Changes In Subspecialty Interest Of Plastic Surgery Residents With Progression Of Training: Impact On Academic Attrition
Background:
•Plastic surgery subspecialties that are most strongly associated with a career in academia are craniofacial, microsurgery, and hand
•Early academic interest is not reflected in graduates’ career choices:
•92.8% report interest in an academic career at the start of residency
•66-90% enter private practice
Methods:
•A survey was distributed through the American Society of Plastic Surgeons Resident Council (ASPSRC) in May 2020
•Survey content: Interest in subspecialties as a junior resident (PGY1-3, or pre-independent) and senior resident (PGY4-6, or independent years 1-3); Subspecialties: Craniofacial (CF), Hand, General reconstruction, Microsurgery (Micro), Gender, Aesthetic (Aes); Perceived characteristics / incentives of specialty of interest; Reasons for change in interest; Narrative responses about change in interest
•Statistics: Junior interest ratings were analyzed with the chi square test; Ratings of specialty characteristics were analyzed with paired t-tests
Results:
•276 residents (126 juniors, 150 seniors), 39 programs
•Significant factors for decreasing interest (↓) in CF and Micro: Desire to work in private practice (CF: +66%, Micro: +87%), Perceived job opportunities (CF: +52%, Micro: +25%), Compensation (CF: +44%, Micro: +66%)
•Same significant factors for increasing interest (↑) in Aes: Desire to work in private practice (+83%), Perceived job opportunities (+51%), Compensation (+56%)
•Least significant factors: Desire to work in academia (↓ CF: -21%, ↓ Micro: -42%, ↑ Aes: -38%), Desire to emulate a mentor (↓ CF: -10%, ↓ Micro: -28%, ↑ Aes: -16%)
•Highest rated reasons for change: ↓ CF: Found passion in new specialty choice (4.45/5), ↓ Micro: Work/life balance (4.53/5), ↑ Aes: Work/life balance (4.67/5)
Conclusions:
•Junior and senior groups expressed similar rates of initial interest in academic surgery, general reconstruction, and microsurgery, but current juniors were more interested in hand and gender
•Subspecialty interests and ratings of incentives shift among plastic surgery trainees from their junior to senior years
•Subspecialties associated with academia (craniofacial and microsurgery) suffer from the highest incidence of resident attrition due to the desire for improved work/life balance and a greater sense of control, compensation, and perceived lack of job opportunities
