1
|
James I, Kochuba A, Grow JN, Ho I, Calobrace MB, Movassaghi K, Zins JE. Trends in Aesthetic Surgery Fellowship Training: An Analysis of Supply and Demand. Aesthet Surg J 2023; 44:95-101. [PMID: 37431878 DOI: 10.1093/asj/sjad208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/13/2023] [Accepted: 07/09/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Aesthetic surgery fellowship applications were consolidated under the San Francisco Match in 2018. The impact of these changes on aesthetic program and applicant numbers had not yet been investigated. OBJECTIVES In this study we sought to evaluate changes in programs, positions, applications, match rates, and fill rates since aesthetic surgery joined the San Francisco Match. We also aimed to compare these trends to craniofacial surgery, microsurgery, and hand surgery fellowships over this same time period. METHODS San Francisco and National Resident Matching Program (NRMP) match data for aesthetic, craniofacial, microsurgery, and hand fellowships were obtained from 2018 to 2022, and the number of applications, positions, programs, and successful matches were evaluated. RESULTS The number of aesthetic fellowship positions increased from 17 to 41 (141%) over the period studied. This resulted in increased match rates and more unfilled positions. Over the same period, fellowship positions for craniofacial, hand, and microsurgery increased by 3.4%, 6%, and 2.5% respectively. There was no increase in applications to any postgraduate subspecialty, nor was there any change in the number of residents pursuing fellowship. Similarly, there was no change in the percentage of fellowship-bound residents applying to any given discipline. CONCLUSIONS The increase in aesthetic fellowship programs and positions did not generate an increase in applications. Applications to other plastic surgery subspecialties also failed to increase. Unlike aesthetic fellowships, their program numbers have remained stable. Given the limited fellowship applicant pool, our focus should be on enhancing the quality of existing aesthetic programs rather than continuing to increase the number of aesthetic positions. LEVEL OF EVIDENCE: 3
Collapse
|
2
|
Tuaño KR, Fisher MH, Woodall J, Iorio ML. Plastic Surgery Training: Trends in Hand Surgery Fellowship in the Setting of a Pandemic. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5066. [PMID: 37342304 PMCID: PMC10278718 DOI: 10.1097/gox.0000000000005066] [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: 02/19/2023] [Accepted: 04/26/2023] [Indexed: 06/22/2023]
Abstract
Given the diminishing presence of hand surgeons trained in plastic surgery, we evaluated the associated trends in annual hand meeting educational content and postgraduate job offerings, and analyzed the effect of the coronavirus disease 2019 (COVID-19) pandemic on trainees in hand surgery. Methods Hand meeting registration and educational content were analyzed over the past 10 years. Current hand surgery job offerings were evaluated for training requirements, and the annual rates of subspecialty certificate in surgery of the hand board certifications were compared across training backgrounds. Results Top categories of annual meeting educational content were "bone/joint," "other," and "professional development." A majority of American Society for Surgery of the Hand presidents had training backgrounds in orthopedics (55%), followed by plastics (23%) and general surgery (22%). The job offerings on the American Society for Surgery of the Hand and Association for Surgery of the Hand websites specified more training requirements in orthopedics than in plastics. Additionally, there were two to three times as many examinees taking the surgery of the hand examination from orthopedic surgery compared with plastics, with an overall higher pass rate. Hand fellowship programs were also predominantly offered for orthopedic surgery (80.8%). Conclusions Optimization of training, society membership, and clinical practice profiles may increase the presence of plastic surgery-trained hand surgeons. The extent of the economic impact of the COVID-19 pandemic is yet to be fully determined, but our analysis suggests that a lucrative market for reconstructive/hand surgery may exist in the face of economic downturn.
Collapse
Affiliation(s)
- Krystle R. Tuaño
- From the Division of Plastic and Reconstructive Surgery, University of Colorado, Department of Surgery, Anschutz Medical Center, Aurora, Col
| | - Marlie H. Fisher
- From the Division of Plastic and Reconstructive Surgery, University of Colorado, Department of Surgery, Anschutz Medical Center, Aurora, Col
| | - Jhade Woodall
- From the Division of Plastic and Reconstructive Surgery, University of Colorado, Department of Surgery, Anschutz Medical Center, Aurora, Col
| | - Matthew L. Iorio
- From the Division of Plastic and Reconstructive Surgery, University of Colorado, Department of Surgery, Anschutz Medical Center, Aurora, Col
| |
Collapse
|
3
|
Abstract
BACKGROUND Economic conditions affect surgical volumes, particularly for elective procedures. In this study, the authors aimed to identify the effects of the 2008 U.S. economic downturn on hand surgery volumes to guide surgeons and managers when facing future economic crises. METHODS The authors used the California State Ambulatory Surgery and Services Database from January of 2005 to December of 2011, which includes the entire period of the Great Recession (December of 2007 to June of 2009). The authors abstracted the monthly volume of five common hand procedures using International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes. Pearson statistics were used to identify the correlation between unemployment rate and surgical volume for each procedure. RESULTS The total number of operative cases was 345,583 during the 7-year study period. Most common elective hand procedures, such as carpal tunnel release and trigger finger release, had a negative correlation with unemployment rate, but the volume of distal radius fracture surgery did not show any correlation. Compared with carpal tunnel release (r = -0.88) or trigger finger release volumes (r = -0.85), thumb arthroplasty/arthrodesis volumes (r = -0.45) showed only a moderate correlation. CONCLUSIONS The economic downturn decreased elective hand procedure surgical volumes. This may be detrimental to small surgical practices that rely on revenue from elective procedures. Taking advantage of the principle that increased volume reduces unit cost may mitigate the lost revenue from these elective procedures. In addition, consolidating hand surgery services at larger, regional centers may reduce the effect of the economic environment on individual hand surgeons.
