Nationwide Analysis of Pipelining and Medical School Affiliation in the US Integrated Plastic Surgery Residency Match

"Pipelining" is a phenomenon whereby a residency program repeatedly matches individuals from the same medical school across several application cycles. This is potentially disadvantageous to qualified applicants without a history of institutional legacy at their schools. We aimed to evaluate the prevalence of pipelining by US integrated plastic surgery residency programs to promote an equitable playing field for future applicants.

An analysis of every Accreditation Council for Graduate Medical Education-accredited US integrated plastic surgery residency program was conducted. The graduated medical schools of 2229 current and former plastic surgery residents were collected. Pipeline scores were defined as the ratio of total residents to number of unique medical schools represented at the program (Pipeline^C, current residents; Pipeline^C+F, current and former residents). Programs were stratified by geographic location and by affiliation with the top 25 medical schools that graduate plastic surgery residents.

The average Pipeline^C score was 1.23, and the average Pipeline^C+F score was 1.45. Programs in the Northeast had the highest Pipeline^C (P < 0.001) and Pipeline^C+F (P = 0.042) scores. Programs affiliated with the top 25 medical schools had higher Pipeline^C (P < 0.001) and Pipeline^C+F (P = 0.015) scores than all other programs. Overall, 17.4% of current and 22.6% of former residents matched at their home residency programs.

There is a measurable prevalence of pipelining in plastic surgery, especially in the Northeastern US and at programs affiliated with medical schools with historical match success. Fostering an inclusive and meritocratic match process will benefit the field of plastic surgery entirely.