Underrepresentation of African Americans in Plastic Surgery: Examining Demographics, Specialty Factors, and Medical School Experiences.

BACKGROUND: Racial representation among medical trainees translates into physicians that are able to communicate with diverse patient populations and are perceptive to health disparities. This is important within plastic surgery where an optimal physicianpatient relationship is essential to health outcomes. OBJECTIVE: The purpose of this study is to address underrepresentation of African Americans (AA) in plastic surgery through improving understanding of factors that may contribute to AA medical student interest in plastic surgery. DESIGN: This was a voluntary, cross-sectional survey. An online survey was designed to collect information on demographics, specialty factor importance, medical school experiences, and plastic surgery interest among medical students. The survey was distributed to medical students within three national medical organizations between August 2018 and February 2019. The following groups of respondents were statistically COMPARED: AAs interested vs. AAs not interested in plastic surgery and AA vs. Caucasian medical students both interested in plastic surgery. SETTING: Online survey for medical students in the United States. PARTICIPANTS: All 428 participants were medical students that belonged to at least 1 of the 3 national medical organizations between August 2018 and February 2019. RESULTS: The survey was completed by 428 participants of which 142 were excluded for incomplete surveys, leaving 286 (66.8%) participants to be included in the study. Among AA medical students, 128 (75.3%) were not interested in Plastic Surgery and 42 (24.7%) were interested. The 2 groups were similar demographically but differed significantly across multiple specialty factors and medical school experiences (p < 0.05). When compared to interested Caucasian medical students (n = 30), interested AA medical students differed significantly in demographics, specialty factors, and medical school experiences (p < 0.05). CONCLUSIONS: This study supports the implementation of medical school interventions emphasizing specialty factors and medical school experiences unique to AA medical students interested in plastic surgery to promote their application into the specialty.

Análisis demográfico de la Cirugía Plástica en Argentina / Demographic analysis of Plastic Surgery in Argentina

En un país geográficamente vasto, dividido en 24 jurisdicciones (23 provincias y un distrito federal), con características diferentes, desde el Comité de Estadísticas de la Sociedad Argentina de Cirugía Plástica se decidió averiguar la distribución demográfica de la especialidad y de las subespecialidades. Para tal fin se realizó una encuesta anónima entre los 1142 miembros de la Sociedad Argentina de Cirugía Plástica (nota: actualización abril 2023). Fueron en total 11 preguntas respondidas por 239 miembros SACPER (20,92% del total de los miembros). Además de las preguntas de los procedimientos, hemos agregado datos como grupo etario, sexo y región del país en el que ejercen su profesión y tipos de entidades laborales para las cuales trabajan. En las últimas dos preguntas, se les solicitó a los socios que nos informen, según su conocimiento y criterio, si evidencian déficit de alguna/s subespecialidades reconstructivas en la región donde ejercen su profesión. Esta encuesta de análisis demográfico de la cirugía plástica en Argentina tuvo como objetivo informarnos la distribución por región de los diferentes procedimientos estéticos, miniinvasivos y reconstructivos que realizan los cirujanos plásticos argentinos, características de las entidades laborales donde ejercen la profesión y tipo de cirugía reconstructiva identificada por los colegas como deficitaria en su lugar de ejercicio profesional. Se lograron obtener interesantes datos sobre la distribución entre las tres principales actividades de la especialidad, distribución geográfica, características laborales y déficit de subespecialidades reconstructivas. Los datos obtenidos a través de la encuesta, y vertidos en este artículo, pueden ser usados en el presente y en el futuro por la Sociedad Argentina de Cirugía Plástica, por sus regionales, por autoridades sanitarias nacionales o locales y por los actuales cirujanos plásticos en formación para orientarlos en cuáles subespecialidades elegir y donde ejercerlas a partir del déficit informado por los colegas, o por cualquier cirujano plástico que desee usar los datos en futuras publicaciones, conferencias o divulgaciones científicas

