Recent Trends in Resident Career Choices After Plastic Surgery Training

Do Plastic Surgery Programs with Integrated Residencies or Subspecialty Fellowships Have Increased Academic Productivity?

The aim of this study was to evaluate the effect of different surgical training pathways on the academic performance of plastic surgical divisions.

METHODS

Eighty-two academic parameters for 338 plastic surgeons (PS), 1737 general surgeons (GS), and 1689 specialist surgeons (SS) from the top 55 National Institutes of Health (NIH)-funded academic departments of surgery were examined using data gathered from websites, SCOPUS, and NIH Research Portfolio Online Reporting Tools.

RESULTS

The median size of a PS division was 7 faculty members. PS faculty had lower median publications (P)/citations (C) (ie, P/C) than GS and SS (PS: 25/328, GS: 35/607, and SS: 40/713, P < 0.05). Publication and citation differences were observed at all ranks: assistant professor (PS: 11/101, GS: 13/169, and SS: 19/249), associate professor (PS: 33/342, GS: 40/691, and SS: 44/780), and professor (PS: 57/968, GS: 97/2451, and SS: 101/2376). PS had a lower percentage of faculty with current/former NIH funding (PS: 13.5%, GS: 22.8%, and SS: 25.1%, P < 0.05). Academic productivity for PS faculty was improved in integrated programs. P/C for PS faculty from divisions with traditional 3-year fellowships was 19/153, integrated 6-year residency was 25/329, and both traditional and 6-year programs were 27/344, P < 0.05. Craniofacial and hand fellowships increased productivity within the integrated residency programs. P/C for programs with a craniofacial fellowship were 32/364 and for those that additionally had a hand fellowship were 45/536. PS faculty at divisions with integrated training programs also had a higher frequency of NIH funding.

CONCLUSIONS

PS divisions vary in degree of academic productivity. Dramatically improved scholarly output is observed with integrated residency training programs and advanced specialty fellowships.

The Public Recognizes Plastic Surgeons as Leading Experts in the Treatment of Congenital Cleft and Craniofacial Anomalies

OBJECTIVE

The aim of this study is to assess the public perception of plastic surgeons (PS) as craniofacial surgery specialists.

METHODS

Members of the public (N = 1514) were asked to choose 1 or 2 specialists that they perceived to be an expert for 13 craniofacial surgery-related scenarios. Response patterns were distributed as "plastic surgeon alone" (PS alone), "PS combined with other specialists", or "no plastic surgeon" (No PS). Sociodemographic data, previous plastic surgery contact, and source of reported information were also collected.

RESULTS

"Plastic surgeon alone" was significantly (all P < 0.05) more recognized as experts than all other response patterns particularly in congenital anomalies-related scenarios (83.33%). There was a significantly (all P < 0.05) poor understanding of the role of PSs in head/neck infection management, chronic facial palsy management, dental disease management, head and neck cancer surgery, vascular malformation surgery, and facial fracture surgery. Sex, age, education level, health care professional, prior plastic surgery contact, and source of reported information were not significant (all P < 0.05) determinants of "PS" as the response in bivariate and multivariate analyses.

CONCLUSIONS

Public recognized PSs as experts primarily in treatment of congenital cleft and craniofacial anomalies, but as the overall scope of craniofacial surgery practice was poorly understood and known, improved public education is needed.

Employment Satisfaction in Plastic and Reconstructive Surgery and Its Influence on Graduating Residents in an Evolving Health Care Climate

BACKGROUND

The current state of employment satisfaction in plastic surgery has not been defined. Similarly, the factors influencing residents as they search for employment and the role of attending surgeons as mentors in this process have not been elicited. The authors aim to elucidate these measures through a survey of attending surgeons and senior residents.

METHODS

A survey was created assessing employment satisfaction and was distributed to members of the American Society of Plastic Surgeons with available contact information. Responses were analyzed, with values of p < 0.05 deemed significant.

RESULTS

A total of 616 plastic surgeons and senior plastic surgery residents responded. Compared with attending surgeons in private practice, those in academic practice were more satisfied with their case mix (p = 0.0005; OR, not significant) and less satisfied with their incentive structure (p = 0.0001; OR, 0.3155) and payor mix (p = 0.0005; OR, 0.6156). Employment change occurred in 225 surgeons (39.2 percent) since beginning practice. Surgeons that changed employment ranked base salary (p = 0.0031), earning potential (p = 0.0001), and incentive structure (p = 0.0001) as most important. Those that did not change employment ranked lifestyle (p = 0.0048), location (p = 0.0001), and desire to teach (p = 0.0002) as more important. Residents ranked location (p = 0.0030), desired case mix (p = 0.0131), and desire or lack of desire to teach residents (p = 0.0329) as more important than attending surgeons felt they should be, and guaranteed salary (p = 0.0178) and incentive structure (p = 0.0069) as less important.

CONCLUSIONS

In an evolving health care environment, plastic surgeons' employment satisfaction is significantly dependent on a myriad of factors. Residents and their attending mentors differ significantly in perceived importance of these factors.

