Career Development in Plastic Surgery

Characteristics and academic career outcomes of Godina Fellowship recipients

The American Society for Reconstructive Microsurgery (ASRM) sponsors the Godina Fellowship to expand the careers of talented early career microsurgeons. This study characterizes the scholarly impact and academic career outcomes of Godina Fellows. The ASRM provided a list of Godina Fellows since program inception (1993 - 2020). An Internet based search obtained demographic, academic pedigree, and scholarly impact metrics. Curriculum vitae were reviewed to characterize future career outcomes including academic leadership positions. Of the 28 Godina Fellows, most were men (96%) and from the United States (61%). The average age of selection was 44 ​± ​4 years. Training pedigrees consisted primarily of plastic surgery residency training (93%) followed by orthopedic surgery (3%) and otolaryngology (3%). 32% completed reconstructive microsurgery fellowship training, 25% completed hand fellowship training, and 32% had no sub-specialty fellowship training. A minority of Fellows had a PhD (32%) and Master's Degree (14%). The average h-index was 33 ​± ​11 resulting from 160 ​± ​90 peer-reviewed manuscripts cited 3998 ​± ​2516 times. At the time of selection, Godina fellows had an average of 65 ​± ​42 peer-reviewed manuscripts. Most selected academic careers (79%), including 43% serving as chief of a sub-specialty service line (25%) or chair of a division or department (18%). Godina Fellowship recipients make important contributions to the field of reconstructive microsurgery through research impact and leadership at academic departments.

Defining the Incidence of the Impostor Phenomenon in Academic Plastic Surgery: A Multi-Institutional Survey Study

BACKGROUND

Impostor phenomenon occurs when high-achieving individuals have persistent self-doubt despite objective measures of competence and success, and has been associated with professional burnout and attenuated career advancement in medical specialties. This study aimed to define the incidence and severity of the impostor phenomenon in academic plastic surgery.

METHODS

A cross-sectional survey containing the Clance Impostor Phenomenon Scale (range, 0 to 100; higher scores indicate greater severity of impostor phenomenon) was distributed to residents and faculty from 12 academic plastic surgery institutions across the United States. Generalized linear regression was used to assess demographic and academic predictors of impostor scores.

RESULTS

From a total of 136 resident and faculty respondents (response rate, 37.5%), the mean impostor score was 64 (SD 14), indicating frequent impostor phenomenon characteristics. On univariate analysis, mean impostor scores varied by gender (67.3 for women versus 62.0 for men; P = 0.03) and academic position (66.5 for residents versus 61.6 for attendings; P = 0.03), but did not vary by race or ethnicity; postgraduate year of training among residents; or academic rank, years in practice, or fellowship training among faculty (all P > 0.05). After multivariable adjustment, female gender was the only factor associated with higher impostor scores among plastic surgery residents and faculty (estimate 2.3; 95% CI, 0.03 to 4.6; P = 0.049).

CONCLUSIONS

The prevalence of the impostor phenomenon may be high among residents and faculty in academic plastic surgery. Impostor characteristics appear to be tied more to intrinsic characteristics, including gender, rather than years in residency or practice. Further research is needed to understand the influence of impostor characteristics on career advancement in plastic surgery.

How to Start and Build a Practice in Microsurgical Breast Reconstruction: Success and Sustainability in a Private Practice Setting

The aim of this article is to provide a template for building and sustaining a microsurgical breast reconstruction practice in a private practice setting. The target audience including residents, microsurgical fellows, and reconstructive microsurgeons were currently employed in an academic setting, and reconstructive microsurgeons were currently employed in a private group entity. We present five pillars that initiate, support, and sustain a successful practice in microsurgical breast reconstruction. The five key concepts are (1) establishing a practice vision and culture, (2) obtaining funding, (3) assembling staff, (4) negotiating insurance and other contracts, and (5) striving for efficiency and sustainability. These concepts have been at the core of Plastic, Reconstructive and Microsurgical Associates of South Texas-a private practice eight-physician group based in San Antonio, Tex.-since its inception. However, these concepts have evolved as the practice has grown and as the economic landscape has changed for reconstructive microsurgeons. In the article, we will present what we have done well, what we could have done better, and some pitfalls to avoid.

The Influence of Training Pathway, Institution Type, Gender, and a Global Pandemic on Post Graduation Career Plans in Plastic Surgery

Background

Anecdotal statements are often made about what percentage of residents go into fellowship versus private practice versus academia after graduation. However, few objective studies have been completed on this topic. This project is designed to shed light on the career choices of plastic surgery residents immediately after graduation from 2018 to 2022. A secondary objective was to determine whether the COVID-19 pandemic had any measurable impact on postgraduation plans.

Methods

After obtaining institutional review board approval, publicly available data were obtained from institution websites or via program queries. Comparison between pre-COVID-19 and post-COVID-19 (2018-2019 versus 2020-2022), integrated versus independent, and private versus public cohorts were analyzed using Fisher exact test. A two-sided P value less than 0.01 was considered statistically significant.

Results

Data were collected for 690 graduates across 64 plastic surgery training programs. Responses were obtained from 60 of 88 (68%) integrated and 30 of 47 (64%) independent programs. Most graduates pursued fellowship training (61%), followed by private practice (28%), academic practice (5%), or military post (1%). Independent residents were more likely to pursue private practice (40% versus 26%, P = 0.001), whereas integrated residents were more likely to pursue fellowship (49% versus 70%, P < 0.0001). Public institution graduates were more likely to go into private practice (37% versus 23%, P = 0.0002), whereas private institution residents were more likely to pursue fellowship (55% versus 72%, P < 0.0001). Public institutions were more likely to graduate women (45% versus 35%, P = 0.009). The COVID-19 pandemic (P = 0.31) had no impact on postgraduation plans.

Conclusions

This study demonstrates that training pathway and institution type have a significant impact on postgraduation plans, whereas a global pandemic does not. This information can be used by educators, residents, and medical students as they plan for the future.

Practice Management in Plastic Surgery: A Survey Comparing Skills Acquired During Residency and Those Applied in Independent Practice

BACKGROUND

Understanding the extent of practice management education within plastic surgery residency may serve to enhance elements of current curricular training.

METHODS

A survey was sent to private practice plastic surgeons who completed training between 2008 and 2020. The survey elicited opinions about their practice management training during residency and experiences as attendings.

RESULTS

Forty-nine private practice plastic surgeons completed the survey with a mean of 5 years in practice. 96% of respondents entered private practice immediately following their final training program. 48% of respondents cited "autonomy" as the primary reason for pursuing private practice. Surgeon's narrative responses regarding practice management skills learned outside of residency revealed the most grouped into the following themes: "Finance, Marketing, Accounting, Human Resources (HR), Operations" (n = 19), "Hiring, Firing, Employee Management" (n = 17), "Insurance Coverage, Billing, Coding" (n = 13), "General Skills" (n = 12), and "Starting & Running a Practice" (n = 11). 71.4% of respondents reported that they learned practice management skills from on-the-job training. Almost all respondents felt that there should be formal training in practice management (n = 35), with "Finance & Accounting" and "Management" cited as the most important skills to learn as a plastic surgeon. 51% of current surgeons felt allowing senior residents additional opportunities to rotate in private practices was the best way to enhance residency curricula.

CONCLUSION

Incorporating practice management skills into training curricula will address the demonstrated knowledge gap and accelerate plastic surgeons' career growth.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. 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 .

Opportunity Costs of Internal Promotions in Plastic Surgery: Are Women Given a Fair Shot?

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