Challenges to Professional Success for Women Plastic Surgeons: An International Survey.

BACKGROUND: Female plastic surgeons face specific challenges in their careers that impact lifestyle and professional choices. OBJECTIVE: The authors sought to delineate these specific issues further through means of an anonymous survey and to suggest areas for improvement. METHODS: In August 2017, a link to an online email questionnaire via SurveyMonkey.com was sent to 398 women members of the International Society of Aesthetic Plastic Surgery, which included questions on demographics, surgical training, practice characteristics and preferences, leadership and professional activities, marriage and childcare, financial status, workplace sexism and sexual harassment and surgeon attitudes. RESULTS: A total of 138 female plastic surgeons responded to the survey for a response rate of 34.7%. Critical issues most cited by respondents included work-life balance and childcare responsibilities, sexual harassment and the lack of gender parity at meetings. CONCLUSIONS: Plastic surgery training programs, institutions and societies should acknowledge the additional challenges that female surgeons face. The greatest areas for improvement include the balance of work and family responsibilities, addressing the prevalence of sexual harassment and improved representation at scientific meetings. LEVEL OF EVIDENCE IV: 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 .

The influence of career stage, practice type and location, and physician's sex on surgical practices among board-certified plastic surgeons performing breast augmentation.

BACKGROUND: Breast augmentation is the most commonly performed cosmetic surgical procedure in the United States, but surgeon preferences in terms of technique and postoperative care regimen vary widely. OBJECTIVES: The authors investigated the influence of career stage, practice type and location, and physician's sex on surgical technique preferences among board-certified plastic surgeons performing breast augmentation. METHODS: In October 2009, an online survey was e-mailed to all active members of the American Society of Plastic Surgeons practicing within the United States. Response frequencies were calculated and correlated with surgeon demographics. RESULTS: From the pool of 4737 respondents, 898 responses were received (18.9%). Surgeons performing breast augmentation were more frequently male, between 46 and 65 years old, and had practiced for at least 20 years in solo private practice in a suburban setting. Surgical volume most frequently consisted of 10% to 25% cosmetic surgery, with 10 to 50 breast augmentations performed per year. Surgeons in practice for five years or less were more likely to use smooth, round silicone gel-filled implants, to select implants smaller than 300 cc, to use the dual-plane pocket, and to recommend yearly follow-up. Surgeons in practice for more than 20 years were more likely to select saline implants, utilize the subglandular plane, perform closed capsulotomy, and place drains. Surgeons at academic centers performed fewer breast augmentation surgeries and placed smaller implants than those in private practice, while surgeons in suburban locations performed more breast augmentations than those in urban or rural locations. Surgeons in the West performed the greatest number of augmentations, although the largest-sized implants were placed in the Southwest. Compared with men, women surgeons appeared significantly less likely to use saline implants, were less likely to perform more than 100 breast augmentations per year, and were significantly more likely to place implants less than 300 cc. CONCLUSIONS: Surgical preferences were associated with years in practice and included differences in technique and postoperative care. Practice location was associated with differences in procedural volume, implant size, incision location, and recommended follow-up time, while practice type was related to surgical volume, implant size, implant location, and percentage of cosmetic surgery performed.

Impact of AOA status and perceived lifestyle on career choices of medical school graduates.

BACKGROUND: Based upon student ratings of such factors as predictable work hours and personal time, medical specialties have been identified as lifestyle friendly, intermediate, or unfriendly. Lifestyle friendly programs may be more desirable, more competitive, and for students elected to the Alpha Omega Alpha (AOA) Honor Medical Society, more attainable. OBJECTIVE: The objective of this study was to evaluate whether AOA students increasingly entered lifestyle friendly residency programs and whether trends in program selection differed between AOA and non-AOA graduates. DESIGN: This retrospective cohort study examined PGY-2 data from the Association of American Medical Colleges and the 12 allopathic schools in the Associated Medical Schools of New York. PARTICIPANTS: Data on 1987-2006 graduates from participating schools were evaluated. MAIN MEASURES: Residency program selection over the 20-year period served as the main outcome measure. KEY RESULTS: AOA graduates increasingly entered lifestyle-friendly residencies--from 12.9% in 1987 to 32.6% in 2006 (p < 0.01). There was also a significant decrease in AOA graduates entering lifestyle unfriendly residencies, from 31.6% in 1987 to 12.6% in 2006 (p < 0.01). Selection of lifestyle intermediate residencies among AOA graduates remained fairly stable at an average of 53%. Similar trends were found among non-AOA students. However, within these categories, AOA graduates increasingly selected radiology, dermatology, plastic surgery and orthopedics while non-AOA graduates increasingly selected anesthesiology and neurology. CONCLUSIONS: While lifestyle factors appear to influence residency program selection, AOA graduates differentially were more likely to either choose or attain certain competitive, lifestyle-friendly specialties. Health care reform should be targeted to improve lifestyle and decrease income disparities for specialties needed to meet health manpower needs.

