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PURPOSE: The present study was performed to compare the practice profiles of candidates for Recertification or Maintenance of Certification (MOC-PS) and Primary Certification by the American Board of Plastic Surgery (ABPS) over the past 9 years. In addition, comparisons to unemployment data were made as a reference measure by which to further evaluate changing trends in practice profile.
METHODS: Case-logs from candidates for both Primary certification and Recertification/MOC-PS by the ABPS were examined from exam years 2003 through 2011. De-identified data were utilized for each case submission including operative year, CPT codes, and the candidate’s designation of the case relative to 1) cosmetic or reconstructive; 2) the MOC-PS module (Comprehensive, Cosmetic, Craniomaxillofacial, and Hand). Case collection periods for Primary candidates ranged from 7 to 9 months, and that for Recertification candidates was 6 months. To equalize for these differences each candidate’s data were expressed as the median number of cases per six months. The Department of Commerce Unemployment Data were collated on a quarterly basis from 2003-2011 to serve as an economic indicator. Data were compared using multiple regression and shift-away analyses.
RESULTS: A statistically significant downward trend for the 6-month median in the number of cases per candidate was observed for both Primary and Recertification groups from 2003 to 2011 for Cosmetic, Reconstructive, and Total number of cases (p<0.002; Fig. 1). This downward trend correlates with the unemployment data collected over the same time period (p<0.05). With every 1% increase in unemployment rate, Recertification candidates demonstrated an increased downward shift in the number of cosmetic cases relative to Primary candidates (4 versus 2-case decrease per 6 months, respectively; p<0.05), and an accelerated decline in the number of reconstructive cases per candidate starting in 2007 (p<0.002).. Distribution of the four MOC-PS modules demonstrated a negative trend for Cosmetic and Comprehensive modules in both groups (p<0.0001; Fig. 2). Hand and Craniofacial modules consistently comprised about 20% of modules for Primary Candidates and 14% of modules for Recertification Candidates. However, there was a shift away from Hand modules and shift towards Craniofacial modules in both groups from 2003-2011 (p<0.05).
Figure 1:
Figure 2:
CONCLUSIONS: This report represents the first time practice trends of candidates for the MOC-PS have been analyzed. These data demonstrate that there has been a statistically significant downward trend in the number of cases reported by both Primary and Recertification candidates over the past 9 years. Recertification candidates are more leveraged in cosmetic cases, losing cosmetic cases more rapidly as overall caseloads declined, and experiencing an accelerated decreased in reconstructive caseload from 2007 onwards correlating with a sharp upturn in unemployment. In contrast, Primary candidates appear to have maintained a more stable practice profile despite negative economic trends.