Association of Residency Applicant Sociodemographic Characteristics With Specialty Choice and Interview Outcomes

To evaluate associations of residency applicant sociodemographic characteristics with specialty choice, academic metrics, and application outcomes. Academic metrics included clerkship honors, honor society membership, United States Medical Licensing Exam (USMLE) scores, degree type (allopathic or osteopathic), second degrees or research year, required remediation, couples match, research output, and volunteer or leadership positions.

Retrospective, cross-sectional analysis of applicants who responded to the Texas Seeking Transparency in Application to Residency (STAR) survey.

National survey of medical students in the United States.

Medical students in the United States participating in the 2021 to 2022 and 2022 to 2023 residency application cycles.

Among 10,856 applicants during the 2022 and 2023 match years, 1,687 (15.5%) identified as Underrepresented in Medicine (URiM), 1642 (15.1%) were the first generation to attend college, 931 (8.6%) reported a history of food or housing insecurity, and 6104 (56.2%) identified as female. All of these groups were significantly less likely to apply to surgical subspecialties (OR 0.76, p < 0.001; OR 0.81, p = 0.009; OR 0.81, p = 0.041; OR 0.41, p < 0.001, respectively). When adjusting for academic metrics, this association persisted for female applicants (OR 0.58, p < 0.001), and it was the inverse for URiM applicants (OR 1.28, p = 0.016). Applicants with a history of food or housing insecurity had a lower match rate (73.3% vs. 83.4%; p = 0.008) than those without. Interview and match outcomes were noninferior among the other sociodemographic groups historically underrepresented in surgery.

Underrepresentation, already pervasive in medicine, is amplified in surgical subspecialties, underscoring the need for applying an equity lens across the continuum of medical education.