A Retrospective Comparative Analysis of MD and DO Applicants' Acceptance to Plastic Surgery Residency

Background Doctor of osteopathic medicine (DO) applicants are underrepresented in integrated plastic surgery. We hypothesized they would match at a lower rate compared to similarly qualified doctor of medicine (MD) applicants. Methods Applications to a large integrated plastic surgery residency program with a dedicated DO position were analyzed 2020–2023. Residents and faculty scored applications on research (1–5), letters of recommendation (LOR; 1–5), and USMLE Steps 1 and 2 (>240 = 1, >250 = 2), which summed to the total score. Residency match outcomes were verified online. Logistic regression modeling was used to assess MD versus DO odds of successful applications in the full dataset and a 3:1 MD-to-DO cohort matched by USMLE, research, and LOR scores. Applications were placed into quartiles based on total scores, and successful match outcomes were compared. Results In the full dataset (MDs = 1100, DOs = 47), MDs had significantly stronger metrics ( P < 0.05) compared to DOs. In the adjusted logistic regression of the full dataset, MDs had 9.56 times the odds of success compared to DOs (95% CI, 3.84–27.62; P < 0.01). In the matched cohort, MDs had 5.89 times the odds of success compared to similarly qualified DOs (95% CI, 2.43–16.71; P < 0.01). Although MD applicants were evenly distributed across the quartiles, DO applicants were concentrated in the lowest quartile and were significantly less successful within this group. Conclusion DO applicants with similar credentials to their MD counterparts have lower odds of matching into integrated plastic surgery, suggesting potential bias. However, disparities in overall scored metrics highlight areas to improve competitiveness.