Have Degree, Will Travel? Geography and Orthopaedic Surgery Residency Match

The paucity of objective data on the residency application is challenging to Orthopedic Surgery residency programs when selecting candidates to interview and to rank. Qualifying or quantifying the effect of geography on match results will help programs screen and rank candidates more effectively. The aim of this study is to describe the geographic background of current Orthopedic Surgery residents in the United States relative to their current residency program. We hypothesize there is a significant relationship between residents' geographic background and the location of their residency programs.

Geographic background information of current Orthopedic Surgery residents in the United States was obtained from public websites of Orthopedic Surgery residency programs. Information included region and city of each resident's residency program, hometown (HT), undergraduate (UG) school, and medical school (MS). The relationships between residents' program region and city and their geographic background was analyzed. Cramer's V values were calculated to describe the strength of association between program region and HT, UG, and MS regions. Distance of program from HT, UG city, and MS city was calculated using the Haversine distance formula.

3718 US orthopedic residents were included. 47.2% of residents matched in the same region as their HT. 40.7% matched in the same region as their UG institution, and 49.6% matched in the same region as their MS. Of residents with data for HT, UG, and MS regions, 36.6% are in a program outside of the region of their HT, UG school, and MS. There was a statistically significant relationship between program region and HT, UG, and MS regions (p < 0.0001) with the strongest relationship seen with medical school region. The average distance of residency program from HT was 1175 km, from UG city was 1041 km, and from MS city was 894 km. Of residents with data for HT, UG, and MS cities, only 0.61% had all 3 in the same city as their residency program, and 13.3% had HT, UG city, and MS city within 100 km of their residency city.

The association between the geographic history of Orthopedic Surgery residents and their residency program location is complex. Most residents are in residency in a location with which they have some history, but many live a considerable distance from their hometowns and the cities in which they have previously studied. This information may be helpful to residency programs as they weigh the importance of geography with other factors when considering their rank lists.