Analysis of Trends in the Selection and Production of U.S. Academic Plastic Surgery Faculty

An Analysis of the Characteristics and Trends in Practicing Plastic Surgeons in California

BACKGROUND

Studies suggest an increasing trend of plastic surgeons choosing private practice after training, with up to 90% pursuing private practice without future fellowships.1 Previous data showed that 66.7% of graduates from plastic surgery residency programs chose to pursue private practice without future fellowship, while more recent studies estimate this statistic has risen close to 90%.1,2 The literature has yet to characterize the current plastic surgery workforce and changes in its composition over time. This study aims to analyze the characteristics and training of plastic surgeons in California through a comparative study with general surgeons.

METHODS

Surgeon demographics were extracted from the Centers for Medicare and Medicaid Services open database. Urban/rural classification and academic affiliation were crosslinked from the Inpatient Prospective System database and sole proprietorship status was cross-linked from the NPI Registry. Summary statistics and logistic regressions with chi-squared analysis were analyzed using STATA/MP17.

RESULTS

Our analysis consisted of 3871 plastic and general surgeons in California. Compared to general surgeons, plastic surgeons were less likely to be females (P < 0.000), and more likely to be sole proprietors (P < 0.000), and affiliated with a teaching hospital (P < 0.005). There was no statistically significant difference in the percentage of rural-practicing plastic and general surgeons (P = 0.590). More recent plastic surgery graduates were more likely to be affiliated with an academic hospital (P < 0.0000). The composition of females significantly increased from the older graduated cohort to the most recent one. There was no significant difference in sole proprietorship and rural practice status between the oldest and youngest graduating cohorts.

CONCLUSIONS

Although the California plastic surgery workforce is gaining female plastic surgeons and shifting to academic institutions, significant progress in serving rural communities is yet to be made. Our study suggests that there may be a shift in the trend of plastic surgeons opting for private practice, possibly driven by a desire for more stable positions in academia. Continued improvement in diversity and training of future plastic surgeons is needed to alleviate the rural care gap.

Orphan Applicants in Plastic Surgery: Where Do Medical Students Without an Affiliated Residency Program Match?

BACKGROUND

The number of resident positions in integrated plastic surgery residencies are relatively few and highly sought after. Medical students interested in plastic surgery as a career are faced with the challenge of deciding where to apply for these highly competitive spots. This sense of keen competition means students are often applying to almost all available programs across the country with the idea of increasing their chance of successfully matching. Previous research has shown that exposure to specialty programs in medical school portends enhanced success in residency matches. This study focuses on medical students who come from schools without plastic surgery residencies-orphans-and the characteristics of those who successfully matched into integrated plastic surgery programs.

METHODS

This study evaluated trends in successfully matched applicants in integrated plastic surgery residencies from 2016-2021 by looking at applicants' medical school type, presence of plastic surgery residency associated with the medical school, and geographic region. Geographic region of residency programs, medical school of applicants, and national quality ranking of medical schools were correlated with applicant demographics. The data were tabulated and analyzed utilizing chi-square analysis.

RESULTS

Orphans who graduated from allopathic medical schools without an affiliated integrated plastic surgery residency program comprised 24.4% of successfully matched applicants, whereas those with affiliated integrated residency programs comprised 72.2%. However, at the top quartile of prestige-rated residency programs, these orphan applicants only comprised 17.4% of residents. Of all medical school applicants, 18.2% matched at a residency program affiliated with their medical school (P = 0.04). Annually, 1 to 3 osteopathic medical school graduates and 3 to 9 international medical graduates matched, representing less than 1 and 4%, respectively, of all matched applicants; these applicants had the least successful match rates.

CONCLUSIONS

There continues to be a modest number of successfully matched integrated plastic surgery residents who are graduates of allopathic medical schools with no affiliated residency program but disproportionately fewer at the top quartile institutions. There are also very few osteopathic and international medical school graduates who match, which has seen no significant change over the last 6 years.

The Influence of Academic Pedigree on Integrated Plastic Surgery Resident Training Location

INTRODUCTION

Plastic surgery residencies are among the most competitive programs for graduate medical education. While board scores and research output are well-studied indicators of match success, no studies describe the association between an applicant's medical school ranking and subsequent residency ranking.