Collapse
|
4
|
Arshi A, Barad JH, Patel RK, Allis JB, Soohoo NF, Johnson EE. The Crush Index: Orthopedic Trauma as an Economic Indicator. Orthopedics 2017; 40:248-255. [PMID: 28295127 DOI: 10.3928/01477447-20170308-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 02/03/2017] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to evaluate the relationship between economic activity and the incidence of high-energy orthopedic trauma. California's Office of Statewide Health Planning and Development patient discharge database was queried to identify monthly orthopedic trauma incidence from 1995 to 2010. Patient inclusion required 1 diagnosis code and 1 associated procedural code for fractures of the femur, tibia, ankle, pelvis, or acetabulum. Data on composite market indices, energy and transportation use, and unemployment were obtained from government sources. Statistical analysis was performed using univariate and multivariate linear regression. The average monthly incidence of orthopedic trauma was 2.92 cases per 100,000 people. Of 15 economic indicators analyzed with univariate regression, 7 variables correlated with trauma incidence to statistical significance. Dow Jones Industrial Average (P=.032), Standard & Poor's 500 (P=.034), vehicle miles driven (P<.001), personal disposable income (P=.033), Coincident Economic Activity Index for California (P=.007), and vehicles purchased (P<.001) were positively correlated with trauma incidence. Unemployment (P<.001) was inversely correlated with trauma incidence. Multivariate regression was used to compute a combination of independent predictors of trauma volume: personal disposable income (P<.001), vehicles purchased (P=.008), and unemployment (P=.005). This combination of variables was used to develop the Crush Index to model the relationship between economic activity and orthopedic trauma volume. The authors show a positive correlation between economic strength and activity and the monthly volume of high-energy orthopedic trauma. The Crush Index serves as a proof of concept that may be useful in guiding preparedness among practitioners and health care system administrators. [Orthopedics. 2017; 40(4):248-255.].
Collapse
|
5
|
Gaspar MP, Kane PM, Honik GB, Shin EK, Jacoby SM, Osterman AL. Geographic and Age-Based Variations in Medicare Reimbursement Among ASSH Members. Hand (N Y) 2016; 11:347-352. [PMID: 27698639 PMCID: PMC5030864 DOI: 10.1177/1558944715627631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: The purpose of this study was to investigate how American Society for Surgery of the Hand (ASSH) members' Medicare reimbursement depends on their geographical location and number of years in practice. Methods: Demographic data for surgeons who were active members of the ASSH in 2012 were obtained using information publicly available through the US Centers for Medicare and Medicaid Services (CMS). "Hand-surgeons-per-capita" and average reimbursement per surgeon were calculated for each state. Regression analysis was performed to determine a relationship between (1) each state's average reimbursement versus the number of ASSH members in that state, (2) average reimbursement versus number of hand surgeons per capita, and (3) total reimbursement from Medicare versus number of years in practice. Analysis of variance (ANOVA) was used to detect a difference in reimbursement based on categorical range of years as an ASSH member. Results: A total of 1667 ASSH members satisfied inclusion in this study. Although there was significant variation among states' average reimbursement, reimbursement was not significantly correlated with the state's hand surgeons per capita or total number of hand surgeons in that given state. Correlation between years as an ASSH member and average reimbursement was significant but non-linear; the highest reimbursements were seen in surgeons who had been ASSH members from 8 to 20 years. Conclusions: Peak reimbursement from Medicare for ASSH members appears to be related to the time of surgeons' peak operative volume, rather than any age-based bias for or against treating Medicare beneficiaries. In addition, though geographic variation in reimbursement does exist, this does not appear to correlate with density or availability of hand surgeons.
