Specialty Creep Into Plastic Surgery—Evidence For Declining Market Share Based On 430,472 Cases
Danielle H. Rochlin, MD1, Evan Matros, MD, MMSc2, Clifford C. Sheckter, MD1.
1Stanford University School of Medicine, Palo Alto, CA, USA, 2Memorial Sloan Kettering Cancer Center, New York, NY, USA.
PURPOSE: As a surgical discipline without anatomic boundaries, plastic surgery overlaps with several other specialties. The study aim is to measure longitudinal trends in the proportion of procedures traditionally performed by plastic surgeons compared to other specialties. The hypothesis is that there is encroachment by anatomically-defined specialists within otolaryngology, dermatology, and ophthalmology.
METHODS: The IBM® MarketScan® Commercial Database was queried from 2007-2016 to extract patients who underwent rhinoplasty, skin cancer reconstruction, and eyelid procedures that were covered by commercial insurance. Surgeon specialty was identified. Poisson regression modeled predictors of provider specialty for each procedure over time, adjusting for patient gender, region, facility setting, and diagnosis.
RESULTS: 430,472 rhinoplasty, skin cancer, and eyelid procedures were performed during the study period. For each year, the proportion of cases performed by plastic surgeons decreased 2.1% for rhinoplasty compared to otolaryngologists, 3.0% for skin cancer reconstruction compared to dermatologists, and 2.0% for eyelid procedures compared to ophthalmologists (p<0.001). Plastic surgeons were less likely to perform the procedure if the underlying diagnosis or preceding procedure drew from referral bases of "anatomic" specialists, such as sinonasal disease for otolaryngology (incidence rate ratio [IRR] 0.829), Mohs excision for dermatologists (IRR 0.381), and disorders of the eyelid or orbit for ophthalmologists (IRR 0.646) (p<0.001).
CONCLUSION: Plastic surgeons are losing ground on procedures historically performed by our specialty. Plastic surgeons must develop strategies to preserve specialty market share, which will require a critical evaluation of the gatekeeper effect that dictates referral patterns, professional and public perceptions, and economic forces.
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