No Place like Home: Is There Selection Bias in Plastic Surgery Residency Match Process?

Integrated plastic surgery is among the most competitive specialties in medicine. In 2015, there were 67 integrated plastic surgery residency programs, offering 148 training positions, with 206 applicants for these positions.[1] Geography plays a significant role in applicants’ decision as to where to apply. An association between residents’ matriculated medical school and residency program has been identified in several surgical specialties, including ophthalmology, general surgery, and otorhinology.[2-4] Although many factors contribute to the success of an applicant in matching into a plastic surgery program, the role of geography in the match has not been explored.

American Medical Association’s interactive database was accessed for the list of integrated plastic surgery programs in June 2015. Sixty-seven plastic surgery program Web sites were accessed and data were collected. Programs were categorized based on US census bureau-designated regions, namely Northeast, Midwest, South, and West, and number of residency positions available. One-way Analysis of Variance (ANOVA) and Student’s t test were used for comparison with P value of <0.05 considered as statistically significant.

Four hundred seventy-three residents belonging to 43 programs, which had complete listing of residents available on their Web sites, were identified. Ninety-three (19.6%) residents attended the medical school affiliated with their residency program. This is similar to the trends seen with otolaryngology residency match where 20% of the residents attended the program affiliated with their medical school.[3]

Larger programs, with 11 or more residents, were found to have a higher proportion of residents attending the program affiliated with their medical school compared with smaller programs, with less than 11 residents (24.2% versus 14.8%) (Table 1) (P value = 0.03). Interestingly, geographic bias also differed with regions. Northeast had the highest proportion of residents from the same region (57.7%), whereas the West had the lowest proportion (13.2%; P value < 0.0003) (Table 2). It is important to note that residents who matched at programs in the West versus those that matched in the Northeast had no statistically significant difference in availability of plastic surgery residency program affiliated with their medical school of graduation.

Table 1.

Geographical Trends of Residents Based on Size of the Program

Table 2.

Geographical Trends of Residents Based on Region of the Program

In conclusion, in integrated plastic surgery residency programs, one fifth of residents attend the same program as their matriculated medical school. Geographic association between residency program and medical school is strongest for the residents in the Northeast and weakest for those in the West. We believe this geographic bias has implications for applicants in the match as it appears that medical students in the Northeast and those from large programs are more likely to match at a program affiliated with their medical school of graduation compared with other regions. These data may also be relevant to the few undergraduate students who have an interest in plastic surgery. Whether our findings are secondary to program or applicant preference is unclear, but our analysis sheds light on some biases that may be exceedingly relevant to aspirants of plastic surgery.

ACKNOWLEDGMENT

Authors thank Hector Campbell, MD, for his assistance toward acquisition of data for this manuscript.