Geographic Variation in Access to Plastic Surgeons.

INTRODUCTION: While recent studies project a national shortage of plastic surgeons, there may currently exist areas within the United States with few plastic surgeons. We conducted this study to describe the current geographic distribution of the plastic surgery workforce across the United States. METHODS: Using the 2013 to 2014 Area Health Resource File, we estimated the number of plastic surgeons at the health service area (HSA) level in 2010 and 2012. The density of plastic surgeons was calculated as a ratio per 100,000 population. The HSAs were grouped by plastic surgeon density, and population characteristics were compared across subgroups. Characteristics of HSAs with increases and decreases in plastic surgeon density were also compared. RESULTS: The final sample included 949 HSAs with a total population of 313,989,954 people. As of 2012, there were an estimated 7600 plastic surgeons, resulting in a national ratio of 2.42 plastic surgeons/100,000 population. However, over 25 million people lived in 468 HSAs (49.3%) without a plastic surgeon, whereas 106 million people lived in 82 HSAs (8.6%) with 3.0 or more/100,000 population. Plastic surgeons were more likely to be distributed in HSAs where a higher percentage of the population was younger than 65 years, female, and residing in urban areas. Between 2010 and 2012, 11 HSAs without a plastic surgeon increased density, whereas 15 HSAs lost all plastic surgeons. CONCLUSIONS: Plastic surgeons are asymmetrically distributed across the United States leaving over 25 million people without geographic access to the specialty. This distribution tends to adversely impact older and rural populations.

Perineal reconstruction with bilateral bilobed flap for cloacal-like defect after childbirth.

Fourth degree lacerations of the vaginal wall and perineum following childbirth can cause cloacal-like defects of the perineum. The loss of the anterior anal sphincter and resultant thinning of the perineum and rectovaginal septum can lead to fecal incontinence and difficulties with sexual activity. This article introduces a technique to combine repair of the anterior anal sphincter with reconstruction of the perineal body with bilateral pedicled bilobed flaps.

The ABMS MOC Part III Examination: Value, Concerns, and Alternative Formats.

This article describes the presentations and discussions at a conference co-convened by the Council on Medical Education of the American Medical Association (AMA) and by the American Board of Medical Specialties (ABMS). The conference focused on the ABMS Maintenance of Certification (MOC) Part III Examination. This article, reflecting the conference agenda, covers the value of and evidence supporting the examination, as well as concerns about the cost of the examination, and-given the current format-its relevance. In addition, the article outlines alternative formats for the examination that four ABMS member boards are currently developing or implementing. Lastly, the article presents contrasting views on the approach to professional self-regulation. One view operationalizes MOC as a high-stakes, pass-fail process while the other perspective holds MOC as an organized approach to support continuing professional development and improvement. The authors hope to begin a conversation among the AMA, the ABMS, and other professional stakeholders about how knowledge assessment in MOC might align with the MOC program's educational and quality improvement elements and best meet the future needs of both the public and the physician community.

A tribute to the founding figures of the American Board of Plastic Surgery.

The American Board of Plastic Surgery recently celebrated its 75th anniversary as an established specialty board. This historical article provides an outline of the events that led to the formation of the American Board of Plastic Surgery and gives insight into the personalities and achievements of the key individuals whose unique talents coalesced into a common vision of making plastic surgery the diverse and well-respected specialty that it is today. This is a historical literature review outlining the circumstances leading to the formation of American Board of Plastic Surgery. The emphasis on the role of its founding fathers is reviewed and detailed in the article. The founding figures continue to inspire us through their unrelenting dedication to the field of plastic surgery. Over the past 75 years, the field of plastic surgery has been very well served by their successors, and these founding figures have fostered a surgical specialty of great repute.

A 9-year comparison of practice profiles of candidates for primary and recertification examinations of the American Board of Plastic Surgery relative to economic indicators.

