SPECIAL TOPIC

Applying to Plastic Surgery Residency:

Factors Associated with Medical Student
Career Choice
Arin K. Greene, M.D.,
Background: Applications to plastic surgery residency increased 34 percent
M.M.Sc. from 2002 to 2005, despite decreasing applications to other surgical subspe-
James W. May, Jr., M.D. cialties. During this period, medical education, reimbursement, work hours, and
Boston, Mass. media coverage have changed.
Methods: To determine factors responsible for rising applications to plastic
surgery residencies, medical student applicants to plastic surgery residencies for
2005 were surveyed. Applicants recorded exposure to plastic surgery during
medical school and graded the influence of personality, lifestyle, income po-
tential, and media coverage on their decision to choose plastic surgery training.
To further study the effects of plastic surgery exposure on career choice, the
percentage of graduating students applying to plastic surgery residency was
compared between medical schools with and without plastic surgery training
programs.
Results: Medical schools that provided greater exposure to plastic surgery and
schools with plastic surgery training programs had a higher percentage of
graduates applying to plastic surgery residency (p ⬍ 0.001). Applicants rated
compatibility with the personality of plastic surgeons as a significant factor in
their career choice. Lifestyle and income potential were moderately important,
whereas media coverage minimally affected career decision. Applicants typically
decided on a plastic surgical career during the third year of medical school.
Conclusions: Medical student exposure to plastic surgery is the most influential
factor in a student’s decision to pursue a career in plastic surgery. To continue
the increasing applicant trend toward plastic surgery, plastic surgeon engage-
ment of medical students should be emphasized, ideally before the third year
of medical school. (Plast. Reconstr. Surg. 121: 1049, 2008.)

P
lastic surgery is a thriving specialty. Cosmetic
surgical procedures have increased 424 per-
cent over the past 12 years.1 In addition,
many popular television programs now feature
plastic surgeons. Not only has plastic surgery en-
joyed a surge in popularity among consumers and
the media, but medical student interest in pursu-
ing the specialty has increased as well. Medical
student applications to plastic surgery residency
programs have increased 34 percent from 2002
to 2005.2 In contrast, applications to the other
surgical subspecialties coordinated by the Elec-
tronic Residency Application Service, orthope-
dics and urology, have increased 12 percent and
decreased 4 percent, respectively, over the same
time period.2
Several factors may be responsible for the in-
creasing interest in plastic surgery among medical
student graduates. First, plastic surgeons may be
doing a better job engaging students during med-
ical school compared with other specialties. Con-
sequently, greater exposure to potential role mod-
els and increased familiarity with plastic surgery
may stimulate a graduating medical student to
choose a plastic surgical career. Second, more
medical students may be interested in plastic sur-

From the Division of Plastic Surgery, Massachusetts General

Hospital, Harvard Medical School.
Received for publication July 14, 2005; accepted September
28, 2005.
Copyright ©2008 by the American Society of Plastic Surgeons
DOI: 10.1097/01.prs.0000299454.10281.33
Disclosure: Neither of the authors has a financial
interest in any of the products, devices, or drugs
mentioned in this article.

