The Impact of Geographical Background on the Orthopedic Surgery Residency Match

Introduction: With the introduction of geographic preferences, orthopedic surgery residency applicants can transparently indicate their preference for geographic regions. While studies have evaluated how board scores and preference-signaling affect an applicant's match, little research has evaluated the impact of geography. The purpose of this study was to analyze geographic trends among orthopedic surgery residents. Methods: Orthopedic surgery residency program websites were used to identify residents and their sex, hometown, undergraduate institution, and medical school attended. Residency programs, medical schools, undergraduate institutions, and hometowns were categorized into regions as defined by the AAMC's “Geographic Preference Divisions Map.” Bivariate analysis and logistic regression were performed to compare geographic variables and their impact on matching in certain regions. Results: In 151 residency programs, 3725 residents were identified, with 98.3% (3661/3725) of residents obtaining the M.D. degree. Males comprised 78.4% (2921/3725) of all residents, with 23.6% (878/3721) matching at their home institution. Residency program region was significantly associated with a resident's hometown (χ² = 2.1e+03, p < 0.05), undergraduate institution (χ² = 1.9e+03, p < 0.05), and medical school region (χ² = 5.3e+03, p < 0.05). Home-institution match rates were significantly associated with geographic region (χ² = 42.5; p < 0.05). Logistic regression revealed a significant increase in likelihood of matching into an orthopedic residency program based on the number of ties to the program region (p < 0.05). Discussion: Geographic background has a significant role in an applicant's match for orthopedic surgery residency, with home institution match rates varying significantly by geographic region. With the introduction of geographic preferences, applicants should consider their geographic background when applying into orthopedic surgery.