Solving Congestion in the Plastic Surgery Match: A Game Theory Analysis

Abstract

Summary: Plastic and reconstructive surgery is among the most competitive specialties in the residency match. Applicants seeking to maximize their chances of a successful match often submit numerous applications to the National Residency Matching Program. It is not uncommon for those applying to plastic and reconstructive surgery to apply to every program. The high application volume imparts significant time and financial burden for applicants and programs alike. Furthermore, it makes distinguishing between applicants with a genuine interest in a specific program and those who are merely hoping to improve their chances vastly more difficult. The authors sought to characterize trends in the match rate, as the number of integrated plastic and reconstructive surgery programs continues to increase. Furthermore, they reviewed the literature on game theory for possible solutions to residency application congestion. The authors propose the use of the game theory model to explain the observed results and show why an application limit is the most reasonable approach to address this issue.

Social media impact in the Match: A survey of current trends in the United States

“…As discussed earlier, a vast majority of current applicants apply indiscriminately, likely due to a fear of "missing out" or not matching into an integrated position. However, this creates con-gestion in the Match process, which negatively impacts both applicants and programs [4]. Decreased review time of applicants by faculty, institution of "cutoffs" (USMLE, research experiences, AOA status), and overbooking of applicants are all results of this congestion [5].…”

“…Applicants frequently take a "shotgun" approach, applying indiscriminately to every available program. According to recent literature, applicants in the 2017 Match cycle applied to a median 70 out of 73 programs [4]. Anecdotally, most applicants explain this behavior as resulting from a fear of not matching into a competitive field.…”

“…However, this behavior is not without consequence. Molina Burbano et al [4] discussed the "congestion" that exists in the residency interview process as a result of this indiscriminate application approach. The authors reference the game theory phenomenon of "prisoner's dilemma, " previously described in urology residency application by Weissbart et al [5], which explains why people tend to act in a self-serving manner, even though cooperation amongst individuals would produce a more beneficial result for all.…”

Visiting Subinternships in Wake of the COVID-19 Crisis

“…Currently, completing both home and away rotations is crucial to a successful plastic surgery application, with over 90% of applicants completing at least one away rotation 3 . These rotations provide opportunities for students to evaluate training offered at various programs and earn letters of recommendation.…”

“…Similarly, both home and away rotations enable programs to select candidates who are the best "fit" for their residency. Underscoring the significance of this process, it is estimated that over half of applicants match at either their home institution or a program where they completed an away rotation 3,4 .…”