Presenter(s)
A. D. Williams1, A. Grippin2, R. Brown3, A. Kim4, K. T. Pham1, M. Rosa1, E. Merlinsky1, C. Keehn1, N. Diab1, C. Hanan1, A. Agbi1, A. Zhou1, N. Hernandez1, I. Malick1, C. Bui1, S. A. Copling4, A. Mihalic5, and N. Vapiwala6; 1Baylor College of Medicine, Houston, TX, 2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Gainesville, FL, 3Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, 4McGovern Medical School, Houston, TX, 5University of Texas Southwestern Medical School, Dallas, TX, 6Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
Purpose/Objective(s):
Attendance at elite private high schools and colleges has been associated with increased matriculation into highly selective academic programs, but its influence on residency placement remains unclear. We hypothesized that graduates from private high schools, colleges, and medical schools also match into top-ranked residency programs at higher rates than those from public institutions. Materials/Methods:
We conducted a cross-sectional analysis of current resident physicians across five competitive specialties, identifying their educational backgrounds from publicly available institution websites. To measure program prestige, we used Doximity reputation rankings to identify the most highly regarded programs within each specialty. The proportions of residents from private institutions in top five programs within each specialty were compared to those from public institutions. Graduates from Ivy+ institutions were evaluated separately. This analysis was repeated for 29,302 applicants from the Texas Seeking Transparency in Application to Residency (STAR) dataset to assess differences in interview offers and match rates, controlling for cofactors such as USMLE scores, clerkship performance, and research productivity.
Results:
Among 7,108 current residents from 627 residency program, those who attended private institutions were significantly more likely to matriculate into the top 5 most highly ranked programs per specialty compared to those from public high schools (20.2% vs 10.8%, p<0.0001), colleges (11.7% vs 6.88%, p<0.0001), and medical schools (11.9% vs 6.12%, p<0.0001). Multivariable analysis of Texas STAR respondents confirmed that attendance at a private medical school was associated with significantly higher rates of interviewing at (ß=0.020, p<0.001) and matriculating into (ß=0.039, p<0.001) top-tier programs after controlling for quantifiable applicant characteristics including test scores, clerkship performance, and numbers of peer-reviewed publications. Notably, private school graduates were more likely to have taken a research year (11.9% vs 6.5%, p<0.001) and reported more courses with honors grades (3.7 vs 3.1, p<0.001).
Conclusion:
Graduates of private institutions match into highly regarded residency programs at a significantly higher rate than graduates of public institutions. Applicants from public institutions receive fewer interview offers and convert interviews to a match at lower rates. Potential contributing factors include perceived institutional prestige and socioeconomic flexibility, which may allow for unpaid extended research experiences. These findings suggest systemic advantages for graduates of private institutions. Further research should assess how residency programs can mitigate potential biases in their selection program.
