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Letters to the Editor

The Cost of One Residency Position: A Studio Apartment of Sea Ice

Green, Ellen W. MD, PhD; Burnett, Joel R. MD

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doi: 10.1097/ACM.0000000000003593
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To the Editor:

In 2018, I embarked on my residency interviews along with thousands of other hopeful residents and crisscrossed the country exploring opportunities for my education. As a former natural resource major with a thesis on climate change, I could not help but feel guilt for the hefty contribution to carbon dioxide emissions that I was making through air travel. Was walking the halls of recruiting hospitals worth the detriment to the environment? As a researcher, I knew the anthropogenic contribution of climate change was scientifically established. As a medical student, I knew that the changing climate had implications for human disease. But what choice did I have? For residency interviews, travel was the name of the game.

Then I discovered tools to quantify my concerns.1,2 I calculated that, in the 12 interviews I had attended (4 with my spouse), we had accumulated 25,733 air miles resulting in 6,049 kg of CO2 emissions. Accounting for my seats alone, that was 329.4 square feet of sea ice, just smaller than the average American studio apartment footprint. Now, consider the environmental cost of 44,600 residency applicants and their partners, crossing the country and sometimes the globe, to attend an ever-increasing number of interviews.

It is well established that climate change threatens global health.3 Furthermore, the suffering brought on by climate change is inequitable, disproportionately shouldered by our most vulnerable—the elderly, unsheltered, and those with poor access to weather refuge. As a profession dedicated to the health of humanity, we must confront the effects of climate change on health and align our actions with our values by recognizing the carbon footprint of residency interview travel and taking steps to reduce it.

In the wake of the disruptions to medical education brought on by the COVID-19 pandemic, we have the opportunity to reexamine and redesign systems to better fit our professional values. As training programs adopt virtual interviews out of social-distancing necessity, we urge them, for the sake of the environment, to consider investing permanently in a virtual interview system. In doing so, we honor our commitment as physicians to global health and social justice.


1. Newman A. If seeing the world helps ruin it, should we stay home? New York Times. Published June 3 2019 Accessed June 30, 2020
2. Notz D, Stroeve J. Observed Arctic sea-ice loss directly follows anthropogenic CO2 emission. Science. 2016;354:747–750
3. Watts N, Adger WN, Agnolucci P, et al. Health and climate change: Policy responses to protect public health. Lancet. 2015;386:1861–1914
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