Analysis of Unmatched Orthopaedic Residency Applicants: Options After the Match.

BACKGROUND Orthopaedic surgery is one of the most competitive specialties, resulting in many applicants going unmatched. Many unmatched applicants pursue a preliminary internship or research fellowship, but whether these activities make them more successful in subsequent match cycles has not been studied. OBJECTIVE To determine the effectiveness of activities during the intervening period on match success in a subsequent cycle. METHODS After reviewing rank order lists for our program and National Resident Matching Program correspondence from 1994 to 2013, we identified 198 of 1216 ranked applicants (16.3%) who did not initially match. Of these, 57 applicants who matched through the Supplemental Offer and Acceptance Program did not reapply to orthopaedics or trained overseas. RESULTS Of 141 reapplicants, 56 matched into orthopaedic surgery, with 87.5% (P < .001) matching at a program in the same region where they had either completed their medical degree or postgraduate year, and 37.5% matching at their home institution (P < .001). Successful reapplicants after a research fellowship had a significantly higher number of publications than unsuccessful reapplicants (P < .05). There was no significant difference in success after research or internship (P = .80) and no significant difference in success rates for US versus international reapplicants (P =  .43). CONCLUSIONS Success of reapplication into orthopaedic surgery may be less dependent on the route taken during the interim period, and more dependent on developing relationships with faculty at a local or regional institution.