Not All Is Lost: Career Options for Unmatched Plastic Surgery Applicants

Integrated plastic surgery residency training positions are among the most competitive in the United States. During the 2020–2021 residency application cycle, all 187 training positions were filled, with 69.9 percent of U.S. senior medical students matching into a program.1 Unmatched applicants are tasked with swiftly making career-altering decisions given that the Supplemental Offer and Acceptance Program begins promptly upon receiving their decision. In addition, information regarding career-altering decisions for unmatched applicants is scarce. In this article, we outline the career planning process for unmatched applicants and discuss the benefits and limitations of various avenues. Unmatched applicants must schedule to meet with their mentors immediately upon receiving their decision. Meetings should be planned with mentors who have extensive experience in plastic surgery education as they are likely to provide the most helpful information.2 During their meeting, unmatched applicants and mentors can review the residency application to identify weaknesses and determine how they can be addressed for future application cycles. At this point, unmatched applicants must decide whether their career would benefit most from undertaking a research fellowship or attempting to match into a preliminary surgery position during the Supplemental Offer and Acceptance Program (Table 1). Table 1. - Benefits and Limitations of Potential Career Options for Unmatched Applicants Potential Career Options Benefits Limitations Research fellowship Dedicated time to increase research output to bolster future residency applicationMay result in receiving highly personalized letters of recommendation from a research mentorProvides opportunities to network with residents, fellows, and faculty of plastic surgery programs Often unpaidUnmatched applicants may require 2 years of dedicated research to improve their residency application sufficientlyDoes not count toward clinical training Preliminary surgery position Paid positionRotations undertaken during preliminary surgery position count toward plastic surgery training Poor job security upon completion of 1-year positionClinical duties limit trainee’s ability to improve the residency application for a subsequent cycleOffers limited opportunities to increase technical skill Research productivity is highly valued by integrated plastic surgery residency programs, with matched applicants averaging 14.2 abstracts, presentations, and publications.3 Individuals with limited research output are likely to benefit significantly from undertaking a research fellowship.4 In addition to bolstering their research productivity, individuals who undertake a research fellowship frequently interact with mentors and may procure strong letters of recommendation. When applying to research fellowships, unmatched applicants are likely to primarily benefit from applying to institutions with a history of high research output and taking their research fellows during the match; however, many of these positions may not be available upon applicants receiving their decision. Applicants may consider undertaking a 2-year fellowship because of the brief period between the match and the application deadline for the following residency interview cycle. Preliminary surgery positions are typically the only surgical training opportunities available during the Supplemental Offer and Acceptance Program. Similar to research fellowship positions, preliminary surgery positions at an institution with an integrated plastic surgery residency program are preferred. These allows trainees to network within the program, which may benefit them in future application cycles. In contrast to most research fellowships, preliminary surgery positions count toward an individual’s residency training and are paid. One major limitation of undertaking a preliminary surgery position is that it provides individuals little time to improve many aspects of their application and offers minimal job security after program completion.5 Applicants applying after undertaking a preliminary surgery position may also apply for a research fellowship should they not match. Unmatched applicants face enormous pressure when making career-altering decisions in a period of significant uncertainty. Despite their unfavorable result, a future in plastic surgery is still attainable if the applicant remains level-headed and approaches the situation objectively. Increased investment in resources for unmatched applicants by professional societies is critical moving forward, given the increased competitiveness of plastic surgery. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. There was no funding for this work.