Background

1. Reconstructive or cosmetic plastic surgery: factors influencing the type of practice established by Canadian plastic surgeons Colin W. McInnes1, Cynthia G. Verchere2, Douglas J. Courtemanche2, Kevin Bush2, Jugpal S. Arneja2 1Faculty of Medicine, University of British Columbia, Vancouver, BC.2Division of Plastic Surgery, British Columbia Children’s Hospital, Vancouver, BC. Background Recently, some in organizational plastic surgery have voiced concerns that the specialty is facing an identity crisis. Challenged by factors such as increasing competition in the cosmetic marketplace and decreasing reimbursement for reconstructive procedures, many American plastic surgeons have adopted increasingly cosmetic-focused practices. This study will investigate the currently unknown practice profiles of Canadian plastic surgeons to determine the reconstructive-cosmetic mix, as well as factors which influence the type of practice to see if a similar pattern is occurring in Canada. Methods An anonymous online survey was distributed to all 352 Canadian plastic surgeons with email accounts registered with the Canadian Society of Plastic Surgeons (CSPS) and/or the Canadian Society for Aesthetic Plastic Surgery (CSAPS) which contained questions regarding practice profiles. Reconstructive plastic surgeons were defined as those who spend at least 50% of their time on reconstructive procedures. 120 surgeons completed the survey (34% response rate), of which 91 (76%) currently have reconstructive practices and 29 (24%) have cosmetic practices (Figure 1). 23% of respondents transitioned into a cosmetic practice from a previous reconstructive practice (Figure 2). Variables that appear to be associated with a reconstructive practice were female gender, younger age, research based degree’s, and having children and/or relatively high educational debt after residency, among others (Table 1). Reconstructive surgeons work longer hours, take more emergency call, and were less influenced by financial and non-financial (eg. flexible schedule) considerations (Table 2). Results Figure 1. Proportion of reconstructive and cosmetic procedures performed by Canadian plastic surgeons. Figure 2. Type of practice established by Canadian plastic surgeons in the first few years following the completion of their training compared to their current practice. Table 2. Influence of the Following Factors in Determining the Type (Reconstructive or Cosmetic) of Practice Among Canadian Plastic Surgeons Table 1. General Demographics and Practice Profile of Canadian Plastic Surgeons Conclusions • Reconstructive plastic surgery appears to be thriving in Canada despite the increased demand for cosmetic surgery. • The vast majority of Canadian plastic surgeons initially establish a reconstructive practice, and a substantial proportion of them switch to a cosmetic practice later in their career. • Reconstructive plastic surgeons work relatively long hours and spend more days on emergency call. • Female gender, older age, advanced degrees (Master’s and/or PhD), and greater educational debt all appear to be associated with a future reconstructive practice. • A greater proportion of cosmetic plastic surgeons were influenced by financial and non-financial (lifestyle, autonomy) factors when deciding to establish a reconstructive or cosmetic practice. Conversely, a greater proportion of reconstructive surgeons were influenced by academic opportunities. Collectively, most surgeons were influenced by the opportunity to perform their favorite procedures and to work in their desired practice location.