Advertisement

Declining commercial market share in facial reconstructive surgery: Implications for academic plastic surgery and training future generations

  • Danielle H. Rochlin
    Affiliations
    Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, United States

    Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States
    Search for articles by this author
  • Evan Matros
    Affiliations
    Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States
    Search for articles by this author
  • Clifford C. Sheckter
    Correspondence
    Corresponding author at: Division of Plastic and Reconstructive Surgery, Stanford University, 770 Welch Road, Suite 400, Palo Alto, CA 94304, United States.
    Affiliations
    Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, United States
    Search for articles by this author
Published:August 28, 2022DOI:https://doi.org/10.1016/j.bjps.2022.08.071

      Summary

      Background

      As a surgical discipline without anatomic boundaries, plastic surgery overlaps with several other specialties. This study aims to measure longitudinal trends in the proportion of commercially reimbursed procedures performed by plastic surgeons compared to other specialists. We hypothesize that there is encroachment in commercial market share by anatomically defined subspecialists within otolaryngology, ophthalmology, and dermatology.

      Methods

      The IBM® MarketScan® Research Databases were queried to extract patients who underwent rhinoplasty, eyelid procedures, and skin cancer reconstruction covered by commercial insurance from 2007 to 2016 in the USA. 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

      A total of 430,472 rhinoplasty, eyelid, and skin cancer procedures were performed during the study period. For each year, the proportion of cases performed by plastic surgeons decreased by 2.1% for rhinoplasty compared to otolaryngologists, 2.0% for eyelid procedures compared to ophthalmologists, and 3.0% for skin cancer reconstruction compared to dermatologists (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 otolaryngologists (incidence rate ratio [IRR] 0.829), disorders of the eyelid or orbit for ophthalmologists (IRR 0.646), and Mohs excision for dermatologists (IRR 0.381) (p<0.001).

      Conclusions

      Plastic surgeons are losing ground on commercially reimbursed facial reconstructive procedures historically performed by the specialty. Plastic surgeons must develop strategies to preserve the commercial market share of these procedures and avoid compromise to academic centers and resident education.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. American board of plastic surgery. Published 2020. Accessed August 16, 2020. https://www.abplasticsurgery.org/about-us/history/

        • Noone R.B.
        Facing the challenges of subspecialization.
        Plast Reconstr Surg. 2013; 132: 23S
        • ABMS Guide to Medical Specialties 2020
        American Board of Medical Specialties, 2020: 37
        • About AAFPRS
        American Academy of Facial Plastic and Reconstructive Surgery.
        Published 2019 (Accessed November 7, 2021)
      2. About Us | ASOPRS. American society of ophthalmic plastic and reconstructive surgery. Published 2021. Accessed November 7, 2021. https://www.asoprs.org/about-us-

        • About ACMS
        ACMS - American College of Mohs Surgery.
        Published 2021 (Accessed November 7, 2021)
        • American Society of Plastic Surgery
        2020 Plastic Surgery Statistics Report. 26. 2020
      3. IBM WatsonHealth. 2019 IBM MarketScan publication and trademark guidelines. Published online 2019.

