More Women Training to Be Plastic Surgeons; Racial/Ethnic Representation Lags
While the proportion of women entering plastic surgery residency programs has increased in recent years, numbers of black and Hispanic trainees are declining or unchanged, finds a study in the March issue of Plastic and Reconstructive Surgery.
Researchers analyzed data on medical student applications to and resident enrollments in accredited US plastic surgery training programs from 2010 to 2016. The study focused on trends in gender and racial/ethnic representation, as well as possible barriers to increased diversity among plastic surgery trainees.
The proportion of women in plastic surgery residency programs increased during the study period, despite a decrease in female applicants. The number of women residents increased by 2.23 percent per year in integrated plastic surgery programs and by 0.7 percent per year in independent programs.
The increased representation of women in plastic surgery training programs was similar to trends in other specialties, including general surgery, internal medicine, family medicine, and obstetrics and gynecology.
In contrast, the overall proportion of black plastic surgery residents decreased during the study period, despite an increase in black residents in independent programs. This mirrored the trend in other specialties, where the percentage of black applicants was higher than the number of black residents for the same year.
Hispanic representation among applicants and plastic surgery residents showed little or only marginal change during the years studied. The number of Hispanic medical students has also increased in recent years.
“Given that black medical student representation has consistently neared six percent from 2012 to 2016, the decrease in black representation in integrated plastics as well as other specialties is alarming,” says Amanda Gosman, MD, a plastic surgeon at the University of California, San Diego, in a news release.
Past studies have shown under-representation of black, Hispanic, and female medical school graduates training to become plastic surgeons, compared to other surgical fields.
The new study shows an encouraging increase among women in integrated plastic surgery programs—although “there is room for further growth to see gender equality in the field,” Dr. Gosman and coauthors write.
Black and Hispanic representation in plastic surgery training programs has not followed the same trajectory. The researchers believe this lack of progress may reflect barriers beginning as early as medical school, including an absence of mentors, lack of access to plastic surgery resources, or implicit bias.
“We must acknowledge and address these barriers to minority recruitment with the proposed solutions to increase diversity in the workforce,” Dr. Gosman and coauthors conclude. “By doing so, plastic surgery can serve as an example for other specialties with similar barriers to recruitment, and ensure future diversity amongst surgeons to meet the needs of our patients.”
Dermatology, Plastic Surgery Rank Among Highest Paid Specialties
Doximity, the largest professional medical network, released its third annual Physician Compensation Report, showing that after years of steady pay increases, national physician wages have plateaued for the first time since 2016.
Both dermatology and plastic surgery specialties ranked in the top 10 for specialties with the highest average annual compensation (see chart below). Dermatology ranks sixth with an average salary for $455,000 and plastic surgery ranks eight with an average salary of $433,000.
The study also shows that the gender pay gap is decreasing from prior years. Male physician pay has remained flat since 2017, while female physician pay has increased. Major variations in pay were found across metropolitan areas and within medical specialties.
The report is based on the responses of nearly 90,000 licensed US doctors across six years, making it the largest repository of data available on physician compensation.
According to the study, plastic surgery is one of the top five medical specialties with the smallest wage gap between men and women in 2018.
“Compensation transparency is a powerful force. As more data becomes available to us, exposing the pay gap between men and women, we see more movements to rectify this issue,” says Christopher Whaley, PhD, in a statement. He is lead author of the study and adjunct assistant professor at the University of California, Berkeley School of Public Health.
Driving Factors that Lead to Positive Reviews from Patients
Satisfaction with the aesthetic outcome of a tummy tuck is the main factor driving whether patients write a positive or negative online review for their plastic surgeon.
But interactions with office staff and postoperative follow-up by the surgeon also influence plastic surgery ratings on online review sites, according to a study by John Y.S. Kim, MD, a plastic surgeon at the Northwestern University Feinberg School of Medicine. The new study appears in the March issue of Plastic and Reconstructive Surgery.
To arrive at their findings, researchers analyzed ratings of plastic surgeons on three popular review sites: Google, Yelp, and RealSelf, which is dedicated to plastic/cosmetic surgery ratings. The study included nearly 800 reviews written by patients who underwent abdominoplasty in six metropolitan areas: New York, Los Angeles, Chicago, Houston, Philadelphia, and Miami.
Dr. Kim and colleagues performed a quantitative analysis to identify statistically significant themes affecting patient satisfaction after abdominoplasty. Across the three sites, 86 percent of reviews were positive (4 or 5 stars) and 14 percent were negative (1 or 2 stars).
The researchers found that good aesthetic outcomes were the “dominant driver” of positive reviews. “No patient who reported being happy with their aesthetic results left a negative review, indicating that a good aesthetic outcome virtually guarantees a positive review,” the researchers write.
Interactions with office staff were the next most important factor—all reviews mentioning negative staff interactions were negative reviews. Postoperative care and follow-up by the plastic surgeon was also associated with patient satisfaction. In some cases, patients who were satisfied with follow-up care left good reviews despite cosmetic problems or complications.
Other factors—including surgical complications and the costs of surgery—were classified as “nondominant” factors. “Performance on these factors, while influential to satisfaction, is overshadowed by other factors,” Dr. Kim and coauthors write. “Because online reviews are few and polarizing,” the researchers note, “they are unlikely to be representative samples of a surgeon's total practice.”
In a previous qualitative analysis of online ratings after breast augmentation, Dr. Kim and colleagues found that reviews were affected not only by aesthetic outcomes, but also by interactions with the plastic surgeon and staff. The new study is the first quantitative analysis of factors affecting patient satisfaction after cosmetic surgery.