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Certification Examination Cases of Candidates by the American Board of Plastic Surgery: Trends in Practice Profiles Spanning a Decade (2000-2009)
Kevin C. Chung, MD, MS1, Jae W. Song, MD1, Melissa J. Shauver, MPH1, Terry M. Cullsion, RN, MSN2, R. Barrett Noone, MD2, Directors of the American Board of Plastic Surgery3.
1University of Michigan, Ann Arbor, MI, USA, 2The American Board of Plastic Surgery, Inc., Philadelphia, PA, USA, 3The American Board of Plastic Surgery, Philadelphia, PA, USA.
PURPOSE: 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: De-identified data from 2000-2009 consisting of case-logs submitted by young plastic surgery candidates for the Oral Examination were analyzed. These data consisted of exam year, CPT (Current Procedural Terminology) Codes and the designation of each CPT Code as cosmetic or reconstructive by the candidate, and patient age and gender. Subgroup analyses for Comprehensive, Cosmetic, Craniomaxillofacial, and Hand Surgery modules were performed by using the CPT Code list designated by the American Board of Plastic Surgery Maintenance of Certification in Plastic Surgery (MOC-PS®) module framework.
RESULTS: We examined case-logs from a yearly average of 261 candidates over 10 years. Wider variations in yearly percent change in median cosmetic surgery case volumes (-62.5% to 30%) were observed when compared to the reconstructive surgery case volumes (-18.0% to 25.7%) (Figure 1). Compared to 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 MOC-PS® CPT Code category designations revealed Hand Surgery to be the least performed procedure among plastic surgeons early in their practice compared to Comprehensive, Craniomaxillofacial, and Cosmetic Surgery procedures (Figure 2).
CONCLUSION: Ten years of practice profiles of young plastic surgery candidates for initial certification were described and analyzed for the first time by the American Board of Plastic Surgery. Compared to reconstructive surgery cases, cosmetic surgery cases demonstrated variability in year-to-year case volumes. These yearly trends paralleled the economic recession. Nonetheless, despite the recession and declining reimbursement fees, plastic surgery candidates show commitment to satisfying both reconstructive and cosmetic surgery procedure demands in their respective communities. In addition, among the types of reconstructive surgery procedures, Hand Surgery procedures emerged as the least commonly performed procedure during the past 10 years among these young plastic surgeons. An effort to enhance awareness of the need for Hand Surgery is warranted among plastic surgery residents.
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