Routes to Residency: A National Survey Demonstrating the Pathways to Become a Plastic Surgeon

Abstract

Background: Plastic and reconstructive surgery (PRS) residency training can be completed through multiple pathways. Current residents’ experiences regarding these different routes have not been previously described. The objective of the present study was to describe the educational pathways taken by current PRS residents in the United States. We hypothesized that there would be a small cohort of current PRS residents who were initially unsuccessful in matching into an integrated residency. Methods: An online survey was sent to PRS residents across all training years from October 2020 to January 2021. The survey collected information about residents’ match history, experience after not matching, and narrative comments on their route to residency. Public match data from the past 20 years (2001–2021) were also summarized with descriptive statistics. Results: One hundred seventy-four residents responded (response rate 15%; 174/1158). Of these, 133 applied to integrated programs as senior medical students, and 15 (11%) did not match after applying as a senior medical student. Unmatched applicants took multiple different routes to PRS, including participating in the Supplemental Offer and Acceptance Program, reapplying, transferring after some general surgery training, and completing an independent PRS residency. Three-fourths (76%) of independent program residents did not originally apply to the integrated match. Conclusions: An initial unsuccessful match result does not portend that one will not be able to train for a career in PRS. Our findings illustrate the potential routes to successful completion of PRS residency training, both for unmatched applicants and residents who develop later interest in PRS.

Residency Training Pathways of Program Directors and Chiefs/Chairs in Plastic Surgery

“…Stoehr et al looked at residency pathways taken by current plastic surgery residents in the United States, focusing on the routes taken by those residents who were unsuccessful in their initial efforts to match. 11 Residents who did not match into integrated plastic surgery programs pursued a preliminary or categorical year in general surgery, and then matched into independent plastic surgery programs or transferred into integrated plastic surgery programs. 11 Although there are many factors influencing how an applicant is selected for a particular program, it is apparent that the will of applicants to reach their desired goals empowers their ability to become plastic surgeons and, ultimately, leaders in the field.…”

“…This is evidence that either pathway does not hold an advantage in matching into preferred programs. 7,11,14,15 Although most people in the direct pathway group took a research year during medical school, respondents from the indirect pathway group predominantly took it during and after residency. This result is consistent with previous studies that demonstrated that applicants with completed research fellowships were more likely to match into plastic surgery, partially due to a greater number of publications.…”

“…The number of integrated positions has surpassed the number of independent positions in 2014. 6,11,15 The general trend of plastic surgery training reflects this change, with the number of integrated positions increasing every year (91 programs offering 207 positions in 2023) and number of independent positions decreasing every year (36 programs offering 57 positions in 2022), as a greater number of academic centers have opted to shut down their independent program. 1,7,20 The present study surveyed current PDs, chairs, and chiefs of plastic surgery residency programs, all of whom graduated medical schools by 2009 or earlier.…”

“…Although having an alternative plan in the case that one may not match into their top-choice residency is important, medical students should also be aware of the various training pathways that lead to similar leadership positions within plastic surgery. 11,12 The present survey study investigates numerous factors, including demographic diversity and training pathway completed, and asks the respondents to provide subjective perceptions of difficulty that these factors may have played in their career development. By demonstrating the barriers to career development that current PDs/chiefs/chairs experienced during residency, future surgeons who aspire to leadership roles within plastic surgery may have more realistic expectations of their upcoming career development and may therefore be less likely to be dissuaded from persevering in their goals when barriers are encountered.…”