Influence of Residency on Academic Affiliation and Productivity among Plastic Surgery Faculty in the United States
Katherine M. Gast, MD, MS, William M. Kuzon, Jr., MD, PhD, Eric E. Adelman, MD, Jennifer F. Waljee, MD, MS, MPH.
University of Michigan, Ann Arbor, MI, USA.
PURPOSE: Only 24% of graduates of plastic surgery programs enter academic practice, and attrition among academic faculty is common with 46% leaving academic surgery in 5 years. Educational processes that encourage a career in academic plastic surgery remain unclear. Our study aim was to examine the impact of training institution on the pursuit of a career in plastic surgery and academic productivity.
METHODS: We performed an Internet-based search of all 94 ACGME accredited integrated and combined plastic surgery residency programs and independent plastic surgery fellowship programs in order to identify academic plastic surgery faculty (n=838 academic plastic surgeons). Programs were identified by a comprehensive FREIDA search. We gathered data regarding each faculty member from an ACGME-accredited training program including medical school attended, residency program pathway, advanced degrees obtained, plastic subspecialty fellowship training, academic rank, gender, and private-practice affiliation. For each faculty member, a bibliometric analysis of number of peer reviewed publications and Scopus h-indices were obtained to determine academic productivity. Linear and logistic regression analyses were performed to determine the correlation between attributes after adjusting for the clustering of surgeons within programs.
RESULTS: In the United States, 39% of plastic surgeons in academic practice are trained in only eleven programs. Plastic surgery training programs most commonly represented among academic plastic surgery faculty are displayed in Table 1. Compared with programs less frequently represented, faculty from these programs were more likely to pursue fellowship training (OR=1.32; 95%CI: 1.00-1.75), have higher H indices (9.0 vs. 5.4, p<0.001), and have a greater number of peer-reviewed articles (46.6 vs. 24.3, p<0.001). Among faculty currently in academic practice, characteristics associated with higher H indices include male gender (7.1 vs. 4.7, p<0.001), fellowship training (7.3 vs. 6.1, p<0.05), and no private practice affiliation (5.2 vs. 7.8, p<0.001). Female plastic surgeons represented 14.1% of academic plastic surgeons and were younger based on the median year of board certification (2005 vs 2000, p<0.05). A higher proportion of female academic plastic surgeons were on the tenure track than male surgeons (66.9% vs. 57.2%, p<0.05), with more women at the assistant professor level (73.1% vs. 43.6%, p<0.05). Overall, 30 % of academic plastic surgeons remained at their training institution and 39% were affiliated with a private practice model.
CONCLUSION: There is a bottleneck effect within plastic surgery training as 40% of all academic plastic surgeons are trained in eleven programs. Future studies that examine attributes of training programs that encourage a career in academic practice may improve resident mentorship and resident interest in academic plastic surgery.
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