Identifying Barriers Faced by Applicants without a Home Residency Program when Matching into Plastic Surgery

BACKGROUND Applying into plastic surgery is competitive. Lacking a home residency program (HRP) is another barrier. Our goal is to characterize challenges faced by plastic surgery (PS) applicants without HRPs and identify solutions. METHODS Surveys were designed for current integrated PS residents and applicants in the 2022 Match without HRPs. Surveys were distributed electronically. Only U.S. allopathic graduate responses were included. RESULTS Of 182 individuals surveyed, 74 responded (39%, 33-residents, 41-applicants). Sixty-six percent reported feeling disadvantaged due to lacking an HRP. 76% of applicants successfully matched. Of these, 48% felt they required academic time off (research year) vs 10% of unmatched applicants. 97% of matched applicants identified a mentor vs 40% of unmatched applicants (p<0.05). Matched applicants identified mentors through research (29%) and cold calling/emailing (25%). Matched vs unmatched applicants utilized the following resources: senior students (74vs10%), (p<0.05) and social media (52vs10%), (p<0.05). Among residents, sixteen had PS divisions (48%). Thirty-six percent with divisions felt they had opportunities to explore PS, compared to 12% without divisions. Residents without divisions felt disadvantaged in finding research (94vs65%, p<0.05), delayed in deciding on PS (50vs28%), and obtaining mentors (44vs35%) and letters of recommendation (LOR) (31vs24%). CONCLUSIONS PS residents and applicants without HRPs reported feeling disadvantaged when matching. The data suggest access to departments or divisions assists in matching. We identified external outreach and research were successful strategies to obtain mentorship. To increase awareness for unaffiliated applicants, we should increase networking opportunities during local, regional, and national meetings.