Differences in Accessibility and Cost of Plastic Surgery Sub-Internships and Away Rotations for International and US Medical Students
Rodríguez-Silva et al. JPRAS 2025 Feb PMID: 39970748.
In this Journal Club
5-Point Summary
Disparities in plastic surgery sub-internships have been highlighted using 2024–2025 VSLO and program data, focusing on IMGs, uUS-MSs, and hpUS-MSs.
4-Key Findings
IMGs have 80% fewer sub-internship opportunities and pay 17 times more on average. Median 4.5-rotation costs are $9,114 for IMGs vs. $410 for hpUS-MSs, with statistically significant disparities (p < 0.001).
3-Critiques
Program listings may be incomplete or outdated, and excluding travel/visa costs understates true expenses. Findings rely on a single application cycle, limiting their broader applicability.
2-Practical Takeaways
Capping or standardizing sub-internship fees could reduce financial barriers. Targeted financial aid would foster more equitable access for IMGs and uUS-MSs.
1-Recommended Reading
Sergesketter et al. (2021) explores how sub-internships influence match success. This highlights the pressing need for improved and equitable sub-internship access.
Rodríguez-Silva et al effectively identify systemic challenges to plastic surgery pre-residency training programmes in the United States. They demonstrate the differences in accessibility for International Medical Graduates through the reduced number of available schemes and very high cost of these opportunities. The authors should be congratulated for shining a light on the inequities which are likely to hinder the best candidates from pursuing careers in plastic & reconstructive surgery in the US.
Mr Adam Reid, Editor JPRAS
5 Point Summary
This study explores disparities in access and financial burden of plastic surgery sub-internships for IMGs, uUS-MSs, and US medical students with home programs (hpUS-MSs).
1️⃣ Hypothesis
IMGs and uUS-MSs face greater barriers to sub-internships due to limited access and higher costs compared to hpUS-MSs.
2️⃣ Method
Data from the Visiting Student Learning Opportunities (VSLO) platform and institutional websites for the 2024-2025 academic year were analyzed to assess sub-internship availability and costs. Monte Carlo simulations estimated total expenses for an average of 4.5 rotations, with statistical tests (ANOVA and Tukey’s HSD) comparing groups.
3️⃣ Results
IMGs have access to only 20 programs (vs. 100 for US-MSs) and face average costs of $2062.05 per rotation (vs. $121.49 for US-MSs). Median total costs for 4.5 rotations are $9114 for IMGs, $530 for uUS-MSs, and $410 for hpUS-MSs.
4️⃣ Conclusion
Significant financial and systemic inequities disadvantage IMGs and uUS-MSs, potentially reducing their chances of matching into plastic surgery residency.
5️⃣ Implication
Addressing these disparities is vital to ensure equitable access to training and enhance diversity in the plastic surgery workforce.
4 Key Findings
The study uncovers pronounced inequities in access and cost, with IMGs disproportionately affected.
Only 20 programs offer sub-internships to IMGs, compared to 100 for US-MSs, an 80% reduction in opportunities.
IMGs incur an average cost of $2062.05 per sub-internship, over 17 times higher than the $121.49 for US-MSs.
Monte Carlo simulations estimate median total costs for 4.5 rotations at $9114 for IMGs (IQR: $6490–$11,997), $530 for uUS-MSs (IQR: $395–$681), and $410 for hpUS-MSs (IQR: $285–$544).
ANOVA and Tukey’s HSD tests confirm significant cost differences (p < 0.001), with IMGs facing the highest burden ($8812.51 more than hpUS-MSs; $8688.89 more than uUS-MSs).
3 Critiques
While insightful, the study has limitations that warrant consideration.
1️⃣ Data Set
Reliance on VSLO and institutional websites may overlook some sub-internship opportunities not listed or updated.
2️⃣ Scholarships
Standardizing fees and expanding scholarships may reduce the $2062.05 vs. $121.49 cost disparity and improve equity for IMGs and uUS-MSs.
3️⃣ Expenses
Exclusion of personal expenses (e.g., travel, housing) and additional IMG-specific costs (e.g., visas, TOEFL, USMLE fees) underestimates the true financial burden.
2 Practical Takeaways
The findings highlight actionable steps to reduce barriers for IMGs and uUS-MSs.
1️⃣ Cap Costs
Institutions could cap or standardize costs to narrow the $2062.05 vs. $121.49 gap between IMGs and US-MSs.
2️⃣ Grants
Scholarships or grants specifically targeting IMGs and uUS-MSs could help offset the $9114 median cost, enhancing access.
1 Recommended Reading
Sergesketter et al.’s "The Association Between Away Rotations and Rank Order in the Integrated Plastic Surgery Match" (Plast Reconstr Surg, 2021) complements this study by demonstrating the critical role of sub-internships in residency matching, reinforcing the need to address access disparities.
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