UC Irvine

Every year, applicants to genetic counseling graduate programs are burdened with the upfront cost of the application process. In addition to application fees, there are also “hidden costs” of applying, including graduate exam fees, prerequisite coursework, travel expenses for interviews, and time off from work to obtain relevant volunteer experiences. These costs can add up and become a hurdle for many applicants, especially those with fewer resources. Furthermore, the high costs of applying can become a barrier to diversifying the workforce. Because the financial barriers of the application process have not been extensively explored through empirical research, the aims of this study were to address the following: 1) What were the median application costs for prospective students applying to genetic counseling programs in the United States? 2) What aspects of the application process were most expensive? 3) Were there differences between individuals of historically underrepresented racial and ethnic backgrounds in medicine (hURM) and non-underrepresented applicants with respect to total application costs, accrued volunteer hours, parental education, and familial financial assistance? A survey was developed to capture demographic information, application history, application and preparation expenses, time volunteering, and financial resources. A total of 383 responses were analyzed. Median total application costs for respondents who attempted one application cycle were $2,634 (n = 264, range: $202 - $25,693). For those who attempted twice, median total costs were $4,762 (n = 84, range: $909 – $24,206). Interview-related items had the highest median cost (one application cycle: $879, range: $0 - $6,007; two or more application cycles: $1,310, range: $0 - $7,307). Among those who applied to more than one cycle, hURM respondents (n=19) had higher median total costs ($6,713 versus $4,762, p = 0.03) and lower median total volunteer hours (246 versus 381 hours, p =0.03) than those of non-underrepresented individuals (n = 100). Additionally, parental education level differed (p = 0.04) between the two groups. Higher parental education level was correlated with a higher percentage of familial financial support (p = 0.0009). Stakeholders within the profession should implement strategies to reduce financial barriers and the resulting inequities in the application process, which will improve access to genetic counseling graduate programs and enhance efforts to diversify the workforce.