1305 Applying to Neurosurgery Without a Home Program: An Untapped Resource

INTRODUCTION: Recent calls promoting diversity have focused on gender, race, and ethnicity as a means of increasing diversity of thought and experience in neurosurgery. While we have seen record numbers of women and Black residents matching in recent cycles, there remains a large, virtually untapped pool of applicants that have not receive much attention – applicants without home programs. Despite interest in the field, applicants without a home must put in significant effort to reach the same level of accomplishment as their peers, yet often lack access to resources and the network required to match. METHODS: We used public domain sources, such as Doximity and program websites, to collect information from all residents who matched to an ACGME-accredited neurosurgery residency in the United States between 2015 – 2024. RESULTS: There are 113 ACGME-accredited neurosurgery residency programs across 107 institutions. There are 154 LCME-accredited medical schools of which 47 (30.5%) do not have a residency program. Of the 2277 residents, 1846 (81.1%) have a home program of which 469 (25.4%) matched to their home institution. Only 431 (18.9%) applicants matched in the absence of a home program of which 191 (8.4%) were US MDs, 194 (8.5%) were IMGs, and 46 (2.0%) were DOs. CONCLUSIONS: Access to a home neurosurgery program confers a large advantage to successfully match. Currently, US MDs without a home program match to neurosurgery residencies at the same rate as IMGs. While several clinical and research opportunities exist, many are either inaccessible or targeted at IMGs. Students at institutions without a home program represent a large, untapped pool of applicants whose consideration will likely significantly advance efforts focused on promoting diversity of thought, gender, and race.