Plastic Surgery Research Council

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The Plastic Surgery Prisoner's Dilemma: The Relationship Between Applications and Match Rate
Felipe Molina Burbano, BA, Amy Yao, BS, Jeffrey Stock, MD, Peter Taub, MD, FACS, FAAP.
Mount Sinai Hospital, New York, NY, USA.

Purpose:
Plastic surgery is one of the most competitive residency matches. The mean number of applications per applicant is correspondingly high, creating significant time and financial strains. With the increasing cost of the application process in time and money, limiting the number of applications per applicant may offer a potential solution. In this study we examine whether an increased number of applications confers a benefit to applicants.
Methods:
The authors analyzed annual data from NRMP and ERAS for integrated plastic surgery programs between 2010 and 2017. The number of U.S. seniors that matched in each year, and the number of applicant U.S. seniors that year, was obtained from NRMP's Main Residency Match Results and Data report and used to calculate the match rate for that year. The average number of applications per year reported by ERAS was used for our calculations.
Results:
Table 1 presents a summary of our findings. The number of integrated Plastic Surgery programs has increased from 31 in 2010 to 73 in 2017. The average number of applications per US senior in 2017 was 58.36, which corresponds to 80% of programs. In 2010 the average number of applications was 22.75, or 73% of programs. Two programs went unfilled in 2017, one in 2016 and three in 2015.
The number of positions offered has increased from 69 in 2010 to 159 in 2017. However, the number of applicant has increased at a slower rate from 168 in 2010 to 200 in 2017. Accordingly, there has been an increase in the match rate from 36% in 2010 to 74% in 2017.
Overall, since 2010, there is a statistically significant correlation between the mean number of applications and the match rate (p=0.005). However, if the increased number of positions available each year is taken into account by using the percentage of programs applied to instead of the mean number of applications, there is no statistically significant relationship between percentage of programs applied to and match rate (p=0.78).
Conclusions:
Our study suggests that there is no benefit to students applying to a greater number of programs as the percentage of programs applied to does not correlate with a higher match rate. Additionally, even though integrated plastic surgery programs are extremely competitive there have been unfilled positions every year since 2015. This could be explained by the Prisoner's Dilemma in Game theory. The economic theory that all parties are worse off when individuals act in their own self interest. In other words, while a student may increase their own chances by applying to as many programs as possible while other students do not, if every student applies to most programs, all students have a reduced chance of matching.
YearNumber of programsNumber of positions offeredNumber of applicants US seniorsAverage number of applicationsPercentage of programs applied toUS senior applicant match rateUnfilled programs
20177315920058.3680%74%2
20166915217855.0580%75%1
20156714816851.8277%81%3
20146013018144.7775%66%0
20135311617938.0972%62%1
20124510114123.5652%62%3
2011317016624.4579%39%0
2010316916822.7573%36%0


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