Implications of the Shifting Landscape of Plastic Surgery Training Paradigms.

BACKGROUND: Plastic surgery training has evolved into 2 main pathways: independent and integrated, yet their future directions remain largely unaddressed in the literature. This study examines trends during the past decade in program numbers, positions, and competitiveness of the 2 training models, to better guide the mentorship of prospective plastic surgeons. METHODS: Plastic surgery residency match data (2013-2023) were accessed through the National Resident Matching Program for integrated pathways and through the San Francisco Match for independent pathways. Applicant numbers, positions, programs, and matches were analyzed over time, with applicant-to-position ratios used as a measure of competitiveness. Linear regression assessed trends, with R² greater than 0.5 indicating a strong linear trend. RESULTS: From 2013 to 2023, residency programs increased from 107 to 128, with integrated programs rising from 53 to 91 and independent programs declining from 54 to 37. The total number of plastic surgery positions and the total number of integrated positions increased by 5.3 and 8.2 positions per year, respectively, with a strong linear correlation to time (R 2 = 0.97, R 2 = 0.98, respectively). In contrast, independent positions decreased by 2.8 positions per year (R 2 = 0.76). CONCLUSIONS: Plastic surgery training has shifted predominantly to favor the integrated pathway, with the independent pathway offering fewer positions despite steady interest. As a result, early exposure, research, and mentorship are essential, and applicants should be counseled that the integrated pathway is now the primary model.