The Carbon Footprint of Residency Interviews

To the Editor:

Every year, approximately 35,000 medical students apply to the National Resident Matching Program (NRMP). ¹ Many programs require students to travel cross-country for interviews. Although airplane travel is a growing greenhouse gas contributor to the climate emergency, residency interview air travel emissions have yet to be assessed. In this letter, we describe the carbon footprint and environmental impact of in-person residency interviews for the 2020 Stanford Medical School graduating class.

The 89 students of Stanford Medical School’s 2020 graduating class shared their matched residency, number of interviews, and detailed flight information. We calculated carbon dioxide (CO₂) emissions using the Atmosfair flight emissions offset calculator. ² We assumed all respondents traveled in economy class on nonchartered flights.

For the Stanford Medical School’s 2020 graduating class, the median number of interview flights was 8. Total airplane travel CO₂ emissions was 986,710 pounds, with median emissions per student of 12,331 pounds. Students applying for residencies in neurosurgery and family medicine specialties had the highest and lowest mean emissions at 29,882 pounds and 4,284 pounds, respectively. However, students applying for residencies in every specialty produced emissions that exceed the global average annual emissions limit necessary to achieve the 2016 Paris Climate Agreement goals. ³

In sum, travel required by the Stanford School of Medicine 2020 graduating class emitted nearly 1 million pounds of CO₂, roughly equivalent to the carbon sequestration capability of 700 acres of forest. Based on the Social Cost of Carbon (SCC), an environmental, economic conversion factor, we estimate the environmental cost of the NRMP program for Stanford is approximately $5,000 per student. Considering that medical students spend on average $3,500 for residency interview travel, the environmental costs may in fact exceed the direct economic costs. ⁴

Our research reveals that CO₂ emissions are a relevant and underrecognized disadvantage of in-person residency interviews. With the COVID-19 crisis, residency programs are already switching to online interviews. Continuing an online format in the postpandemic era—perhaps along with other changes, including batched regional interviews, strict limits on the number of in-person interviews, and/or a more regional rather than national approach to medical training—could help inform a more sustainable approach to medical education.