METHODS

A cross-sectional study of integrated plastic surgery residents for the 2019 to 2020 academic year was performed. Integrated plastic surgery residency programs were ranked according to 2020 Doximity Residency Navigator. AAMC-affiliated allopathic medical schools were ranked according to US News & World Report 2020 Best Medical Schools. Multiple regression analysis was used to determine if academic pedigree predicted placement at highly competitive plastic surgery residency programs.

RESULTS

A total of 914 residents across 69 integrated plastic surgery residency programs were included. Ten medical schools accounted for 169 (18.4%) of all trainees. 159 (16.5%) matched at their home program for residency. Medical school ranking and medical school-affiliated integrated plastic surgery program ranking were significant predictors of match success and future residency competitiveness. The presence of an affiliated plastic surgery residency program predicted total number of medical school graduates who matriculated into plastic surgery residency (p < 0.0005). Graduates of top-ranked schools represented a disproportionate number of current plastic surgery residents (Top 10 program: 12.5%, Top 20: 24.1%, Top 40: 40.9%, Top 50: 49.1%).

CONCLUSIONS

Both medical school ranking and home plastic surgery program ranking appeared to influence match success and future residency training program competitiveness. This is the first study to demonstrate these associations.

Factors Associated With Colon and Rectal Surgery Fellowship Program Ranking Before and After the COVID-19 Pandemic

Supplemental Digital Content is available in the text.

Hitting the Books: A Nationwide Analysis of Advanced Degrees in Academic Plastic Surgery Faculty

OBJECTIVE

Plastic surgery is one of the most competitive and innovative fields in medicine. The role of the academic plastic surgeon continues to grow beyond clinical care, and many surgeons have pursued advanced degrees (AD) to expand their professional skillset. We present an analysis of ADs of academic plastic surgery faculty in the USA, with consideration of timing of AD attainment.

METHODS

All academic plastic surgery faculty members were identified from plastic surgery program websites, as recognized by the American Council of Academic Plastic Surgeons. ADs were defined as additional degrees beyond the primary medical degree. Outcomes included timing of AD attainment, residency rankings, institutional standings, and research productivity.

RESULTS

949 faculty members were identified, and 167 had ADs. The most common ADs were PhD (30%), MS/MSc (18%), and MBA/EMBA (17%). Timing of AD attainment was available for 146 faculty members (84.7%). Having an AD before residency was associated with matching into higher-tiered and integrated residency programs (both p < 0.05). For attending physicians, having an AD was associated with more journal editorial board positions, more publications, higher H-index, receiving NIH funding, and median number of NIH grants (adjusted for years in practice, all p<0.05). Institutional analysis revealed that employing more faculty with an AD was associated with having an integrated residency program, higher residency research ranking, and higher tier integrated residency (all p < 0.05).

CONCLUSION

ADs are growing in popularity in academic plastic surgery and are temporally associated with specific advantages in terms of residency placement, research productivity, and institutional standing.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Does Medical School Geography and Ranking Influence Residency Match in Otolaryngology?

OBJECTIVE

To elucidate the associations between geographic locations, rankings, and size/funding of medical schools and residency programs among the current otolaryngology residents.

METHODS

This retrospective cross-sectional study queried otolaryngology residency program websites for relevant publicly accessible information. Location was categorized as Midwest, Northeast, South, and West. Ranking was according to Doximity (residency) and US News and World Report (medical school). Medical school and residency programs were labeled large if they had >704 students or >15 residents, respectively.

RESULTS

A total of 1413 residents from 98 (89%) otolaryngology residency programs were included. Residents attending their home medical schools (18%) were equally distributed among regions (P = .845). Residents who attended medical schools in the same US regions (54%) were more likely from top-25 (P = .001) or private (P < .001) medical schools. Southern residents were most likely (64%) and Western residents were least likely (39%) from regional medical schools (P < .001), while residents from Midwest and Northeast had similar rates (54%-55%). The percentage of Midwest residents coming from regional medical schools has decreased from the 2013 to 2014 residency cycle (P = .037). Completing undergraduate school, medical school, and residency in the same region (38%) was also highest in the South (45%) and lowest in the West (25%) (P < .001). Residents at top-ranked residency programs were more likely from top-ranked (P < .001), large (P = .025), and private (P = .018) medical schools.

CONCLUSION

There exist significant associations between otolaryngology residents' medical school location, ranking, size, and funding source and their residency destination. More than half of the current otolaryngology residents attended medical school in the same geographic region, and about one-fifth have attended medical school and residency at the same institution. Future studies are warranted to evaluate how these results change as the match process evolves in the future.

LEVEL OF EVIDENCE

N/A.