Collapse
Affiliation(s)
- Michael P. Gaspar
- The Philadelphia Hand Center, P.C., Philadelphia, PA, USA,Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA,Michael P. Gaspar, The Philadelphia Hand Center, P.C., The Franklin Suite G114, 834 Chestnut Street, Philadelphia, PA 19107, USA.
| | - Patrick M. Kane
- The Philadelphia Hand Center, P.C., Philadelphia, PA, USA,Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Grace B. Honik
- The Philadelphia Hand Center, P.C., Philadelphia, PA, USA
| | - Eon K. Shin
- The Philadelphia Hand Center, P.C., Philadelphia, PA, USA,Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Sidney M. Jacoby
- The Philadelphia Hand Center, P.C., Philadelphia, PA, USA,Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - A. Lee Osterman
- The Philadelphia Hand Center, P.C., Philadelphia, PA, USA,Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| |
Collapse
|
6
|
Waljee JF, Zhong L, Hou H, Sears E, Brummet C, Chung KC. The Use of Opioid Analgesics following Common Upper Extremity Surgical Procedures: A National, Population-Based Study. Plast Reconstr Surg 2016; 137:355e-364e. [PMID: 26818326 PMCID: PMC5090259 DOI: 10.1097/01.prs.0000475788.52446.7b] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The misuse of opioid analgesics is a major public health concern, and guidelines regarding postoperative opioid use are sparse. The authors examined the use of opioids following outpatient upper extremity procedures to discern the variation by procedure type and patient factors. METHODS The authors studied opioid prescriptions among 296,452 adults older than 18 years who underwent carpal tunnel release, trigger finger release, cubital tunnel release, or thumb carpometacarpal arthroplasty from 2009 to 2013 using insurance claims drawn from the Truven Health MarketScan Commercial Claims and Encounters, which encompasses over 100 health plans in the United States. Using multivariable regression, the authors compared the receipt of opioids, number of days supplied, indicators of inappropriate prescriptions, and number of refills by patient factors. RESULTS In this cohort, 59 percent filled a postoperative prescription for opioid medication, and 8.8 percent of patients had an indicator of inappropriate prescribing. The probability of filling an opioid prescription declined linearly with advancing age. On multivariate analysis, patients who had previously received opioids were more likely to fill a postoperative opioid prescription (66 percent versus 59 percent), receive longer prescriptions (24 versus 5 days), receive refills following surgery (24 percent versus 5 percent), and have at least one indicator of potentially inappropriate prescribing (19 percent versus 6 percent). CONCLUSIONS Current opioid users are more likely to require postoperative opioid analgesics for routine procedures and more likely to receive inappropriate prescriptions. More evidence is needed to identify patients who derive the greatest benefit from opioids to curb opioid prescriptions when alternative analgesics may be equally effective and available. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
Collapse
Affiliation(s)
- Jennifer F. Waljee
- Assistant Professor of Surgery, Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States
| | - Lin Zhong
- Research Assistant, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States
| | | | - Erika Sears
- Statistician, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States
| | - Chad Brummet
- Research Coordinator, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States
| | - Kevin C. Chung
- Associate Professor, Department of Anesthesia, University of Michigan Health System, Ann Arbor, MI, United States
| |
Collapse
|
7
|
The Use of Opioid Analgesics following Common Upper Extremity Surgical Procedures: A National, Population-Based Study. Plast Reconstr Surg 2016. [PMID: 26818326 DOI: 10.1097/01.prs.0000475788.52446.7b.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The misuse of opioid analgesics is a major public health concern, and guidelines regarding postoperative opioid use are sparse. The authors examined the use of opioids following outpatient upper extremity procedures to discern the variation by procedure type and patient factors. METHODS The authors studied opioid prescriptions among 296,452 adults older than 18 years who underwent carpal tunnel release, trigger finger release, cubital tunnel release, or thumb carpometacarpal arthroplasty from 2009 to 2013 using insurance claims drawn from the Truven Health MarketScan Commercial Claims and Encounters, which encompasses over 100 health plans in the United States. Using multivariable regression, the authors compared the receipt of opioids, number of days supplied, indicators of inappropriate prescriptions, and number of refills by patient factors. RESULTS In this cohort, 59 percent filled a postoperative prescription for opioid medication, and 8.8 percent of patients had an indicator of inappropriate prescribing. The probability of filling an opioid prescription declined linearly with advancing age. On multivariate analysis, patients who had previously received opioids were more likely to fill a postoperative opioid prescription (66 percent versus 59 percent), receive longer prescriptions (24 versus 5 days), receive refills following surgery (24 percent versus 5 percent), and have at least one indicator of potentially inappropriate prescribing (19 percent versus 6 percent). CONCLUSIONS Current opioid users are more likely to require postoperative opioid analgesics for routine procedures and more likely to receive inappropriate prescriptions. More evidence is needed to identify patients who derive the greatest benefit from opioids to curb opioid prescriptions when alternative analgesics may be equally effective and available. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
