances in virtual reality, applicants could someday get that “gut feel” virtually. In the meantime, we are left pulling personalities from the ether of blank stares in little rectangles on a screen.

Nonetheless, the financial cost of this “gut feel” is not inconsequential. The AAMC (Association of American Medical Colleges) reported that “reducing the cost of interviewing is a critical step in widening access and improving equity.”2 This is a crucially valid point but is also a gap that can be narrowed by programs and efforts to offset the cost to applicants. With conscientious budgeting, programs could allot money for applicant hotel rooms or provide other travel reimbursements. Or perhaps programs could employ a hybrid approach and start with an initial Zoom interview, then progress to a second round of interviews in person, for which lodging costs would be covered by the program. This would narrow the number of in-person interviews down to those in which the applicant and the program are most interested, potentially generating more valuable interactions and further reducing cost. There would still be financial implications for applicants, yet they would be tied to the experience of exploring new places and meeting new people. No computer screen can provide this vantage.

Surveys of residents have shown a mixed picture about whether applicants like virtual interviews. One family medicine residency study showed an even split, where 50% of residents preferred virtual interviews.3 Other institutions have evaluated the best evidence-based practices for optimizing virtual interviews,4 but still, none of these suggestions are equal to an in-person interaction with body language, environmental surroundings, and the creation of a unique five-sense impression.

Particularly in a small field like radiation oncology where our fellow residents will be our colleagues for the rest of our careers, virtual interviews become a barrier to meeting each other. While conferences pose an opportunity to meet and connect, it’s much more intimidating (and easier to be avoidant) if a resident attends only knowing their own core sidents. Whereas if preliminary connections have been made, conferences facilitate an enjoyable way to reconnect and deepen those relationships, with potential implications for employment networking. After all, in a small field, who you know has a substantial impact on professional opportunities, both within and after residency.

However, like any radiation plan, we must weigh the benefits against the toxicity we know may accompany treatment. And just as our patients are individuals with unique anatomy and plans, we also are individuals with varying risk tolerances and goals. While deep human connection is profoundly gratifying (and fundamental to our existence as humans, not just radiation oncologists), it is not without side effects. In the case of residency interviews, that may look like a grade 3 dermatitis of your bank account – painful at the moment, but that erythema may be worth it in the long run.


  1. Lee E, Terhaar S, Shakhtour L, et al. Virtual residency interviews during the COVID-19 pandemic: the applicant’s perspective. South Med J. 2022;115(9):698-706. doi:10.14423/SMJ.0000000000001442
  2. AAMC. Interviews in GME: Where Do We Go From Here? Accessed December 8, 2023.
  3. Bishop T, Heinrich L, Greenberg J, Wenner R, Furst W, Wong J. The impact of virtual interviews on the resident candidate: a before-and-after comparison. Fam Med. 2022;54(10):833-835. doi:10.22454/fammed.2022.510274
  4. Huppert LA, Hsiao EC, Cho KC, et al. Virtual interviews at graduate medical education training programs: determining evidence-based best practices. Acad Med. 2021;96(8):1137-1145. doi:10.1097/ACM.0000000000003868

Kyra N. McComas, MD

PGY4 resident physician, Department of Radiation Oncology, Vanderbilt University Medical Center.