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Swanson E. Diversity, Equity, and Inclusion in Plastic Surgery: A Systematic Review. Ann Plast Surg 2024; 92:353-366. [PMID: 38527336 DOI: 10.1097/sap.0000000000003936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
BACKGROUND The number of publications on the subject of diversity, equity, and inclusion has surged in the last 5 years. However, a systematic review of this topic has not been published. METHOD Six top plastic surgery journals were queried from 2018 to 2023 using the search term "diversity." Methods, conclusions, and recommendations were tabulated. RESULTS A total of 138 publications were identified; 68 studies presented data suitable for analysis. All studies were retrospective. Currently, over 40% of plastic surgery residency applicants are women. The proportion of women in integrated plastic surgery residents is now 43%. In 2021 and 2022, the percentage of female first-year residents exceeded men. The percentage of female presenters at meetings (34%) is double the number in the workforce (17%). Twenty-five percent of academic faculty positions and 22% of program director positions are now held by women. Underrepresented minorities account for fewer than 10% of applicants to integrated plastic surgery residencies. DISCUSSION The proportion of Black and Hispanic applicants to integrated plastic surgery residencies (6% and 8%, respectively) mirrors the proportion of Black and Hispanic medical students (7% and 6%, respectively). Numerous recommendations have been made to increase the proportion of underrepresented minorities in plastic surgery programs. CONCLUSIONS The representation of women in plastic surgery has increased dramatically. A lack of Hispanics and Blacks reflects a small pool of applicants, as opposed to a "leaky pipeline."
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Horne MJ, Bray SMC, Schalet BJ, Kpodzo DS. Exploring Trends in Immediate Postresidency Career Paths: A Multi-year Analysis of Plastic Surgery Resident Graduates Across the United States. Aesthet Surg J Open Forum 2023; 6:ojad115. [PMID: 38250455 PMCID: PMC10798821 DOI: 10.1093/asjof/ojad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Background Plastic surgery is one of the most diverse specialties in medicine. Because of the competitiveness of plastic surgery residency, applicants are entering the field with increased experience and more developed interests in specific specialties. Programs and prospective applicants may find it beneficial to know trends in the career paths of recent graduates. Objectives To identify trends in postresidency career paths for plastic surgery graduates. Methods Data from all integrated plastic surgery residency programs were analyzed from 2013 to 2022. Eighty-eight residency programs were analyzed for review. Residency websites were the primary source of data. Postresidency career paths were categorized into subspecialty fellowships, academic practice, or private practice. Secondary data included program rank, size of the program, associated fellowship program, associated independent program, and program location. Results Seventy-three programs met the inclusion criteria. Private practice was the most common immediate postgraduation path. Microvascular and aesthetic fellowships demonstrated maximum growth in the last 10 years, followed by hand fellowships. Programs ranked in the top 25 by Doximity reputation were significantly associated with graduates going into craniofacial (P = .05) and microvascular fellowship (P = .021), and immediate academic practice (P = .011). Lower-ranked programs were correlated with higher levels of graduates entering directly into private/community hospital practice (ρ = 0.327). Conclusions Life after residency is a necessary consideration for training physicians. Understanding trends in postresidency career paths could help programs and prospective applicants make more informed decisions on what programs may offer the best opportunities to pursue their desired career path. Level of Evidence 5
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Affiliation(s)
| | | | | | - Dzifa S Kpodzo
- Corresponding Author: Dr Dzifa S. Kpodzo, Albany Medical Center, 50 New Scotland Avenue 1st Floor, Albany, NY 12208, USA. E-mail: ; Twitter: @drkpodzo; Instagram: @drkpodzo
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Ngaage LM, Borrelli MR, Ketheeswaran S, Shores JT. Article Factors Influencing Gender Disparities in Senior Authorship of Plastic Surgery Publications. Ann Plast Surg 2023; 91:638-643. [PMID: 37962253 DOI: 10.1097/sap.0000000000003709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Female plastic surgeons publish fewer and lower impact articles. To better understand how to address this gender gap, we explored the temporal trends in female senior authorship and evaluated predictive factors for female senior authorship. METHODS A retrospective review of articles published in the 3 highest impact plastic surgery journals published from 2010 to 2020 was conducted. Trends with female senior authorship across time were analyzed with respect to study type, subspeciality, and geographical origin. RESULTS Of the 5425 articles included, 13% (n = 720) had a female senior author, and female senior authorship increased across time ( R = 0.84, P = 0.033). Over the decade, an increased proportion of cohort studies ( R = 0.82, P = 0.045), systematic reviews ( R = 0.96, P = 0.003), breast-related articles ( R = 0.88, P = 0.022), and reconstruction-related articles ( R = 0.83, P = 0.039) were published by female senior authors. Subspecialty and geography predicted female senior authorship; articles focused on aesthetic (odds ratio [OR] = 1.3, P = 0.046) and breast (OR = 1.7, P < 0.001) subspecialties or those originating from Canada (OR = 1.7 P = 0.019), Europe (OR = 1.5, P < 0.001), and Latin America (OR = 3.0, P < 0.001) were more likely to have a female senior author. Articles from East Asia were less likely to have female senior authors (OR = 0.7, P = 0.005). CONCLUSION Female senior authorship in plastic surgery has increased over the last decade, and the proportion of female plastic surgeons leading cohort studies and systematic reviews is increasing. Sex of the senior author is influenced by plastic surgery subspecialty and geographical origin, but article type did not impact the odds of female senior authorship.