Collapse
|
8
|
Richardson C, Mattison G, Workman A, Gupta S. Pricing of common cosmetic surgery procedures: local economic factors trump supply and demand. Aesthet Surg J 2015; 35:218-24. [PMID: 25657294 DOI: 10.1093/asj/sju067] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The pricing of cosmetic surgery procedures has long been thought to coincide with laws of basic economics, including the model of supply and demand. However, the highly variable prices of these procedures indicate that additional economic contributors are probable. OBJECTIVES The authors sought to reassess the fit of cosmetic surgery costs to the model of supply and demand and to determine the driving forces behind the pricing of cosmetic surgery procedures. METHODS Ten plastic surgery practices were randomly selected from each of 15 US cities of various population sizes. Average prices of breast augmentation, mastopexy, abdominoplasty, blepharoplasty, and rhytidectomy in each city were compared with economic and demographic statistics. RESULTS The average price of cosmetic surgery procedures correlated substantially with population size (r = 0.767), cost-of-living index (r = 0.784), cost to own real estate (r = 0.714), and cost to rent real estate (r = 0.695) across the 15 US cities. Cosmetic surgery pricing also was found to correlate (albeit weakly) with household income (r = 0.436) and per capita income (r = 0.576). Virtually no correlations existed between pricing and the density of plastic surgeons (r = 0.185) or the average age of residents (r = 0.076). CONCLUSIONS Results of this study demonstrate a correlation between costs of cosmetic surgery procedures and local economic factors. Cosmetic surgery pricing cannot be completely explained by the supply-and-demand model because no association was found between procedure cost and the density of plastic surgeons.
Collapse
Affiliation(s)
- Clare Richardson
- From the Department of Plastic Surgery at Loma Linda University in Loma Linda, California
| | - Gennaya Mattison
- From the Department of Plastic Surgery at Loma Linda University in Loma Linda, California
| | - Adrienne Workman
- From the Department of Plastic Surgery at Loma Linda University in Loma Linda, California
| | - Subhas Gupta
- From the Department of Plastic Surgery at Loma Linda University in Loma Linda, California
| |
Collapse
|
9
|
Sharma V, Zargaroff S, Sheth KR, Le BV, Dupree JM, Sandlow JI, Polackwich AS, Hedges JC, Fuchs EF, Goldstein M, Brannigan RE. Relating economic conditions to vasectomy and vasectomy reversal frequencies: a multi-institutional study. J Urol 2014; 191:1835-40. [PMID: 24423435 DOI: 10.1016/j.juro.2013.12.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE It was theorized that the use of permanent contraceptive methods may vary with economic conditions. We evaluated the relationship between vasectomy/vasectomy reversal frequencies at several large referral centers and national economic indicators during 2 recessions spanning 2001 to 2011. MATERIALS AND METHODS We performed an institutional review board approved, retrospective chart review to identify the number of vasectomies/vasectomy reversals per month at several large referral centers from January 2001 to July 2011. The rates of these procedures were pooled, correlated with national economic data and analyzed in a multivariate linear regression model. RESULTS A total of 4,599 vasectomies and 1,549 vasectomy reversals were performed at our institutions during the study period. The number of vasectomies per month positively correlated with the unemployment rate (r=0.556, p<0.001) and personal income per capita (r=0.276, p=0.002). The number of reversals per month negatively correlated with the unemployment rate (r=-0.399, p<0.001) and personal income per capita (r=-0.305, p<0.001). Neither vasectomy nor vasectomy reversal frequency significantly correlated with the inflation rate or the S&P 500®. Regression models confirmed that the unemployment rate explained more of the variance in vasectomy/vasectomy reversal frequencies than other indicators. CONCLUSIONS We noted a correlation between the number of vasectomies/vasectomy reversals performed at our institutions and national economic indicators. The strongest association was with the unemployment rate. This points to the importance of financial pressure on family planning decisions.
Collapse
Affiliation(s)
- Vidit Sharma
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sherwin Zargaroff
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kunj R Sheth
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Brian V Le
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James M Dupree
- Department of Urology, Baylor College of Medicine, Houston, Texas
| | - Jay I Sandlow
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - A Scott Polackwich
- Department of Urology, Oregon Health and Science University, Portland, Oregon
| | - Jason C Hedges
- Department of Urology, Oregon Health and Science University, Portland, Oregon
| | - Eugene F Fuchs
- Department of Urology, Oregon Health and Science University, Portland, Oregon
| | - Marc Goldstein
- Department of Urology and Institute for Reproductive Medicine, Weill Cornell Medical College of Cornell University and Center for Biomedical Research, the Population Council, New York, New York
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| |
Collapse
|
10
|
|