Prevalence of Pipelining in the United States Orthopedic Surgery Residency Match

Pipelining is the phenomenon whereby applicants from the same medical schools repeatedly match into the same residency programs. We sought to quantify the prevalence of pipelining in the United States (US) orthopedic surgery residency match and to compare these practices amongst geographic regions.

Resident information was obtained from program webpages. New programs without five years of residents, programs that did not publicly report resident information, and programs with incomplete information were excluded. For the remaining programs, the pipelining ratio was calculated (pipelining ratio = no. of residents/no. of different medical schools represented over the study duration). We also recorded the proportion of each program's residents that attended the single most represented medical school at each program during the study period and the number of years in which at least two residents from the same medical school matched into a program. Residency program geographic region and the number of medical schools within a 50-, 100-, and 200-mile radius of each program were also recorded.

The median pipelining ratio amongst programs included (n = 159) was 1.5 (interquartile range (IQR) = 1.32-1.79; Range = 1-4.83). The pipelining ratio varied by geographic region (p<0.01), with programs in the Midwest (p = 0.04) and South (p = 0.04) having a higher pipelining ratio than programs in the Northeast. The proportion of each program composed of the most represented medical school varied by geographic region (p<0.01), with programs in the South having a higher proportion of their classes composed of residents from a single medical school than programs in the Northeast (p<0.01) and Western US (p = 0.03). The pipelining ratio and proportion of each program's residents from a single shared medical school showed no correlation or a very weak negative correlation with the number of medical schools within a 50-, 100-, and 200-mile radius of each program.

Most orthopedic residency programs fall within a range of fair to moderate pipelining, though it is more common in Southern US programs. These practices can limit opportunities for qualified applicants and should be monitored due to recent changes in pass/fail scoring of the US Medical Licensing Step 1 Exam and virtual interviews.