www.PRSJournal.com 1049
 Plastic and Reconstructive Surgery • March 2008
gery because of the potential to earn a high in-
come in the field. Plastic surgeons are less exposed
to shrinking insurance reimbursements than
other surgical specialties because plastic surgeons
may choose to perform insurance-independent
aesthetic surgery. A third factor that may be in-
fluencing medical student graduates to apply to
plastic surgery residencies is the relatively good
lifestyle of a plastic surgeon compared with other
surgical disciplines. Plastic surgeons, particularly
those practicing aesthetic surgery, rarely are re-
sponsible for critically ill patients or emergency
consultations. Finally, the introduction of many
popular television programs featuring plastic sur-
gery may have increased medical student aware-
ness of the specialty.
As educators in plastic surgery, we are inter-
ested in recruiting the best medical students to our
specialty to ensure the future success of our field.
As a result, the purpose of this study was to de-
termine which factors have contributed to the in-
creased interest in plastic surgery among medical
students recently. By understanding the reasons
for the rising number of residency applications, we
can emphasize the factors that are important to
applicants to ensure that the best and brightest
students are continually attracted to the field of
plastic surgery.
MATERIALS AND METHODS
To test the hypothesis that plastic surgeon en-
gagement of medical students leads to increased
applications to plastic surgery residency, we first
compared the percentage of medical student ap-
plicants to plastic surgery residencies from med-
ical schools with plastic surgery training programs
to the percentage of applicants from medical
schools without residencies. We assumed that stu-
dents attending medical schools with plastic sur-
gery training programs would have more exposure
to the field of plastic surgery than students attend-
ing medical schools without programs. Institu-
tional review board approval was granted, and the
number of medical student applicants to plastic
surgery residency programs between 2002 and
2004 from United States medical schools was ob-
tained from the Electronic Residency Application
Service. Next, the percentage of medical school
graduates that applied to plastic surgery residency
over the past 3 years was compared between med-
ical schools with and without plastic surgery train-
ing programs.
After comparing applicants from medical
schools with and without plastic surgery training
programs, the amount of interaction between
1050
plastic surgeons and medical students was assessed
further by survey. An anonymous questionnaire
was distributed by the Electronic Residency Ap-
plication Service to all U.S. medical students ap-
plying to plastic surgery residencies for positions
beginning in 2005 after the submission of their
rank list to minimize bias. Applicants interested in
participating in the study could access the survey
by means of a link to an anonymous Web page.
The predictor variable was the applicant’s
medical school. Outcome variables included
whether students received lectures from plastic
surgeons during the first and second or the third
and fourth years of medical school. In addition,
applicants were asked whether mandatory or elec-
tive rotations on plastic surgery were available dur-
ing medical school. Subjects were divided into two
groups for comparison. One group of applicants
was exposed to plastic surgeons for 1 or 2 years of
medical school (low exposure). The second group
of applicants interacted with plastic surgeons for
3 or 4 years of medical school (high exposure).
Students also were asked when they decided to
apply to plastic surgery residency (before medical
school or during the first, second, third, or fourth
year of medical school).
In addition to investigating whether plastic
surgeon–medical student engagement influences
applications to plastic surgery residency, other po-
tential factors for increasing applications to plastic
surgery programs were ascertained through the
survey. Specifically, medical students applying to
plastic surgery programs were asked whether com-
patibility with the personality of plastic surgeons,
controllable lifestyle, income potential, or televi-
sion program exposure were reasons for choosing
plastic surgery as a career. Responses were re-
corded on a 10-point continuous scale (1 ⫽ did
not influence decision at all; 10 ⫽ very influential
in decision).
Comparisons between groups were performed
using the nonparametric Mann-Whitney test. Dif-
ferences were considered significant for values of
p ⬍ 0.05. Percentages and cumulative scores are
expressed as mean ⫾ SD.
RESULTS
Effects of Plastic Surgeon–Medical Student
Engagement on Applications to Plastic Surgery
Residency
The percentage of U.S. medical school grad-
uates applying to plastic surgery training programs
from 2002 to 2004 was obtained from the 121 U.S.
medical schools. One hundred fifteen medical
Volume 121, Number 3 • Plastic Surgery Residency
schools had a least one graduate who applied to a
plastic surgery residency during this period (95.0
percent). Eighty-one medical schools were affili-
ated with a plastic surgery training program,
whereas 40 medical schools did not have a plastic
surgery residency. A greater percentage of grad-
uates applied to plastic surgery programs from
medical schools with affiliated plastic surgery
training programs (1.5 ⫾ 0.008 percent) com-
pared with graduates from medical schools with-
out affiliated plastic surgery residencies (0.9 ⫾
0.007 percent) (p ⬍ 0.001).
The hypothesis that interaction between stu-
dents and plastic surgeons in medical school in-
creases the likelihood of applications to plastic
surgery programs was further supported by the
medical student survey results. The response rate
of the survey was 44 percent (112 of 255). Based
on the 66 medical schools represented in the 2005
applicant class, respondents identified 49 medical
schools with low exposure and 17 medical schools
with high exposure to plastic surgery. Medical
schools with high exposure to plastic surgery had
a greater percentage of its graduating class apply
to plastic surgery residency (2.5 ⫾ 0.009 percent)
over the past 3 years compared with schools with
low exposure to plastic surgery (1.2 ⫾ 0.006 per-
cent) (p ⬍ 0.001). The rates of applications to
plastic surgery residency from medical schools
with high and low exposure to plastic surgery are
summarized in Table 1.
Effects of Personality, Lifestyle, Income Poten-
tial, and Media Coverage of Plastic Surgery on
Applications to Plastic Surgery Residency
Applicants to plastic surgery residency felt that
their compatibility with the personality of plastic
surgeons was very influential on their choice of a
career in plastic surgery, rating it a 9.0 ⫾ 1.3. A
controllable lifestyle, compared with other surgi-
cal specialties, was moderately influential on their
career choice, with a score of 5.6 ⫾ 2.7. High
income potential also was moderately important
in a medical student’s decision to apply to plastic
Table 1. Rates of Medical Student Applications to Plastic Surgery Training Programs (2002 to 2004)
ERAS data
Medical schools without training programs (n ⫽ 40)
Medical schools with training programs (n ⫽ 81)
Survey data
Medical schools with low exposure to plastic surgery (n ⫽ 49)
Medical schools with high exposure to plastic surgery (n ⫽ 17)
ERAS, Electronic Residency Application Service.
surgery residency, with a score of 5.4 ⫾ 2.5. Media
and television coverage did not significantly in-
fluence the decisions of graduating medical stu-
dents to apply to plastic surgery training pro-
grams, with a score of 2.0 ⫾ 1.9. The median
period during which the applicant decided to
choose a career in plastic surgery was the third
year of medical school. The survey results are
presented in Figure 1.
DISCUSSION
Plastic surgery is currently enjoying great pop-
ularity among consumers, the media, and medical
students. Unlike the other subspecialties using the
Electronic Residency Application Service, ortho-
pedics and urology, applications to plastic surgery
residencies have increased significantly since
2002. Although the reason for the increase in ap-
plications to plastic surgery training programs is
most likely multifactorial, interaction between
plastic surgeons and medical students is the stron-
gest stimulus for a medical student to select a
career in plastic surgery.
Several pieces of evidence support the hypoth-
esis that plastic surgeon–medical student engage-
ment strongly influences applications to plastic
surgery residency. First, medical schools with plas-
tic surgery training programs have a higher per-
centage of graduating students applying to plastic
surgery residency than graduates from medical
schools without plastic surgery residency affilia-
tions. Students attending medical schools with
plastic surgery residency are more likely to have
greater exposure to plastic surgery because of in-
teraction with plastic surgery residents during
medical school. In addition, faculty involved with
training residents are probably more likely to
teach medical students compared with plastic sur-
geons at medical schools who do not interact with
residents. Medical schools with a plastic surgery
residency also must have a significant operative
volume, which is necessary to support a training
program.
Percentage of Graduating Class that
Applied to Plastic Surgery Residency p
0.9 ⫾ 0.007
1.5 ⫾ 0.008 ⬍0.001
1.2 ⫾ 0.006
2.5 ⫾ 0.009 ⬍0.001
1051
 Plastic and Reconstructive Surgery • March 2008

