Differences in accessibility and cost of plastic surgery sub-internships and away rotations for international and US...

Sub-internships are crucial for plastic and reconstructive surgery (PRS) residency matching. However, access is affected by economic and systemic barriers, particularly for international medical graduates (IMGs) and medical students without an affiliated PRS residency program, also known as "unaffiliated US medical students" (uUS-MSs). This study examines these students' access to and monetary costs associated with applying for sub-internships in PRS compared to US medical students with a PRS home program (hpUS-MSs).

We used the 2024-2025 Visiting Student Learning Opportunities platform and institutional websites to identify sub-internships in PRS for US-MSs and IMGs. We assessed availability, registration fees, and total financial commitment for an average of 4.5 rotations. Descriptive statistics and Monte Carlo simulation were used to evaluate costs, and an analysis of variance and Tukey's honestly significant difference tests were used to identify cost differences between IMGs, uUS-MSs, and hpUS-MSs.

The analysis revealed that 100 programs offer sub-internships to US-MSs, while 20 offer sub-internships to IMGs. IMGs faced average costs of $2062.05 per sub-internship, compared to $121.49 for US-MSs. Monte Carlo simulations showed that IMGs incur the highest total costs, with a median of $9114, compared to $530 for uUS-MSs and $410 for hpUS-MSs (p<0.001).

Our study identified significant financial inequities in accessing plastic surgery sub-internships between uUS-MSs and IMGs and hpUS-MSs. These economic barriers may deter qualified candidates, decreasing their matching odds and negatively impacting access to training in plastic surgery. Systemic changes, such as standardization of sub-internship costs and more grants and scholarships, are recommended to address these inequities.