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Affiliation(s)
- Ledibabari Mildred Ngaage
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mimi R Borrelli
- Department of Plastic and Reconstructive Surgery, Brown University School of Medicine, Providence, RI
| | - Suvethavarshini Ketheeswaran
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jaimie T Shores
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Tolson HC, Raikar DAH, Morris BE, Ferguson EMN, Shahriary E. Ethnic and Sex Diversity in Academic Plastic Surgery: A Cross-sectional Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4991. [PMID: 37396840 PMCID: PMC10313300 DOI: 10.1097/gox.0000000000004991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/22/2023] [Indexed: 07/04/2023]
Abstract
Ethnic, racial, and sex disparities continue to persist in medicine despite efforts to diversify the profession. In competitive surgical specialties such as plastic surgery, those disparities are particularly pronounced. This study aims to evaluate racial, ethnic, and sex diversity in academic plastic surgery. Methods We compiled a list of major plastic surgery professional societies, plastic surgery journal editorial boards, and plastic surgery accreditation boards to evaluate ethnic and sex diversity in society, research, and accreditation domains, respectively. Demographic data were collected and analyzed using the Mann-Whitney U test and the Kruskal-Wallis test. Results White individuals are significantly overrepresented across the professional and research domains, and Asian individuals are overrepresented in the professional domain when compared to non-white races. White individuals make up a total of 74% of the society domain, 67% of the research domain, and 86% of the accreditation domain when compared to all non-white surgeons. Male surgeons made up 79% of the society domain, 83% of the research domain, and 77% of the accreditation domain when compared to all non-male surgeons. Conclusions Ethnic, racial, and sex disparities persist in academic plastic surgery. This study, which looked at societies, editorial boards, and accreditation boards, demonstrated a persistent ethnic, racial, and sex homogeneity among leadership. Changes are required to continue to diversify the field and provide women and underrepresented minorities the tools needed to succeed.
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Affiliation(s)
- Hannah C. Tolson
- From the University of Arizona College of Medicine Phoenix, Phoenix, Ariz
| | | | - Bryn E. Morris
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Phoenix, Ariz
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Oberoi MK, Reghunathan M, Aref Y, Dinis JJ, Balumuka D, Gosman A. Racial/Ethnic and Gender Disparities Over the Last Decade Within Microsurgery and Craniofacial Fellowship Training. Ann Plast Surg 2023; 90:S281-S286. [PMID: 36752557 DOI: 10.1097/sap.0000000000003403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Racial/ethnic and gender disparities persist in plastic surgery at nearly all levels of training, becoming more pronounced at each stage. Recent studies have demonstrated that the proportion of female plastic surgery residents has increased to nearly 40%, yet only 11% of full professors of plastic surgery are female. Other studies have identified severe declines in underrepresented minority plastic surgery representation between plastic surgery residents and academicians with only 1.6% of Black/African American and 4.9% of Hispanic/Latinx full professors of plastic surgery. Often, residents seek fellowship for advanced training before seeking an academic professorship. This study aims to describe the racial/ethnic and gender representation of microsurgery and craniofacial fellows. METHODS Names and photos of graduated fellows for the past 10 years (2012-2021) were extracted from microsurgery and craniofacial fellowship Web sites. Using a 2-person evaluation method, race/ethnicity and gender were primarily determined by photographic and surname and verified, when possible, through online confirmation methods (articles, social media). Distributions were analyzed with descriptive statistics and compared with the US population. RESULTS Among 30 microsurgery fellowships, 180 graduated fellows (52.7%) were identified, resulting in 66 female fellows (36.7%) and the following racial/ethnic distribution: 113 (62.8%) White, 49 (27.2%) Asian, 12 (6.7%) Hispanic/Latinx, and 6 (3.3%) Black/African American. Among 31 craniofacial fellowships, 136 graduated fellows (45.0%) were identified, resulting in 