Fig. 1. Effects of compatibility with the personality of plastic surgeons,

controllable lifestyle, income potential, and media coverage of plastic
surgery on the decision of medicalstudentstoapplytoplasticsurgerytrain-
ing programs. Responses from 112 medical students were recorded on a
10-point continuous scale (1 ⫽ did not influence decision at all; 10 ⫽ very
influential in decision). Cumulative scores are illustrated as mean ⫾ SD.

A second piece of evidence illustrating the
importance of plastic surgeon–medical student
engagement is the finding that medical schools
that provided greater exposure to plastic surgery
had a higher percentage of graduates choosing a
career in plastic surgery. Studies of applicants to
other specialties support our finding that medical
student exposure to a particular specialty strongly
influences career choice. For example, medical
students who participate in more abdominal and
general surgical operations are more likely to ap-
ply for general surgical residency.3 In addition,
applicants to hand surgery fellowships are primar-
ily influenced by their exposure to hand surgery
during residency.4
The final evidence supporting the importance
of plastic surgeon–medical student engagement is
that medical students identified with the person-
ality of plastic surgeons and felt this was very in-
fluential in their decision to apply to plastic sur-
gery residency. The sense of personal fit with a
specialty has been shown to be important to med-
ical students across different specialties.5 Thus, the
greater the exposure to a specific specialty, the
more likely a student will have the opportunity to
identify role models in the field.
Although engagement with plastic surgeons is
most influential in a medical student’s decision to
pursue a career in plastic surgery, the relationship
between engagement and rising applications to
plastic surgery residency is less clear. Over the past
several years, medical students may have found
that plastic surgeons are more easily engaged than
other physicians because they are happier as a
result of their relative independence from the
negatives of payer-controlled specialties. Specifi-
cally, plastic surgeons have been less affected by
reduced insurance reimbursements, restrictions on
time allowed with patients, and rising malpractice
costs compared with other specialists. As a result,
plastic surgeons may be more enthusiastic about
their specialty than physicians in other fields.
Although we found that applicants to plastic
surgery residency were only moderately influ-
enced by controllable lifestyle, other studies have
suggested that lifestyle is a major determinant of
medical school career choice. Controllable life-
style was found to be a significant factor in the shift
toward more “lifestyle-friendly” specialties that oc-
curred with U.S. medical school graduates be-
tween 1996 and 2002.6 More recently, the reduc-
tion in applications to general surgery residencies
has been linked to medical student concerns about
the lack of controllable lifestyle as a general
surgeon.7,8
Like controllable lifestyle, studies investigat-
ing the effects of income on medical student res-
idency applications are mixed. Although plastic
surgery applicants rated income potential as some-
what influential in their career choice, some stud-
ies have found that income potential was a signif-
icant factor in an applicant’s choice of specialty.6,9

