Evaluating the Plastic Surgery Match: The Impact of Geography and Prestige

The number of resident positions in integrated plastic surgery residency is limited and highly sought after. Because of the intense competition for these positions, applicants are faced with the challenge of submitting multiple applications in the belief that doing so enhances their chances of successfully matching, often applying to the majority of plastic surgery programs across the United States. Much of the initial screening of the numerous applicants is necessarily accomplished through standardized ranking systems, a subjective process that fails to incorporate a candidate’s entire application. Evaluation of desirability of residency programs is similarly subjective and difficult to rank. The Daneshgaran et al.,1 Doximity, and U.S. News & World Report ranking systems, which utilized faculty research productivity, research output, and name recognition as ranking qualifiers, were used in this study to evaluate programs and successful applicants. Data from 1027 matched plastic surgery residents from 2016 through 2021 were collected. Chi-square analysis was performed to evaluate trends regarding home matching, regionality, and whether medical school prestige affected where successful applicants matched. Consistent with previous reports from 2015 of internal matching in plastic surgery (19.6 percent),2 18.2 percent of residents matched at their home institution (Fig. 1). A significant number of applicants matched within their home program and their region as well (p < 0.0001). Hashmi et al.2 reported a bias among residency programs, specifically in the Northeast, for applicants from the same region in 2015 (57.7 percent). In contrast, the South demonstrated the largest regional bias (Fig. 1) from 2016 through 2021 (62.3 percent).Fig. 1.: Effect of geography on home program and regional program matching.A significant number of students from top quartile medical schools matched at top quartile residency programs regardless of ranking system (p < 0.001). A total of 48.6 percent of all matched residents attended top quartile medical schools but comprised 57.8 to 81.4 percent of top quartile program matches annually (Table 1). Top applicants were less represented in the lower quartiles (40.6 percent). Table 1. - Top Quartile Residency Positions Filled by Top Quartile Medical School Graduates Year Daneshgaran et al. 1 Doximity Positions Top Quartile Graduates Percent Positions Top Quartile Graduates Percent 2016 59 37 62.7 55 37 67.3 2017 60 36 60.0 56 36 64.3 2018 61 38 62.3 58 38 65.5 2019 63 48 76.2 59 48 81.4 2020 64 37 57.8 60 37 61.7 2021 65 46 70.8 60 46 76.7 372 p < 0.0001 348 p < 0.0001 These data suggest a selection bias based on school reputation, as medical students from top ranked medical schools comprised up to 80 percent of residents at top-ranked programs. This indicates a significant disadvantage for students applying from non–top-ranked medical schools. Schultz et al.3 has proposed this could be attributable to the belief that these students have increased academic potential compared with their peers. Other studies, however, demonstrated increased program director satisfaction when greater emphasis is placed on subjective rather than objective factors of applicants (i.e., medical school reputation).4,5 Data collection from program websites and social media accounts, which are incomplete and variable year to year, is one of the limitations of this study. Other confounders in the application process include research years and away rotations performed at specific programs. Further research is necessary to fully elucidate the effects of these factors. Many factors are involved in the residency selection process, and it is in the best interest of applicants and residency programs to understand existing trends. This allows for applicants to focus their efforts on nearby programs when applying to residency positions. Integrated plastic surgery residency programs often select applicants from within their affiliated medical schools and geographic region. These data suggest that applicants from highly ranked medical schools are often more successful when applying to residency in plastic surgery, especially at top quartile plastic surgery programs. DISCLOSURE The authors have no financial interests or conflicts of interest to report.