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Female breast cancer patients aged 18–70 years show greater than a 20% difference between the expected and actual percentage of drug usage within this sample subgroup, providing evidence for the psychoactive drug phenomenon. Statistically significant results were found for both the usage of anxiolytics in reconstructive surgery patients and the usage of stimulants in cosmetic surgery patients, compared with the America’s State of Mind report.1 It was found that 31.06% of the sample population took anxiolytic drugs, whereas the national average is 11%. It was concluded that there is a notable difference between reconstructive surgery patient’s antianxiety drug usage and national population antianxiety drug usage. Additionally, it was found that 7.41% of the cosmetic cohort took stimulant drugs, whereas the national average for adult women is 1.9%. Finally, the data collected from our cosmetic and reconstructive surgery patients showed a high percentage of patients prescribed more than one psychoactive drug. The data from each group, 10.62% of cosmetic surgery patients and 14.91% of reconstructive surgery patients were compared against the national average of 3.1% of the population who take more than 1 psychoactive drug. The finding was statistically significant for both reconstructive and cosmetic surgery patients. DISCUSSION The use of psychoactive drugs in patients in general is on the rise, with more than a quarter of the current population taking them.1 Each class of drugs has its own particular set of risks and considerations for patient safety, particularly during surgery and anesthesia. The benefits of discontinuing a patient’s psychotropic drug must be weighed against the physical effects of withdrawal or discontinuation syndrome, in which a patient relapses into a condition that they had up until that point controlled with medication. Those taking psychotropic medications may require more narcotics or anesthesia, and they may be at risk for hazardous drug interactions. Antidepressants are among the most widely prescribed drugs in the world; the rate of antidepressant use in the United States has increased nearly 400% from 1988–1994 through 2005–2008.4 Antidepressants are divided into three categories: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAOIs). Each class of antidepressant works by a different mechanism and has different risks and implications for anesthesia, including drug interactions. Withdrawing a TCA or SSRI may precipitate a relapse of the condition for which it is being used and is to be avoided.5 Selective serotonin reuptake inhibitors are considered to have a low-risk safety profile but are not devoid of adverse effects. SSRIs can increase peripheral serotonin in the body by interfering with platelet uptake, especially when taken in combination with tramadol, meperidine, and pentazocine. Serotonin syndrome is marked by an increase in blood pressure, rapid heart rate, and agitation, and has also been exhibited to be a risk to patients who take MAOIs, which impair serotonin metabolism.5,8 Other risks to patients taking SSRIs include an increased risk of bleeding due to their interference with platelet function and a decrease in platelet serotonin storage.5,9 One study showed a 4-fold greater risk of breast hematoma needing intervention in cosmetic breast surgery patients who used SSRIs compared with those who did not.10 couples to form pairs of choices on their primary rank order lists, which are considered in rank order when the matching algorithm is processed. Couples match to the most preferred pair of programs where each partner has been offered a position. PGY-1 & PGY-2 Post-graduate year one and post-graduate year two. Program Type The NRMP classifies programs for the Main Residency Match into five types: · Categorical (C) programs: Programs that begin in the PGY-1 year and provide the full training required for specialty board certification. · Primary (M) programs: Categorical programs in primary care medicine and primary care pediatrics that begin in the PGY-1 year and provide the full training required for specialty board certification. · Preliminary (P) programs: One-year programs that begin in the PGY-1 year and provide prerequisite training for advanced programs. · Advanced (A) programs: Programs that begin in the PGY-2 year after a year of prerequisite training. · Physician (R) programs: Programs that are reserved for physicians who have had prior graduate medical education. Reserved programs offer PGY-2 positions that begin in the year of the Match and thus are not available to senior medical students. SOAP The Supplemental Offer and Acceptance Program® (SOAP®) is a process by which eligible unmatched applicants in the Main Residency Match apply for and are offered positions that did not fill when the matching algorithm was processed. Results and Data 2021 Main Residency Match® v Introduction This report summarizes data from the National Resident Matching Program (NRMP) 2021 Main Residency Match, the largest in NRMP history when measured by the number of positions offered (38,106) and filled (36,179). The 35,194 PGY-1 positions offered constituted an all-time high and an increase of 928 over 2020; more than half the increase was attributable to growth in Family Medicine and Internal Medicine. The numbers of registrants (48,700) and active applicants (42,508) also were all-time highs, with 3,741 more registrants and 2,424 more active applicants compared to 2020. Position Fill Rate A successful Match is measured not just by volume, but also by how well it matches the preferences of applicants and program directors. Based on that criterion, the overall position fill rate for the 2021 Match was 94.9 percent. After the matching algorithm was processed, 1,927 of the 38,106 positions were unfilled. There were an additional 66 positions that were unfilled in programs that did not submit a rank order list, bringing the total unfilled to 1,993. Of those, 1,892 were placed in the Match Week Supplemental Offer and Acceptance Program (SOAP). At the conclusion of SOAP, there were only 220 total positions remaining unfilled, for a post-SOAP fill rate of 99.6 percent. Applicant Trends This year, 42,508 active applicants vied for the 35,194 first-year and 2,912 second-year (including physician (R)) residency positions U.S. MD senior students comprised 19,866 of the active applicants, 540 more than in 2020. The PGY-1 match rate for U.S. MD seniors was 92.8 percent. Historically, the PGY-1 match rate for U.S. MD seniors has been 92-95 percent. The number of U.S. DO senior students continues to grow. An all-time high of 7,101 U.S. DO seniors submitted rank order lists of programs, 520 more than in 2020, and 6,327 of them matched to PGY-1 positions. The PGY-1 match rate for U.S. DO seniors in 2021 was 89.1 percent. More U.S. citizen and non-U.S. citizen students and graduates of international medical schools (IMGs) registered for the Match than in 2020. Of the 5,295 U.S. IMGs who submitted rank order lists of programs, 3,152 matched to a PGY-1 position for a match rate of 59.5 percent. Of the 7,943 non-U.S. citizen IMGs who submitted rank order lists of programs, 4,356 matched to a PGY-1 position for a match rate of 54.8 percent. Other features of interest include: · In 2021, the overall number of registered applicants was 48,700, the highest in the history of the Match. · The number of registered non-U.S. citizen IMGs was 10,718, 1,762 more than last year. · The percentage of all U.S. MD seniors who matched to their first-choice programs was 46.4 percent; however, 72.3% of U.S. MD seniors matched to one of their top three choices. · The percentage of DO seniors who matched to their first-choice programs was 42.4 percent, however, 72.2% matched to one of their top three choices. Couples Couples have been able to participate in the Match since 1984. In the 2021 Match, 2,448 individuals participated as couples, the same as 2020. The PGY-1 match rate was 93.4 percent in 2021. Other Notable Trends Match results can be an indicator of physician workforce trends. Highlights in 2020 include: · The ratio of PGY-1 positions per active U.S. MD senior was 1.77, the same as last year, and the highest since 1976. ·Primary care specialties offered record-high numbers of positions and had high position fill rates: § In 2021, a total of 6,878 U.S. MD seniors and 3,441 U.S. DO seniors matched to categorical positions in Family Medicine, Internal Medicine, and Pediatrics. § Though the numbers of positions for Internal Medicine (categorical) have fluctuated, 9,024 positions in 2021 is the highest number on record and 8,632 filled (95.7%). U.S. MD seniors filled 39.0 percent, 1.2 percent less than last year; U.S. DO seniors filled 16.4
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