Understanding the Impact and Misconceptions of Rural Plastic Surgery

Changing Faces: Factors Associated with the Intention to Pursue Plastic Surgery and Practice in Underserved Areas

Improving the number of plastic and reconstructive surgeons who provide care to patients in underserved communities is critical to achieving health equity. We aimed to identify factors associated with graduating medical students' intentions to pursue plastic surgery and practice in underserved areas.

Methods

De-identified data for US medical school graduates were obtained from the Association of American Medical Colleges for students who matriculated in academic years 2007-2008 and 2011-2012. Data collected included self-reported demographic and future practice intentions. Multivariate analysis was conducted to determine indicators of students' interest in plastic surgery, and their intention to practice in underserved areas.

Results

Of the 57,307 graduating US medical students in our cohort who completed the Graduation Questionnaire, 532 (0.9%) reported an intention to pursue plastic surgery. Hispanic [adjusted odds ratio (aOR): 1.45; 95% confidence interval (95% CI), 1.07-1.98] and multiracial (aOR: 1.59; 95% CI, 1.03-2.45) students were more likely to pursue plastic surgery compared with other surgical specialties. Among students interested in plastic surgery, compared with non-Hispanic White students, Black (aOR: 6.15; 95% CI, 1.96-19.26) students were more likely to report intention to practice in underserved areas. Students with community-engagement experiences were more likely to report intention to practice in underserved areas.

Conclusions

Diversity among medical trainees pursuing plastic and reconstructive surgery is critical for maintaining and expanding plastic surgery services rendered in underserved areas. These findings suggest that student demographics and experiences with community-engagement experiences are positive indicators of practicing in underserved communities.

A National Survey of Hand Surgeons: Understanding the Rural Landscape

BACKGROUND

Twenty percent of the US population is described as being rural and may have limited access to hand surgeons, especially on an emergency basis. Little is known about case type, call hours, employment status, and other relevant details of rural hand surgery.

METHODS

We surveyed members of the American Society of Surgery for the Hand to begin to describe the problem.

RESULTS

There were 471 responses from 2256 members surveyed with 387 completing 100% of questions asked. Ninety (19%) identified themselves as primarily located in a rural population and 381 (81%) in a metropolitan region. In our study, rural hand surgeons were more likely to be employed by a community hospital, followed by independent private practice, multispecialty group, academics, and then locum tenens. Rural surgeons' practices were 80% solely hand surgery, while metropolitan surgeons' practices were 89% (P < .01). Metropolitan surgeons felt that of the transfers from rural facilities, 46% did not need emergency hand care and that 60% of the time, there was not actually a need for specialty hand surgery care.

CONCLUSIONS

Our survey begins to shed light on the details of rural hand surgery practice. We found that rural surgeons are more likely to be employed in community hospitals and take more call. When available, hand surgery specialists could prevent unnecessary transfer of patients to metropolitan areas. More work needs to be done to describe the differences between rural and metropolitan hand surgery practices as well as create rural hand surgeons.

Creating a Rural Plastic Surgery Practice: Social and Financial Impacts

In the United States, 25 million people are without reasonable access to a plastic surgeon. Previous studies have demonstrated that rural populations have limitations to healthcare, and these limitations result in poor quality of life and poor outcomes. New research points to the importance of rural plastic surgery, but still lacks clarity of what the creation and development of a rural plastic surgery practice may entail. Our aim with this study was to discover both the surgical compilation and financial impact of a single rural plastic surgeon’s practice. We reviewed the first 1.5 years of a single surgeon’s plastic surgery practice from its beginnings in a rural community at a critical access hospital with no previous plastic surgery presence. During the study period, the surgeon completed 2062 clinic visits and 305 surgeries. The practice involved approximately 70% hand surgery and the remaining general plastic surgery. The practice generated approximately $8 million in charges and $3.5 million in collections. Collections were broken down by $2.6 million in surgical procedures, $560,000 from clinical practice, and $330,000 from downstream revenue. A rural plastic surgeon’s practice may have noted positive impacts on medical care and financial bottom lines in rural communities.