Plastic Surgery in the Context of Shifting Federal Funding Priorities: An Analysis of Residency Position Trends.

Purpose: This study characterizes the number of trainee positions allocated to residency programs across surgical and nonsurgical specialties from 2010 to 2024.

Methods: Data from the National Resident Matching Program and San Francisco Match were collected on entry-level trainee positions across specialties from 2010 to 2024. Entry positions into either the plastic surgery integrated residency (PGY-1) and independent positions were summed to evaluate "plastic surgery (total)" positions. Linear regressions analyzed changes in position numbers and year-over-year percent changes. The relative share of positions within surgical specialties and in total was calculated, along with the distribution of new PGY-1 residency positions across the study period.

Results: Total PGY-1 positions offered by National Resident Matching Program rose from 22,809 in 2010 to 38,494 in 2024. From 2010 to 2024, the average surgical specialty gained 14.9 positions annually, and the average primary care field gained 208.6 positions per year ( P < 0.001). Primary care was allocated 54.3% of new PGY-1 positions in 2010-2011 and 70.4% of new PGY-1 positions in 2023-2024. From 2010 to 2024, 6.8 plastic surgery (total) trainee positions were added annually, compared with 14.9 in the average surgical specialty and 208.6 in the average primary care field. Entry-level plastic surgery (total) trainee positions increased in number by 59.6% from 2010 to 2024. From 2010 to 2024, the share of total positions occupied by entry-level positions in plastic surgery decreased by 0.04%, whereas the average primary care field increased its share of total positions by 1.4%.

Conclusions: Entry-level positions in plastic surgery are growing at a rate comparable to other surgical specialties, but new PGY-1 positions heavily favor primary care, likely due to GME funding focusing on rural and underserved areas. To increase trainee numbers in the surgical specialties, including plastic surgery, training programs should enhance rural surgery rotations and highlight the demand for surgical specialists in those settings.