Background: Matching into an integrated plastic and reconstructive surgery (PRS) residency program remains challenging. The number of applicants has steadily increased in the last several years, outpacing the creation of new residency positions and remaining one of the most competitive specialties. In 2022, the match rate for integrated PRS programs was 55% compared to an overall match rate of 80% for all applicants across all specialties. As a result, many PRS applicants are left with the difficult task of deciding what the best course of action is after not matching. For those who wish to reapply, two common options include pursuing a preliminary year of residency (PY) or a research fellowship (RF). This study investigated which option is more likely to lead to a successful match for reapplicants.

Methods: This retrospective study included all reapplicants to an integrated PRS program from 2015-2023. Two cohorts based on reapplication strategy (RF and PY) were created. Demographic variables including gender, IMG status, self-identified race, and degree type were collected. Applicant variables were also collected, including honor society membership, research output, USMLE Step 1 and Step 2 CK scores, number of application attempts, and matched specialty. Pearson’s Chi-squared or Fisher’s exact testing was performed for categorical data. Wilcoxon rank sum testing was conducted for continuous data.

Results: A total of 125 reapplicants were included, of which 57% (n=71) pursued a PY, and 23% (n=29) pursued a RF. There was no significant difference in demographic data, Step scores, or number of application attempts between cohorts. Compared to PY reapplicants, RF reapplicants had a greater mean number of first author publications (8.8 vs. 3.2, p<0.001), non-first author publications (11 vs. 6.0, p=0.02), poster presentations (9.7 vs. 6.0, p=0.03), and oral presentations (12 vs. 6.0, p<0.001). Match rates to any specialty were not significantly different between cohorts. However, RF reapplicants were significantly more likely to match into PRS (p=0.003), with 72% (n=21) of RF reapplicants matching into PRS but only 39% (n=28) of PY reapplicants. This difference remained significant when accounting for those who did not match with reapplication (p=0.01). When not matched into PRS, PY reapplicants were most likely to match into general surgery and RF reapplicants into emergency medicine.

Conclusion: This study found that unmatched applicants who choose to do a RF are more likely to successfully match into an integrated PRS residency upon reapplication compared to those who do a PY. There were no confounding demographic variables. Regarding applicant data, RF reapplicants demonstrated greater research productivity, but no other statistically significant differences between cohorts were apparent. Our study provides an objective perspective for unmatched applicants to reference when deciding their next steps.