Jumaily JS, Spiegel JH. The Unique Practice Needs of Academic Facial Plastic and Reconstructive Surgeons. JAMA Facial Plast Surg. 2015;17(5):384-385. doi:10.1001/jamafacial.2015.0452
The field of facial plastic and reconstructive surgery (FPRS) is an important part of otolaryngology–head and neck surgery and a certification board–mandated component of resident training. Creating a successful FPRS practice in an academic environment can be challenging, especially if the surgeon desires to provide cosmetic surgical services, because of the unique expenses with regard to practice environment, marketing costs, higher staff needs, and frequently evolving costs of equipment.
This was a survey study of American otolaryngology department chairpersons who are members of the Association of Academic Departments of Otolaryngology. The survey consisted of 15 questions. The first survey was conducted in 2009, and a second similar survey was administered in 2013.
Responses were obtained from 39 chairpersons in 2009 and from 24 chairpersons in 2013. The Table summarizes the data from both surveys. Some questions in the survey were left blank by the respondents.
Advances in the field and in the education of residents depend on a robust community of FPRS surgeons in the academic arena. However, unlike other otolaryngology subspecialties in which a higher level of service is expected at academic institutions, academic FPRS surgeons compete directly with community surgeons for their cosmetic cases. This often translates into a need for specialized staff, upscale space, and expensive equipment. Data from this study show that departments and hospitals provide financial contributions for staff, advertising, and major medical equipment expenses. Surgeons pay for these costs in less than 15% of the surveyed departments. The data herein are heterogeneous because they included departments with full-time academic surgeons and private surgeons.
The above expenses can increase the cost of retaining a FPRS surgeon and potentially decrease the profitability. Nonetheless, 77% of departments in the 2013 survey and 53% of departments in the 2009 survey reported that FPRS surgeons were profitable.
For all surgeons, the option of private practice remains an alternative to an academic career. Departments reported that 25% to 41% of their FPRS faculty are in full-time private practice. Although programs reported that their academic FPRS faculty members perform more reconstructive surgery (60%) than cosmetic surgery (40%), a robust FPRS presence requires both reconstructive and cosmetic cases. In general plastic surgery, the trend has been toward increased nonsurgical procedures, less cosmetic surgery, and more reconstructive surgery (80%-98%) at academic institutions.1- 4
The retention of FPRS surgeons is a continuous challenge for otolaryngology departments, with 33% to 35% of respondents reporting concern that FPRS faculty will leave. Reported challenges in the survey include the lure of better private practice compensation, cost of retention because of marketing and staff costs, lack of interest in academic pursuits, and development of strong general plastic surgery departments. In our survey, 81% to 88% of departments have built incentives into their FPRS surgeons’ pay structure. Chen et al1 surveyed general plastic surgery programs and noted a decline in academic faculty over the past 10 years. The most common reasons among departing faculty in that study included inadequate compensation (61%), lack of autonomy (37%), family considerations (36%), and university environment (32%). Eighty percent of departing faculty left for solo or group private practice.
Limitations of our study are the variable and low response rates for the 2 surveys (23% in 2013 and 37% in 2009). In addition, the surveys were anonymous. Therefore, it is unknown if we sampled the same programs. The surveys carry memory and opinion biases. Also, the surveys did not obtain detailed information about the FPRS surgeons themselves. Further research should focus on salary structure, case types, research resources, revenue sources, leadership roles, and administrative responsibilities to better understand the workforce dynamics in this subspecialty.
Corresponding Author: Jeffrey H. Spiegel, MD, Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, 820 Harrison Ave, FGH Bldg, Fourth Floor, Boston, MA 02118 (firstname.lastname@example.org).
Published Online: June 4, 2015. doi:10.1001/jamafacial.2015.0452.
Author Contributions: Drs Jumaily and Spiegel had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Spiegel.
Acquisition, analysis, or interpretation of data: Both authors.
Drafting of the manuscript: Jumaily.
Critical revision of the manuscript for important intellectual content: Both authors.
Statistical analysis: Jumaily.
Obtained funding: Spiegel.
Administrative, technical, or material support: Both authors.
Study supervision: Spiegel.
Conflict of Interest Disclosures: None reported.