AAPS Main SiteEvolution of Practice Patterns in Plastic Surgery Using CPT Mapping: a 9-Year Analysis of Cases Submitted by Primary and Recertification Candidates to the ABPS
Michelle Lee, MD1, Harold S. Haller, PhD1, Directors of the American Board of Plastic Surgery, n/a2, Arun K. Gosain, MD3.
1Case Western Reserve University, Cleveland, OH, USA, 2Directors of the American Board of Plastic Surgery, Philadelphia, PA, USA, 3Northwestern University, Chicago, IL, USA.
PURPOSE:
Practice patterns in plastic surgery are under significant pressure due to changes in market forces and altered emphasis in training modules. A thorough understanding of evolving practice pattern is critical because it allows the specialty to detect subtle shifts in the market and to develop proactive strategies to maintain or increase market share. It also allows educators and young plastic surgeons to emphasize certain training modules to better prepare for the market place of tomorrow.
METHODS:
Two hundred and nine CPT codes from de-identified ABPS case-logs from Recertification and Primary Certification candidates from 2003-2011 were examined. Multiple regression and shift-away statistical analyses were used to identify significant changes in the percentage of surgeons performing each type of procedure and case volume per surgeon normalized to a 6-month collection period for each surgeon.
RESULTS: An average of 161 candidates per year applied for Primary certification and 191 candidates per year applied for Recertification. The period between 2003-2011 encompasses the great recession and its early recovery. As the economy contracted, the overall number of elective plastic surgery procedures contracted as well. However, economic downturn affected the mature and young plastic surgeons differently. For the mature plastic surgeon, elective case volume (no. cases normalized over 6 months) decreased. For the young plastic surgeon, the initial opportunity to perform elective procedures (percentage of surgeons performing each procedure) decreased.
Overall loss of market share was seen in facial cosmetic, facial malignancy, and hand surgery procedures (Figure 1). Over the 9-year study period, there was a significant decrease in the number of mature plastic surgeons performing facial cosmetic, facial malignancy and hand procedures. A decrease in case volume for those plastic surgeons who did perform these procedures (p<.05) was also seen. In contrast, plastic surgery maintained market share in breast and craniofacial surgery. Breast reconstruction volume and number of surgeons performing breast reconstruction steadily rose among both new and mature plastic surgeons. Craniofacial surgery experienced little change in case volume and the percentage of surgeons performing the cases.
CONCLUSIONS: From 2003 to 2011, plastic surgery lost market share in facial cosmetic, facial malignancy and hand surgery while maintaining market share in breast and craniofacial surgery. CPT mapping of ABPS data enables us to actively analyze these trends in order to be prepared to deal with changing pressures both from economic recovery and from competing specialties seeking to benefit from redistribution of case loads. In summary, 1) established practices should develop opportunities for new initiates to participate in procedures for which plastic surgery has been losing market share; 2) training modules should utilize these data to design appropriate curricula that anticipate evolution in practice patterns with career development and to adequately prepare trainees in specific procedures that have been less volatile with market shifts. 
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