38 female fellows (27.9%) and the following racial/ethnic distribution: 75 (55.1%) White, 45 (33.1%) Asian, 8 (5.9%) Hispanic/Latinx, and 8 (5.9%) Black/African American. The intersection between race/ethnicity and gender revealed the most disproportionately low representation among Black women. Relative to the US population, Hispanic/Latinx (0.31-fold) and Black/African American (0.48-fold) fellows were underrepresented, White (0.90-fold) fellows were nearly equally represented, and Asian (5.42-fold) fellows are overrepresented relative to the US population. Furthermore, despite pursuing fellowships at a greater rate, Asian and Black fellows are not reaching adequate representation among academic plastic surgeons. CONCLUSION This study demonstrates that female racial/ethnic minorities are disproportionately underrepresented among microsurgery and craniofacial fellowships. Efforts should be made to improve the recruitment of fellows of underrepresented backgrounds and thus improve the pipeline into academic careers.
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Affiliation(s)
- Michelle K Oberoi
- From the Division of Plastic Surgery, Department of Surgery, Baylor Scott & White Healthcare, Texas A&M Health Science Center College of Medicine, Temple, TX
| | - Meera Reghunathan
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, San Diego, CA
| | - Youssef Aref
- California University of Science and Medicine, Colton, CA
| | - Jacob J Dinis
- Frank H. Netter MD School of Medicine, North Haven, CT
| | - Darius Balumuka
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Oregon Health & Science University School of Medicine, Portland, OR
| | - Amanda Gosman
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, San Diego, CA
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Cevallos P, Amakiri UO, Johnstone T, Kim TSE, Maheta B, Nazerali R, Sheckter C. Is Plastic Surgery Training Equitable? An Analysis of Health Equity across US Plastic Surgery Residency Programs. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4900. [PMID: 37035124 PMCID: PMC10079348 DOI: 10.1097/gox.0000000000004900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/09/2023] [Indexed: 04/11/2023]
Abstract
Achieving health equity includes training surgeons in environments exemplifying access, treatment, and outcomes across the racial, ethnic, and socioeconomic spectrum. Increased attention on health equity has generated metrics comparing hospitals. To establish the quality of health equity in plastic and reconstructive surgery (PRS) residency training, we determined the mean equity score (MES) across training hospitals of US PRS residencies. Methods The 2021 Lown Institute Hospital Index database was merged with affiliated training hospitals of US integrated PRS residency programs. The Lown equity category is composed of three domains (community benefit, inclusivity, pay equity) generating a health equity grade. MES (standard deviation) was calculated and reported for residency programs (higher MES represented greater health equity). Linear regression modeled the effects of a program's number of training hospitals, safety net hospitals, and geographical region on MES. Results The MES was 2.64 (0.62). An estimated 5.9% of programs had an MES between 1-2. In total, 56.5% of programs had an MES between 2 and 3, and 37.7% had an MES of 3 or more. The southern region was associated with a higher MES compared with the reference group (Northeast) (P = 0.03). The number of safety net hospitals per program was associated with higher MES (P = 0.02). Conclusions Two out of three programs train residents in facilities failing to demonstrate high equity healthcare. Programs should promote health equity by diversifying care delivery through affiliated hospitals. This will aid in the creation of a PRS workforce trained to provide care for a socioeconomically, racially, and ethnically diverse population.
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Affiliation(s)
- Priscila Cevallos
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
- Geisel School of Medicine, Dartmouth University, Hanover, N.H
| | | | - Thomas Johnstone
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
| | - Trudy Sea-Eun Kim
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
| | - Bhagvat Maheta
- College of Medicine, California Northstate University, Elk Grove, Calif
| | - Rahim Nazerali
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
| | - Clifford Sheckter
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
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