Socioeconomic Disparities in Research Participation: Bias in Plastic Surgery Residency Match

Abstract

Background: Integrated plastic surgery residency applicants have increased at a rate disproportionate to available positions. Research productivity has become a surrogate marker for competitiveness, and many applicants pursue it to distinguish themselves. To date, no study has investigated socioeconomic disparities in extended research experience (ERE) participation. Methods: A 35-question cross-sectional survey was distributed to applicants to United States-based integrated plastic surgery residency programs during the 2019–2022 application cycles. Summary tables, student t test, and chi-square tests were used for statistical analysis. Results: A total of 161 responses (response rate: 20.9%) were recorded. Fifty-nine (40.7%) respondents participated in an ERE. The most common reason for ERE participation was strengthening one’s application. The most common reason against participation was avoiding delays in career progression. A greater percentage of respondents from Northeastern medical schools participated in EREs (P = 0.019). There were no significant differences in debt burden between those who did or did not participate in an ERE. A greater percentage of applicants whose parents had advanced degrees participated in EREs (P = 0.053). Conclusions: There may be geographic and socioeconomic biases present in access to ERE for students interested in plastic surgery. The growing popularity of EREs may have unintended consequences for applicant diversity. As most plastic surgeons ultimately practice in nonacademic settings, applicants and plastic surgeons may consider the financial hardships and possible socioeconomic disparities in research opportunities before participating in or recommending them.

Unmatched. What’s Next? Is a Preliminary Year of Residency or Research Fellowship Better for Reapplicants to Plastic Surgery?

“…A recent survey examined trainees who engaged in extended research experiences before medical school, between the third and fourth years of medical school, or after medical school. 5 Trainees who pursue extended research experiences are more likely to be from Northeastern medical schools and have parents with more advanced degrees. 5 As programs continue to evaluate applicants, we encourage them to consider the potential bias for trainees of higher socioeconomic status to participate in extended research experiences.…”

“…5 Trainees who pursue extended research experiences are more likely to be from Northeastern medical schools and have parents with more advanced degrees. 5 As programs continue to evaluate applicants, we encourage them to consider the potential bias for trainees of higher socioeconomic status to participate in extended research experiences.…”

“…Plastic surgery is arguably the most competitive specialty in graduate medical education. [1][2][3][4][5] In 2020, there were 291 applicants to only 180 integrated residency positions, corresponding to 84 programs. 6 In 2022, 351 applicants applied to 194 positions, with the growth of applicants outpacing the creation of new positions.…”

The Law of Diminishing Returns in the Integrated Plastic Surgery Residency Match: A Deeper Look at the Numbers

“…This drastically increases their match probabilities, and studies have also found that IMGs that have matched into the integrated plastic surgery program have done at least 2 years of research fellowship. 38,39 It is noteworthy that for all applicant types, it has been found that letters of recommendation are the most important factor in the residency application. [40][41][42][43] The dedicated years of research fellowship enable them to gain reasonable mentorship and form meaningful relationships with their potential letters of recommendation writers.…”

Accessibility of Plastic Surgery Research Fellowships

“…A 2023 study reported socioeconomic biases present in accessing research fellowships, and that lack of monetary support was a main reason for not applying. 5 Further work is needed to address funding availability for fellowships, whether it be through industry sponsors, NIH grants, or partnerships with national plastic surgery organizations. Ultimately, when fellowships function as a pipeline for mentorship, clinical experiences, and a better chance of matching, it is critical to examine who has access.…”