        • IBM WatsonHealth
        IBM MarketScan Research Databases for Life Sciences Researchers.
        2018: 1-16
        • Frome E.L.
        • Checkoway H.
        Use of poisson regression models in estimating incidence rates and ratios.
        Am J Epidemiol. 1985; 121: 309-323
        • Barr J.S.
        • Sinno S.
        • Cimino M.
        • Saadeh P.B.
        Clinicians performing cosmetic surgery in the community: a nationwide analysis of physician certification.
        Plast Reconstr Surg. 2015; 135: 92e-98e
        • Camp M.C.
        • Camp J.S.
        • Ray A.O.
        • Gupta S.
        Demographic and geographic analysis of providers of cosmetic services in the greater Los Angeles area: 2008 to 2009.
        Plast Reconstr Surg. 2010; 126: 115e-116e
        • Matlock D.
        Cosmetic therapies in obstetrics and gynecology practice: putting a toe in the water?.
        Obstet Gynecol. 2008; 112: 703-704
        • Small K.
        • Kelly K.M.
        • Spinelli H.M.
        Are nurse injectors the new norm?.
        Aesth Plast Surg. 2014; 38: 946-955
      4. American Council of Academic Plastic Surgeons - Plastic Surgery Residency Programs.
        Published 2022 (Accessed May 5, 2022)
        • Pacella S.J.
        • Comstock M.C.
        • Kuzon W.M.
        Facility cost analysis in outpatient plastic surgery: implications for the academic health center.
        Plast Reconstr Surg. 2008; 121: 1479-1488https://doi.org/10.1097/01.prs.0000304589.68531.5b
        • Hultman C.S.M.
        Procedural portfolio planning in plastic surgery, part 2: collaboration between surgeons and hospital administrators to develop a funds flow model for procedures performed at an academic medical center.
        Ann Plast Surg. 2016; 74: S347-S351
        • Roostaeian J.
        • Rough J.
        • Edwards M.C.
        A plastic surgery resident's view of aesthetic training and the future.
        Aesthetic Surg J. 2014; 34: 1270-1273
        • Morrison C.M.
        • Rotemberg S.C.
        • Moreira-Gonzalez A.
        • Zins J.E.
        A survey of cosmetic surgery training in plastic surgery programs in the United States.
        Plast Reconstr Surg. 2008; 122: 1570-1578
        • Oni G.
        • Ahmad J.
        • Zins J.E.
        • Kenkel J.M.
        Cosmetic surgery training in plastic surgery residency programs in the united states: how have we progressed in the last three years?.
        Aesthetic Surg J. 2011; 31: 445-455
        • Braza M.E.
        • Adams N.S.
        • Ford R.D.
        Perceptions of preparedness in plastic surgery residency training.
        Plast Reconstr Surg Glob Open. 2020; 8: e3163
        • Hashem A.M.
        • Waltzman J.T.
        • D'Souza G.F.
        • et al.
        Resident and program director perceptions of aesthetic training in plastic surgery residency: an update.
        Aesthetic Surg J. 2017; 37: 837-846
        • Morris M.P.
        • Toyoda Y.
        • Christopher A.N.
        • Broach R.B.
        • Percec I.
        A systematic review of aesthetic surgery training within plastic surgery training programs in the usa: an in-depth analysis and practical reference.
        Aesth Plast Surg. 2022; 46: 513-523
        • Rogers H.W.
        • Coldiron B.M.
        Analysis of skin cancer treatment and costs in the united states medicare population, 1996–2008.
        Dermatol Surg. 2013; 39: 35-42
        • Dolan R.T.
        • Zins J.E.
        • Morrison C.M.
        The aesthetic surgery literature: do plastic surgeons remain at the cutting edge?.
        Plast Reconstr Surg. 2016; 138: 277-287
        • Kreicher K.L.
        • Bordeaux J.S.
        Addressing Practice Gaps in Cutaneous Surgery: advances in Diagnosis and Treatment.
        JAMA Facial Plast Surg. 2017; 19: 147-154
        • Mehta H.
        On Innovations in plastic surgery.
        J Plastic, Reconstruct Aesthetic Surg. 2009; 62: 437-441
        • Rohrich R.J.
        • Rosen J.
        • Longaker M.T.
        So You Want to Be an Innovator?.
        Plast Reconstr Surg. 2010; 126: 1107-1109
        • Perdikis G.
        • Eaves F.F.
        • Glassman G.E.
        • et al.
        Aesthetic surgery in plastic surgery academia.
        Aesthetic Surg J. 2021; 41: 829-841
        • Chen J.T.
        • Nayar H.S.
        • Rao V.K.
        10 years later: lessons learned from an academic multidisciplinary cosmetic center.
        Plast Reconstr Surg Glob Open. 2017; 5: e1459
        • Levin L.S.
        The business of academic plastic surgery.
        Plast Reconstr Surg. 2010; 126: 303-307
        • Tanna N.
        • Patel N.J.
        • Azhar H.
        • Granzow J.W.
        Professional perceptions of plastic and reconstructive surgery: what primary care physicians think.
        Plast Reconstr Surg. 2010; 126: 643-650