BACKGROUND: This study compared the practice profiles of plastic surgeons applying for recertification/maintenance of certification with those applying for primary certification by the American Board of Plastic Surgery between 2003 and 2011. METHODS: American Board of Plastic Surgery case logs from both recertification and primary certification candidates from 2003 to 2011 were examined. Deidentified data included operative year, Current Procedural Terminology codes, and the candidate's designation of the case relative to (1) cosmetic or reconstructive and (2) the Maintenance of Certification in Plastic Surgery module (i.e., comprehensive, cosmetic, craniomaxillofacial, and hand). Department of Commerce unemployment data from 2003 to 2011 served as an economic indicator for the period studied. RESULTS: A negative trend in the median number of cases per candidate was observed for both groups for cosmetic, reconstructive, and total number of cases, corresponding to a rise in unemployment. With every 1 percent increase in the unemployment rate, recertification candidates demonstrated a greater loss of cosmetic cases relative to primary candidates and an accelerated decline in reconstructive cases starting in 2007. Distribution of the four Maintenance of Certification modules demonstrated a negative trend for cosmetic and comprehensive cases in both groups. Hand and craniofacial consistently constituted approximately 20 percent of cases for primary and 14 percent of cases for recertification candidates. There was a shift away from hand cases toward craniofacial cases in both groups. CONCLUSIONS: Both primary and recertification candidates reported a decline in overall caseload from 2003 to 2011. Negative economic trends have a greater impact on the practice profile of recertification candidates.

Adherence to practice guidelines based on American Board of Plastic Surgery Maintenance of Certification data.

BACKGROUND: The American Board of Plastic Surgery Maintenance of Certification program includes the submission of 10 consecutive cases in one of 20 tracer modules for Performance in Practice evaluation. This has resulted in a wealth of data on the practice patterns of Board diplomates. The specific aim of this project was to examine these data to determine whether diplomates are adhering to evidence-based practice guidelines. METHODS: The authors searched the Agency for Healthcare Research and Quality National Guideline Clearinghouse for guidelines. Once the guidelines were identified, the authors compared the recommendations with data entered by Board diplomates for the tracer modules in question. It is important to note that guidelines are recommendations based on the best available evidence and that all guidelines are subject to change, pending periodic reexamination of the evidence. RESULTS: Diplomates are adhering to guidelines regarding age of cosmetic breast augmentation patients, use of prophylactic antibiotics and deep venous thrombosis prophylaxis in abdominoplasty patients, and use of carpal tunnel release in the treatment of carpal tunnel syndrome. Half the diplomates, however, are using splints following carpal tunnel release, despite recommendations to the contrary. In addition, only half the diplomates are following guidelines recommending mammography before breast augmentation. Furthermore, 90 percent of diplomates are not following recommendations against the use of deep venous thrombosis prophylaxis for patients with acute lower limb trauma. CONCLUSIONS: This study revealed that there were few guidelines with which to compare diplomate performance. Steps should be taken to increase the number of evidence-based practice guidelines for plastic surgery procedures.

Certification examination cases of candidates for certification by the American Board of Plastic Surgery: trends in practice profiles spanning a decade (2000 to 2009).

BACKGROUND: The purpose of this study was to evaluate the case mix of plastic surgeons in their early years of practice by examining candidate case logs submitted for the oral examination. METHODS: Deidentified data from 2000 to 2009 consisting of case logs submitted by young plastic surgery candidates for the oral examination were analyzed. Data consisted of examination year, Current Procedural Terminology codes and the designation of each code as cosmetic or reconstructive by the candidate, and patient age and sex. Subgroup analyses for comprehensive, cosmetic, craniomaxillofacial, and hand surgery modules were performed by using the Current Procedural Terminology code list designated by the American Board of Plastic Surgery Maintenance of Certification in Plastic Surgery module framework. RESULTS: The authors examined case logs from a yearly average of 261 candidates over 10 years. Wider variations in yearly percentage change in median cosmetic surgery case volumes (-62.5 to 30 percent) were observed when compared with the reconstructive surgery case volumes (-18.0 to 25.7 percent). Compared with cosmetic surgery cases per candidate, which varied significantly from year to year (p < 0.0001), reconstructive surgery cases per candidate did not vary significantly (p = 0.954). Subgroup analyses of proportions of types of surgical procedures based on Maintenance of Certification in Plastic Surgery Current Procedural Terminology code categories revealed hand surgery to be the least performed procedure relative to comprehensive, craniomaxillofacial, and cosmetic surgery procedures. CONCLUSIONS: Graduates of plastic surgery training programs are committed to performing a broad spectrum of reconstructive and cosmetic surgical procedures in their first year of practice. However, hand surgery continues to have a small presence in the practice profiles of young plastic surgeons.