In a geographically vast country, divided into 24 jurisdictions (23 provinces and a federal district), with different characteristics, the Statistics Committee of the Argentine Society of Plastic Surgery decided to find out the demographic distribution of the specialty and subspecialties. For this purpose, an anonymous survey was carried out among the 1,142 members of the Argentine Society of Plastic Surgery (note: update April 2023). There was a total of eleven questions answered by 239 SACPER members (20.92% of the total members). In addition to the procedural questions, we have added data such as age group, sex and region of the country in which they practice their profession and types of labor entities for which they work. In the last two questions, the partners were asked to inform us, according to their knowledge and criteria, if they evidence a deficit in any reconstructive subspecialties in the region where they practice their profession. This survey of demographic analysis of plastic surgery in Argentina, aimed to inform us about the distribution by region of the different aesthetic, mini-invasive and reconstructive procedures performed by Argentine plastic surgeons, characteristics of work entities where they practice the profession and type of reconstructive surgery identified by colleagues as deficient in their place of professional practice. Interesting data were obtained on the distribution between the three main activities of the specialty, geographical distribution, work characteristics and deficit of reconstructive subspecialties. The data obtained through the survey and presented in this article can be used in the present and in the future by the Argentine Society of Plastic Surgery, by its regional offices, by national or local health authorities and by current plastic surgeons in training. to guide them in which subspecialties to choose and where to practice them based on the deficit reported by colleagues, or by any plastic surgeon who wishes to use the data in future publications, conferences or scientific report

Racial/Ethnic and Gender Disparities Over the Last Decade Within Microsurgery and Craniofacial Fellowship Training.

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.

A Guide to Industry Payments and an Algorithm for Their Management.

BACKGROUND: The Open Payments database was created to increase transparency of industry payment relationships within medicine. The current literature often examines only 1 year of the database. In this study, the authors use 5 years of data to show trends among industry payments to plastic surgeons from 2014 to 2018. In addition, the authors lay out the basics of conflict-of-interest reporting for the new plastic surgeon. Finally, the authors suggest an algorithm for the responsible management of industry relationships. METHODS: This study analyzed nonresearch payments made to plastic surgeons from January 1, 2014, to December 31, 2018. Descriptive statistics were calculated using R Statistical Software and visualized using Tableau. RESULTS: A total of 304,663 payments totaling $140,889,747 were made to 8148 plastic surgeons; 41 percent ($58.28 million) was paid to 50 plastic surgeons in the form of royalty or license payments. With royalties excluded, average and median payments were $276 and $25. The average yearly total per physician was $2028. Of the 14 payment categories, 95 percent of the total amount paid was attributable payments in one of six categories. Seven hundred thirty companies reported payments to plastic surgeons from 2014 to 2018; 15 companies (2 percent) were responsible for 80 percent ($66.34 million) of the total sum paid. Allergan was responsible for $24.45 million (29.6 percent) of this amount. CONCLUSIONS: Although discussions on the proper management of industry relationships continue to evolve, the data in this study illustrate the importance of managing industry relationships. The simple guidelines suggested create a basis for managing industry relationships in the career of the everyday plastic surgeon.

Industry Payments to Plastic Surgeons, 2013 to 2018: Who's Getting Paid?

BACKGROUND: The Physician Payments Sunshine Act of 2010 mandated that all industry payments to physicians be publicly disclosed. To date, industry support of plastic surgeons has not been longitudinally characterized. The authors seek to evaluate payment trends from 2013 to 2018 and characteristics across plastic surgeon recipients of industry payments. METHODS: The authors cross-referenced those in the 2019 American Society of Plastic Surgeons member database with Centers for Medicare & Medicaid Services Open Payments database physician profile identification number indicating industry funds received within the study period. We categorized surgeons by years since American Board of Plastic Surgery certification, practice region, and academic affiliation. RESULTS: A sum of $89,436,100 (247,614 payments) was received by 3855 plastic surgeons. The top 1 percent of earners (n = 39) by dollar amount received 52 percent of industry dollars to plastic surgeons; of these, nine (23 percent) were academic. Overall, 428 surgeons (11 percent) were academic and received comparable dollar amounts from industry as their nonacademic counterparts. Neither geographic location nor years of experience were independent predictors of payments received. The majority of individual transactions were for food and beverage, whereas the majority of industry dollars were typically for royalties or license. CONCLUSIONS: Over half of all industry dollars transferred went to just 1 percent of American Society of Plastic Surgeons members receiving payments between 2013 and 2018. Considerable heterogeneity exists when accounting for payment subcategories.

