Pay to Play: A Cost Analysis of Open Access Publications for Matched Plastic Surgery Applicants.

[INTRODUCTION] The integrated plastic surgery (IPS) match is one of the most competitive in medicine. Following the United States Medical Licensing Examination Step 1 transition to pass/fail, research productivity has become increasingly important. Open access (OA) publishing offers additional publishing routes and increased visibility for students but requires article processing charges (APCs), creating potential financial barriers.

[METHODS] We conducted a cross-sectional analysis of PubMed-indexed publications authored by matched IPS residents from the 2022-2024 cycles (n = 555). Residents were identified on program websites. OA journals were confirmed via publisher websites and the Directory of Open Access Journals. APCs were recorded from publisher fee schedules and assigned by article type. Expenditures were compared across cycles and between top 20 versus non-top 20 programs per Doximity.

[RESULTS] Among 555 matched applicants, 68.9% had at least one OA publication; 27.8% of all publications were OA. OA articles had lower median 2-year impact factors than subscription publications (1.5 versus 2.6, P < 0.0001). Plastic and Reconstructive Surgery - Global Open accounted for single highest publication venue (24.3% of OA publications). A total of $2.7 million in APCs were associated with OA publications across all three cohorts. The median APC expenditure per applicant rose from $1600 in the Class of 2022 to $1992 in the Class of 2023, and reaching $3500 in the Class of 2024, showing a 118.8% increase over 3 y (P = 0.0053). Applicants matching at top 20 programs carried median OA costs that were 111.0% more than peers ($3165 versus $1,500, P = 0.00005). The highest single applicant expenditure exceeded $98,000.

[CONCLUSIONS] OA publishing now constitutes a significant feature of IPS applicant research. APC costs surpass other match-related expenses and are disproportionately concentrated among applicants matching at highly ranked programs, potentially reinforcing inequities tied to institutional resources.