6. The Influence of Integrated vs Independent Pathway and Hospital Type on Plastic Surgery Post-Residency Plans Unchanged by Global Pandemic

Abstract

Background: Statements are often made about what percentage of plastic surgery (PRS) residents go into fellowship vs. private practice vs. academia after graduation. However, few objective studies have been completed. This project is designed to illuminate career choices of PRS residents immediately after graduation from 2018-2022 and secondarily, determine if the pandemic had any measurable impact. Methods: Publicly available data was obtained from institution websites or program queries. Demographic data was collected including sex/gender, training pathway, primary residency, length of training, and post-residency fellowship vs private practice job vs academic job vs military appointment. Comparison of percentages between pre-Covid and post-Covid (2018-19 vs 2020-22), training pathways (independent vs integrated), institution type (private vs public) and program rank (per Doximity) were analyzed using Fisher’s exact test. P values were 2-sided and comparisons with P < 0.01 were considered significant. Statistical analysis was performed using SAS software. Results: Data was collected for 691 graduates across 64 training programs (28% independent, 71% integrated). Most graduates pursued fellowship-training (61%) followed by 28% direct to private practice, 5% direct to academic practice and 1% assumed a military post. Independent residents were more likely to pursue private practice (40%vs.26%, p=0.001), while integrated residents were more likely to pursue additional fellowship training (49%vs70%, p<0.0001). Public institution graduates are more likely to go into private practice (37%vs.23%, p=0.0002), while private institution residents are more likely to pursue fellowship (55%vs.72%, p<0.0001). However, pandemic (p=0.31) and institutional rank (p=0.11) showed no association. Conclusion: In this report, we present career choice trends amongst PRS trainees. We found independent residents more likely to pursue private practice, perhaps due to prolonged training period (minimum 8 years vs 6 years), while integrated residents were more likely to pursue fellowship training. Public/State institution graduates were more likely to pursue private practice, potentially influenced by more exposure to community faculty than trainees in private academic settings. This study demonstrates that training pathway and institution type have a significant impact on post-graduation plans, whereas global pandemic and institutional rank do not. This information can be used by programs and students as they plan for the future.