Avaliação da autoestima em pacientes submetidos à blefaroplastia / Assessment of self-esteem in patients undergoing blepharoplasty

INTRODUÇÃO: A forma subjetiva que o indivíduo se vê representa a autoestima, A blefaroplastia é um dos procedimentos mais realizados em cirurgia plástica e este estudo teve como objetivo correlacionar a realização da blefaroplastia com possíveis alterações na autoestima. MÉTODO: No período de março de 2021 a fevereiro de 2022, 17 pacientes de ambos os sexos foram selecionados e divididos em 3 grupos: somente blefaroplastia superior, somente blefaroplastia inferior e blefaroplastia superior em conjunto com inferior. Foram aplicados os questionários de autoestima de Rosenberg ­ EPM em consulta pré-operatória e após 3 meses da cirurgia realizada. A indicação dos diferentes procedimentos variou de acordo com a indicação clínica. A técnica de escolha para as blefaroplastias inferiores foi a incisão transcutânea com retalho miocutâneo e as bolsas gordurosas foram retiradas de acordo com indicação clínica. Foi realizada a análise de variâncias com medidas repetidas (ANOVA), complementada pelo método de Bonferroni. RESULTADOS: Houve uma melhora nos resultados dos questionários nos grupos de blefaroplastia superior e blefaroplastia superior + inferior, porém somente quando avaliados os procedimentos em sua totalidade, foi estatisticamente significante. O grupo de somente blefaroplastia inferior só teve uma representante, não havendo melhora no resultado do teste pré e pós operatório. CONCLUSÃO: Diversos fatores podem ter influenciado o resultado da pesquisa, porém houve uma melhora na maioria dos grupos, sendo estatisticamente significativo quando considerados os procedimentos em sua totalidade. Palavras-chave: Blefaroplastia. Autoestima. Pálpebras. Autoimagem.

Female Leadership in Academic Plastic Surgery: A Comprehensive Analysis.

BACKGROUND: Gender equity remains to be realized in academic plastic and reconstructive surgery. The purpose of this study was to measure the proportion of women in leadership roles in academic plastic and reconstructive surgery to verify where gender gaps may persist. METHODS: Six markers of leadership were analyzed: academic faculty rank, manuscript authorship, program directorship, journal editor-in-chief positions, society board of directors membership, and professional society membership. Descriptive statistics were performed, and chi-square tests were used to compare categorical variables. RESULTS: About 16 percent to 19 percent of practicing plastic surgeons are female, as measured by the percentage of female faculty and American Society of Plastic Surgeons members. Female plastic surgeons comprised 18.9 percent (n = 178) of the faculty from 88 academic plastic surgery institutions, and represented 9.9 percent of full professors and 10.8 percent of chiefs. Nineteen institutions had no female faculty. Women were first authors in 23.4 percent of publications and senior author in 14.7 percent of publications. No journal studied had a female editor-in-chief. Of the examined plastic and reconstructive societies, the proportion of women on the board of directors ranged from 16.7 percent to 23.5 percent. CONCLUSIONS: The proportion of female program directors, first manuscript authors, and board members of certain societies is commensurate with the number of women in the field, suggesting an evolving landscape within the specialty. However, women remain underrepresented in many other leadership roles, heralding the work that remains to ensure gender parity exists for those pursuing leadership roles in the field of plastic and reconstructive surgery.

Plastic Surgeon Financial Compensation-Incentivization Models in Surgical Care Delivery: The Past, Present, and Future.

BACKGROUND: Surgeons are critical for the success of any health care enterprise. However, few studies have examined the potential impact of value-based care on surgeon compensation. METHODS: This review presents value-based financial incentive models that will shape the future of surgeon compensation. The following incentivization models will be discussed: pay-for-reporting, pay-for-performance, pay-for-patient-safety, bundled payments, and pay-for-academic-productivity. Moreover, the authors suggest the application of the congruence model-a model developed to help business leaders understand the interplay of forces that shape the performance of their organizations-to determine surgeon compensation methods applicable in value-based care-centric environments. RESULTS: The application of research in organizational behavior can assist health care leaders in developing surgeon compensation models optimized for value-based care. Health care leaders can utilize the congruence model to determine total surgeon compensation, proportion of compensation that is short term versus long term, proportion of compensation that is fixed versus variable, and proportion of compensation based on seniority versus performance. CONCLUSION: This review provides a framework extensively studied by researchers in organizational behavior that can be utilized when designing surgeon financial compensation plans for any health care entity shifting toward value-based care.