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Aesthetic & Reconstructive Surgery Credentialing: A comparison of resident operative experience among Surgical Subspecialties
Purpose: The field of Plastic Surgery is unique because it is not limited by geography of the body; however, the ubiquitous nature of the field also leads to overlap between other surgical specialties. Practitioners in other specialties have increasingly been performing cosmetic and reconstructive procedures that were traditionally done by Plastic Surgeons. In addition, future competition is likely with new fellowship training programs: Oculoplastic surgery (after Ophthalmology), Facial Plastic Surgery (after Otolaryngology), Hand Surgery (after Orthopedic Surgery), Oncoplastic Surgery (after General Surgery) and even Cosmetic Surgery Fellowships. To credentialing committees, hospital administrators, the media, and the public, practitioners trained outside of Plastic Surgery justify this practice by claiming they have received adequate exposure and experience during their residencty training programs. A disciplines’ operative log is a good indication of adequacy in training and may be used by hospitals for credentialing reconstructive procedures or by the public when choosing an experienced cosmetic surgeon. Since no previous study compared operative experience of graduating residents from various disciplines, the authors reviewed the case log experience of surgical subspecialties to determine adequacy in training for common cosmetic and reconstructive procedures.
Methods: The Accreditation Council for Graduate Medical Education’s (ACGME’s) national operative case log data for the last 5 years for Plastic Surgery, Head and Neck Surgery, Dermatology, Orthopedic Surgery, Ophthomology and General Surgery were compared by the mean total number of cases for specific procedures. This data consists of the average number of cases performed for all graduating residents within that specialty during each year. For cosmetic surgery we compared 1)Facelifts, 2)Rhinoplasty, 3)Liposuction, 4)Breast Augmentation, 5)Blepharoplasty. For Reconstructive procedures we compared 1)Cleft lip and palate, 2)Facial Fractures, 3)Breast Reconstruction, 4)Hand Procedures.
Results: With regards to cosmetic surgery, Plastic Surgical Residents were superior with the number of 1)Facelifts=21.1 (more than all other specialties combined including H&N: 4.5 times more; and Derm/Ophtho); 2) Rhinoplasty=19.0 (compared to H&N=15.4); 3)Liposuction=42 (40 times more than all others, H&N=0.8) and 4)Blepharoplasty=30.3 (slightly more than Ophtho but over 5 times more than others). With regards to reconstructive procedures, Plastic Surgical Residents had more training and cases logged in 1)Cleft lip repair=15.6 (or over 15 times H&N and all other fields), Cleft palate repair=14.6 (or over 6 times all other fields) 2)Facial Fractures: Mandible fractures=20.6, (compared to H&N=17.6 and others had much less), 3)Breast Reconstruction=case log numbers were dominated by Plastic Surgery (with others recording minimal to none), 4)Hand Procedures: Hand fracture/dislocation=41.5 (compared to Ortho=26), Amputations=13 vs 6.7 for Ortho.
Conclusions: While graduating residents in other specialties are performing procedures that overlap with Plastic Surgery, their operative experience for these cases is below that of the average graduating Plastic Surgery resident. This data continues to support the notion that Plastic Surgeons should remain at the forefront of aesthetic & reconstructive surgical procedures. This information will be valuable for hospital credentialing of new surgeons and for those patients choosing an aesthetic or reconstructive surgeon.