1052
Volume 121, Number 3 • Plastic Surgery Residency
However, other evidence suggests that an associ-
ation does not exist between resident career
choice and earning potential.4,10
It is possible that the effect of income potential
on career choice was underreported because re-
spondents were hesitant to truthfully record a
non–“politically correct” answer. In addition, the
students who did not participate in the study may
have been more likely to choose plastic surgery
because of income potential. Although these po-
tential biases exist, they have been minimized by
several factors. First, pressure to not acknowledge
income as a factor in career choice was reduced by
indicating to the respondent that the question-
naire was voluntary, anonymous, and without any
identifiable or linking information. Second, the
survey was distributed to applicants after the sub-
mission of their rank lists so that, although anon-
ymous, students would not be influenced by an-
swering questions before the submission of their
rank list. Third, the validity of our survey instru-
ment is supported by studies using similar meth-
odology that have shown both a positive and a
negative correlation of income on an applicant’s
choice of specialty.4,9,10 Finally, although a greater
response rate would increase the validity of the
results, the 44 percent response rate is considered
excellent, as participation for similar surveys is
typically less than one-third.4
The recent explosion of fictional and nonfic-
tional television programs and media coverage of
plastic surgery did not significantly influence the
decision of graduating medical students to apply
to plastic surgery residency. Although students
may not have identified with an actor or illness, they
may not have appreciated that they were being ex-
posed to the specialty. Because it has been shown
that medical students have a poor understanding of
the range of problems that plastic surgeons manage,
it is possible that medical students were uncon-
sciously learning about the field.11
CONCLUSIONS
Each graduating medical student has a unique
set of reasons for pursuing a career in plastic sur-
gery. A role model may primarily influence one
student, whereas another may be focused on a
controllable lifestyle. Cumulatively, though, we
found that the major determinant of a student’s
decision to apply to plastic surgery residency was
the graduate’s exposure to plastic surgery in med-
ical school. Interestingly, applicants to a specialty
with significant income potential were not espe-
cially influenced by future earnings. Rather than
being very concerned about lifestyle, applicants
cited their compatibility with the personality of a
plastic surgeon role model as a significant influ-
ence on their decision to pursue a career in plastic
surgery. To continue to attract the best medical
students to the field of plastic surgery, plastic sur-
geons must engage medical students. Because
medical students typically decide on their career
choice during the third year of medical school,
plastic surgeon engagement of medical students
should be emphasized early in the medical school
experience.
James W. May, Jr., M.D.
Division of Plastic Surgery
Massachusetts General Hospital
15 Fruit Street
Boston, Mass. 02114
jwmay@partners.org
ACKNOWLEDGMENT
The authors thank Malcolm Cox, M.D., dean for
medical education at Harvard Medical School, for help-
ful discussions regarding this article.
REFERENCES
1. American Society of Plastic Surgeons. Available at: www.
plasticsurgery.org/public_education/Statistical-Trends.
cfm. Accessed July 2005.
2. Association of American Medical Colleges. Available at:
www.aamc.org/programs/eras/programs/statistics/residency/
plassurg.htm. Accessed July 2005.
3. O’Herrin, J. K., Lewis, B. J., Rikkers, L. F., et al. Medical
student operative experience correlates with a match to a
categorical surgical program. Am. J. Surg. 186: 125, 2003.
4. Chung, K. C., Lau, F. H., Kotsis, S. V., et al. Factors influ-
encing residents’ decisions to pursue a career in hand sur-
gery: A national survey. J. Hand Surg. (Am.) 29: 738, 2004.
5. Burack, J. H., and Irby, D. M., and Carline, J. D. A study of
medical students’ specialty-choice pathways: Trying on pos-
sible selves. Acad. Med. 72: 534, 1997.
6. Dorsey, R. E., Jarjoura, D., and Rutecki, G. W. Influence of
controllable lifestyle on recent trends in specialty choice by
US medical students. J.A.M.A. 290: 1173, 2003.
7. Lind, D. S., and Cendan, J. C. Two decades of student career
choice at the University of Florida: Increasingly a lifestyle
decision. Am. Surg. 6: 53, 2003.
8. Marschall, J. G., and Karimuddin, A. A. Decline in popularity
of general surgery as a career choice in North America:
Review of postgraduate residency training selection in Can-
ada, 1996-2001. World J. Surg. 27: 249, 2003.
9. Fincher, R. M., Lewis, L. A., and Rogers, L. Q. Classification
model that predicts medical students’ choices of primary
care or non-primary care specialties. Acad. Med. 67: 324, 1993.
10. Kassebaum, D. G., and Szenas, P. L. Factors influencing the
specialty choices of 1993 medical school graduates. Acad.
Med. 69: 163, 1994.
11. Dunkin, C. S. J., Pleat, J. M., Jones, S. A. M., et al. Perception
and reality: A study of public and professional perceptions of
plastic surgery. Br. J. Plast. Surg. 56: 437, 2003.
1053