Work

69. Exponential Increases in Cost, Competitiveness, and Complexity: The Integrated Plastic Surgery Match Burden

Year: 2023

Type: article

Abstract: PURPOSE: Integrated plastic surgery residency is now the dominant pathway for training future plastic surgeons. An increasing pool of applicants in conjunction with the transition of the Step 1 examination to pass/fail and the COVID-19 pandemic may have increased competitiveness and altered applicant behavior. We detail the current application burden, provide insights into the plastic surgery match, and posit a response to stabilize future cycles. METHODS: In total 2,166 applicants to integrated plastic surgery programs were included. The American Association of Medical Colleges and Electronic Residency Application Service databases were examined to determine applicant trends for the years: 2017, 2018, 2019, 2020, and 2021. The ERAS fee schedule for 2021 was used to estimate application cost and a conservative 4.3% interest rate was used to estimate future value of application costs. RESULTS: In 2017, there were 564 applicants and in 2021 there were 416, a 26% decrease. However, across this same time period the number of applications per applicant nearly doubled (97%) from 29.8 in 2017 to 58.7 in 2021. From 2017 to 2021, a 10% increase in the number of female applicants and a 43% decrease in the number of male applicants was observed. Applicants of all races other than Native Hawaiian decreased from 2017 to 2021. Cost of applications per applicant increased by 146%, from $514 in 2017 to $1,265 in 2021. Collectively, this represents an 81% increase in the total cost of applications despite fewer applicants. Total application costs in 2021 were $526,323. The future value of these expenditures equals an economic burden of $801,855, assuming a 10-year loan at a 4.3% interest rate. CONCLUSIONS: Despite a fluctuation in applicants to integrated plastic surgery within the past five years, the number of applications per applicant and resulting cost to apply has increased greatly. This is representative of the increasingly competitive application process, heightened in particular by the virtual application seasons of 2021 and 2022. Program personnel are already overwhelmed with the number of highly qualified applicants, and it will be detrimental to applicants and programs alike if the observed trends continue. Ideas to confront this issue include limiting the number of programs applicants can apply to or implementing a secondary application. We argue a secondary application is the most tangible mechanism to mitigate this escalating issue, as it will decrease the number of applications each applicant submits by raising the barriers to entry. It appears that more female applicants are applying to integrated plastic surgery residency positions, increasing their representation in the field. Increased cost may pose a barrier for socioeconomically challenged and/or underrepresented minority applicants. Intervention is needed to enhance application efficiency and reduce these issues for residency programs and applicants.

Source: Plastic & Reconstructive Surgery Global Open

DOI: 10.1097/01.gox.0000937868.08837.a7

Authors: Nikhi Paul Singh, Stefan Kovac, Timothy W. King, Carter J. Boyd

Institutions: Indiana University Indianapolis, University of Alabama at Birmingham, Edward Hines, Jr. VA Hospital, NYU Langone Health

Language: English

Topic: Medical Education and Admissions

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,195