Racial disparities in research productivity among integrated plastic surgery applicants

Prior findings reported no racial differences in research productivity among plastic surgery trainees, but by combining integrated and independent pathways, they may obscure disparities relevant at residency selection. Given the competitiveness of integrated plastic surgery (IPS) and its emphasis on scholarly output, understanding the differences among applicants is critical.

We analyzed 555 matched IPS applicants from the 2022-2024 cycles identified via program websites. Bibliometric data on PubMed-indexed publications up to electronic residency application service deadlines were collected. Applicants were classified as underrepresented (URM) or overrepresented in medicine (ORM) by headshot and surname analysis. The Mann-Whitney U tests were used to assess differences.

ORM applicants had significantly higher median total publications (5 vs. 3; p=0.021), first-author publications (1 vs. 0; p=0.008), second-author publications (1 vs. 0; p=0.006), and published in marginally higher impact journals, although this was not significant (2.7 vs. 2.5; p=0.1). There was no significant difference in plastic surgery-specific publications (median 1 in both groups; p=0.13). Despite fewer publications, URM applicants published a higher percent of articles in open access (OA) journals and incurred significantly higher average OA costs per publication ($750 vs. $657; p=0.001).

These findings demonstrated measurable differences in research portfolios between URM and ORM IPS applicants, contradicting earlier findings that did not separate training pathways. Reasons for these trends and the solutions to address them warrant further exploration. Higher proportion of the Top 40 medical school graduates and OA publications among URM applicants challenge assumptions that financial resources and lack of research opportunities drive ORM publication advantages.

ORM applicants to IPS programs had stronger research profiles across key metrics and lower average OA spending per publication. These differences underscore the need to examine structural factors contributing to the disparities at the residency application stage.