Breastfeeding education and support services offered to pediatric residents in the US.

OBJECTIVE: The American Academy of Pediatrics (AAP) encourages pediatricians to support the practice of breastfeeding and residency educators to develop formal curricula in breastfeeding education. Few studies, however, describe breastfeeding education or support services currently provided to pediatric residents in the United States. The goals of this study were to investigate breastfeeding training offered during 3-year pediatric residency programs and to describe residency programs' policies and services for residents who breastfeed. METHODS: We conducted a cross-sectional study using a Web-based survey of pediatric program directors regarding breastfeeding education and support services for residents. RESULTS: Seventy percent of program directors (132 of 189) completed the survey, with 77.3% of respondents (n = 102) estimating the amount of breastfeeding education offered to their pediatric residents. Residents are provided with a median total of 9.0 hours of breastfeeding training over 3 years, primarily in continuity clinic and in lectures and rounds with attendings. At the programs' primary teaching hospitals, breastfeeding residents are provided breastfeeding rooms (67.0%), breast pumps (75.3%), and breast milk storage facilities (87.6%). Only 10 programs reported having an official policy to accommodate breastfeeding residents. CONCLUSIONS: Pediatric residents receive approximately 3 hours of breastfeeding training per year. In addition, there is less than universal implementation by residency programs of AAP recommendations for supporting breastfeeding in the workplace. Pediatric residency programs should find ways to improve and assess the quality of breastfeeding education and workplace support to better role model this advocacy standard.

Evaluation of housestaff knowledge and perception of competence in palliative symptom management.

PURPOSE: The Accreditation Council for Graduate Medical Education requires that internal medicine (IM) core curricula include end-of-life care and pain management concepts and that fellows in hematology/oncology, pulmonary/critical care, and geriatrics should receive formal instruction and clinical experience in palliative and end-of-life care. We aimed to assess the effectiveness of current teaching methods for housestaff in these fields. METHOD: All of the IM residents, geriatric medicine fellows, hematology/oncology fellows, and pulmonary/critical care fellows from four regional graduate medical education sites were asked to participate in an online survey at the beginning and end of the 2008-2009 academic year. We evaluated seven domains of knowledge of palliative care and pain management with a self-assessment of competence in these areas. We also asked participants to describe their current curriculum and training in palliative medicine. RESULTS: There were 326 e-mailed survey invitations. There were 180 responses for the start-year survey and 102 responses for the end-year survey. All sites were represented in the responses. The only learners to significantly improve their palliative knowledge during a year of training were PGY-1s and PGY-4s. The majority of housestaff surveyed report that their current palliative medicine training is inadequate. The vast majority (84.6%) said a dedicated palliative medicine rotation would be "useful" or "very useful." CONCLUSIONS: Housestaff recognize their lack of experience and training in palliative medicine and are interested in many teaching venues to improve their skills. A more focused curriculum in palliative and end-of-life care is required at both resident and subspecialty fellowship levels.

Predictors of death within six months in patients with advanced AIDS.

OBJECTIVES: This study sought to identify potential predictive variables of death within 6 months in patients with advanced AIDS. METHODS: Investigators enrolled a consecutive series of patients with advanced AIDS admitted to a skilled nursing facility in New York City over a 1-year period. Demographic, clinical, laboratory, and outcome data were abstracted from medical records using a standardized data collection instrument. RESULTS: Of the 152 patients enrolled during the study period, 61 patients (40%) died within 6 months from date of admission. Serum albumin, percent deviation from ideal body weight, and number of comorbidities at the time of admission proved to be the best combination of predictors of death within 6 months. SIGNIFICANCE OF RESULTS: The decrease in AIDS mortality over the past decade, along with an increase in prevalence due to longer survival, has been attributed primarily to the successful use of highly active antiretroviral therapy (HAART). HAART regimens, however, can also produce both short-term adverse effects and long-term complications. The prognostic model developed by this study may be useful in guiding treatment decisions in patients with advanced AIDS for whom a more palliative care plan may be sought.

Unrecognized thyroid dysfunction in patients with cancer.

Abnormal thyroid function can cause subtle medical symptoms in "healthy" individuals. Because cancer can cause similar symptoms, physicians may fail to suspect and test for thyroid abnormalities. We measured thyroid function in 158 patients with various types of cancers being followed at a comprehensive cancer center and found that 16% of them had a thyroid abnormality, which had not been diagnosed and treated in any of them. We conclude that thyroid dysfunction is usually unrecognized in cancer patients and may possibly contribute to their morbidity.