Evaluation of content and accessibility of hand fellowship websites

BACKGROUND

Graduates of general, orthopedic, and plastic surgery residencies utilize web-based resources when applying for hand fellowship training. The purpose of this study was to evaluate the accessibility and content of hand fellowship websites (HFWs).

METHODS

Websites of accredited hand surgery fellowships were eligible for study inclusion. HFWs were evaluated for comprehensiveness in the domains of education and recruitment. Website content was correlated with program characteristics via Fisher exact tests.

RESULTS

Fifteen plastic, 65 orthopedic, and 1 general surgery hand fellowships were analyzed. Seventy-four hand fellowships maintained an HFW (91 %). HFWs were not found for 3 plastic and 4 orthopedic hand programs (20 versus 6 %, p = 0.118). HFWs provided only half of all analyzed content (54 %-education and 49 %-recruitment). Orthopedic programs had more education content than plastic surgery programs (55 versus 44 %, p = 0.030). Programs in the South had more education content than programs in the Northeast (63 versus 47 %, p = 0.001), but not more than programs in the West (54 %) or Midwest (55 %). Larger programs with more fellows had greater education content than those with only one fellow (57 versus 49 %, p = 0.042). Programs affiliated with top-ranked medical schools had less education content than lower-ranked schools (48 versus 56 %, p = 0.045). No differences existed in recruitment content between programs.

CONCLUSIONS

Most hand surgery fellowships lack readily accessible and comprehensive websites. The paucity of online content suggests HFWs are underutilized as educational resources and future opportunity may exist to optimize these tools.

The Academic Scholar Award of the American Association of Plastic Surgeons: the first 20 years

BACKGROUND

This study evaluated the 20-year history of the American Association of Plastic Surgeons Academic Scholar Award from 1992 through 2012, to assess the program's value and justify future investment.

METHODS

The curricula vitae of 18 Academic Scholars who completed their award by 2012 were analyzed. Data were compiled into 5-year blocks and reviewed.

RESULTS

Award recipients has 589 grants, an average of 33 per recipient. Sixty-nine grants were active, and the recipient was the principal investigator in 61 of these grants. Active funding is $68 million. Recipients average 3.7 active grants per person, with a value of $3.8 million per grant. The average number of grants peaks at 5 to 10 years after award completion and then declines slightly to 42 at 10 to 15 years. During this time, total grant money increased from $956,667 to $8.1 million, suggesting that senior surgeons produce more money with fewer grants. Recipients produced 2378 peer-reviewed articles, and productivity was the highest 5 to 10 years after award completion. Three hundred forty-one individuals were mentored, and each recipient mentored an average of 18 individuals. Forty-two mentees entered academics, and 32 generated extramural funding. Scholars increased mentorship activity, as demonstrated by (1) increased grants as any role, (2) increased grant funding as any role, (3) increased median number of senior author publications, and (4) mentorship activities and accomplishments of mentees.

CONCLUSIONS

The Academic Scholar program met its goals based on (1) Scholars' careers, (2) increased mentorship, and (3) cost-benefit ratio of the American Association of Plastic Surgeons investment. Every $1 invested produces $70, with a return that exceeds 1000 percent.

Influence of training institution on academic affiliation and productivity among plastic surgery faculty in the United States

BACKGROUND

Educational processes that encourage a career in academic plastic surgery remain unclear. The authors' study aim was to examine the impact of training institution on the pursuit of a career in academic plastic surgery.

METHODS

Academic plastic surgery faculty (n = 838) were identified through an Internet-based search of all 94 Accreditation Council for Graduate Medical Education-accredited residency and fellowship training programs. Academic productivity was determined by number of peer-reviewed publications and Scopus h-index. Linear and logistic regression analyses were performed to determine the correlation between attributes after adjusting for the clustering of surgeons within programs.

RESULTS

In the United States, 39 percent of plastic surgeons in academic practice are trained in only 11 programs, 30 percent of faculty remained at training institutions, and 39 percent were affiliated with a private practice model. Faculty from frequently represented training programs were more likely to pursue fellowship training (OR, 1.32; 95 percent CI, 1.00 to 1.75), have higher h-indices (9.0 versus 5.4; p < 0.001), and have a greater number of peer-reviewed articles (46.6 versus 24.3; p < 0.001). Higher h-indices were correlated with male sex (7.1 versus 4.7; p < 0.001), fellowship training (7.3 versus 6.1; p < 0.05), and no private practice affiliation (5.2 versus 7.8; p < 0.001). Female surgeons represented 14.1 percent of academic plastic surgeons, were younger based on the median year of board certification (2005 versus 2000; p < 0.05), and were more likely to be on the tenure track (66.9 percent versus 57.2 percent; p < 0.05) and at the assistant professor level (73.1 percent versus 43.6 percent; p < 0.05).

CONCLUSION

Identification of educational processes that encourage a career in academic practice may improve resident mentorship and resident interest in academic plastic surgery.