American Association of Plastic Surgeons Meeting 2022

Home Sweet Home – The Integrated Plastic Surgery Residency Match During The COVID-19 Pandemic

Introduction:

Over the past 5 years, the number of integrated plastic surgery applicants has experienced a 53.3% increase However, the number of residency positions offered has only seen a 15.5% increase. This translates to a 10.7% increase in applicants per year compared to a 3.1% increase in positions offered per year.1 (Table 1)

The COVID-19 pandemic has led to inevitable changes in the residency application process. The past 3 years have been the most competitive in history. (Table 1) Therefore, any advantage an applicant can garner is of utmost importance (e.g. home matching). In previous years, one-fifth of plastic surgery residents matched into their home program with approx. 43% matching at programs where they completed an away rotation.2,3

Objectives:

Primary: To assess if the 2020-2021 and 2021-2022 plastic surgery match cycles and their outcomes related to home matching differed from previous years (2018-2020).

Secondary: To assess if the number of available positions, Doximity program rankings, geographic region, or rural-urban classification affected likelihood of home matching

Methods:

Data Collection

We reviewed publicly available match data from 86 ERAS-participating integrated US plastic surgery residencies between 2018 and 2022. Information was collected on residents’ medical school affiliation for US medical graduates or most recent clinical or research affiliation for international medical graduates (total, n=904). (Table X)

Statistical Analysis

The mean percentages of program spots matched to home across the years were compared using a t-test (α=0.05).

Logistic regression analysis was performed for priori-defined variables (and possible confounders). Both crude univariable and adjusted multivariable logistic analyses were performed.

•Variables included program size, program Doximity rank by reputation (1-25, 26-50, 51-75, 76-100, unranked), geographic region (Midwest, Northeast, South, West), and rural-urban classification (as per 2013 RUCC codes).

For analysis by number of positions, two (median program size) was used as the reference, while reference groups for analysis by ranking (1-25) and region (Midwest) were arbitrarily defined

Results:

Overview

•904 matched applicants identified across all 5 years. Of those, 901 (99.7%) had identifiable medical school or research fellowship affiliations.

•77 programs had complete 5-year match data (Table 2)

Incidence of Home Matching (Figure 1)

•Results revealed a statistically significant (t-test, p=0.0002) increase in the incidence of home matches in 2021 as compared to the aggregated three previous matches [2018-2020].

•Match 2022 experienced a statistically significant (t-test, p=0.037) decrease in home match incidence versus 2021.

Logistic Regressions (Table 3)

Match Year

•Applicants in previous years [2018-2020] were 50% less likely to match at their home as compared to 2021 (CI:0.3,0.9, p=0.01). Remained significant when accounting for confounders in the multivariate analysis (p=0.04).

•No statistically significant difference between 2021 and 2022.

Program Size

•Programs with only 1 available position were 30% less likely to match a home applicant in previous years [2018-2020] when compared to 2021 (CI:0.2,0.6, p=0.001). Remained significant when accounting for confounders in the multivariate analysis (p=0.003).

Ranking

•Statistically significant (p=0.04) in our multivariate analysis however no applicable significance was attained.

Region and RUCC

•No statistical significance in both univariate and multivariate analyses.

Conclusions:

•We suggest applicants were less comfortable ranking unfamiliar programs after virtual interviews in Match Cycle 2020-2021, and thus perhaps more likely "up-ranked” their home institutions.

•As for Match 2021-2022, we suggest that residencies were similarly likely to home match as seen by no significant difference compared to odds ratio seen in 2021.

•However, changes in this year’s cycle such as the reintroduction of away rotations (restricted to only 1) may have driven applicants, residencies , or both to decrease overall home-matching incidence.

•Future studies should focus on what specific factors are driving these changes in candidate and/or residency mentality related to home matching.

American Association of Plastic Surgeons Meeting 2022

Home Sweet Home: The Integrated Plastic Surgery Residency Match During The COVID-19 Pandemic

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