Innovation: A Sustainable Competitive Advantage for Plastic and Reconstructive Surgery

Abstract

Plastic and reconstructive surgeons face increasing competition clinically, especially in aesthetic surgery. Otolaryngologists, dermatologists, oral surgeons, and ophthalmologists, as well as physicians in other subspecialties, are increasingly turning to aesthetic surgery. There is little doubt that the attractive revenue stream from aesthetic surgery underlies the current clinical landscape involving so many different specialties competing in the same arena. The “discretionary medicine” or “cash business” aspect of aesthetic surgery stands in stark contrast to the eroding reimbursement by insurance carriers for reconstructive surgery. As with any business, attractive margins draw competition, and eventually the supply-and-demand principles of economics will reduce margins. Given this clinical reality, is there a competitive advantage strategy for plastic and reconstructive surgeons? The answer is yes. Innovation is the sustainable competitive advantage for plastic surgeons, as it has been since plastic surgery became a specialty. It is critically important that plastic and reconstructive surgery residents and fellows understand how integral this competitive advantage is when they finish their training. It is a daunting and oftentimes discouraging time when a plastic surgeon finishes his or her training and starts a practice. Because of the very nature of aesthetic surgery, it is difficult to build a practice with the stiff competition from other specialties. Simply being a board-eligible or board-certified plastic surgeon does not distinguish our “brand” in the minds of aesthetic surgery patients. While this reality may describe the first year of practice for many plastic surgeons, it stands in marked contrast to the competitive advantage these same surgeons enjoyed as chief residents in plastic surgery. Simply put, the plastic surgery chief resident is probably the most innovative clinical problem-solver in the hospital in which he or she works. When the neurosurgeon needs tissue coverage or calvarial reconstruction, when the orthopedic surgeon has exposed hardware or bone, when the thoracic surgeon needs help closing the chest wall or when a sternal wound breaks down, when the general surgeon needs help with an abdominal wall closure reconstruction, whom do they consult? The answer is usually plastic surgery, oftentimes through the chief resident. The specialties that compete so aggressively with our recently trained plastic surgeons are usually not the answer for the wide variety of clinical problems that plastic surgery chief residents solve on an everyday basis. There is a lesson here. Innovation, whether it be clinical or through research, has distinguished plastic surgeons historically and will continue to do so in the future. Innovation for plastic surgeons is analogous to the research and development pipeline of a big pharmaceutical or biotechnology company. We must not forget that innovation makes plastic surgery different and distinctive—the very definition of what strategy is all about. We cannot simply hang a shingle and build an aesthetic practice, because it is difficult to distinguish ourselves easily in the competitive aesthetic surgery arena. Our strategy should continue to emphasize innovation within plastic surgery. Microsurgery, craniofacial surgery, hand surgery, breast reconstruction, and myocutaneous flaps are examples of how plastic surgery innovation has introduced and advanced clinical care. Most of these innovations were initially published in this Journal (Table I), helping to fuel further innovation and refinement in the new field of plastic surgery. Plastic surgeons developed innovative approaches to solve clinical challenges. Driving these clinical advances were research efforts. Taking clinical problems to the laboratory and developing solutions that are translated back to the operating room is the ideal translational research paradigm.TABLE I: Selected Advances in Plastic Surgery Published in Plastic and Reconstructive SurgeryPlastic surgeons should continue to invest time, effort, and resources to maintain a robust, innovative pipeline. Clinical advances in scar reduction and skin remodeling, cell-based strategies for tissue engineering, and regenerative medicine will lead to innovative therapies for plastic surgeons. These new techniques (as well as products) pioneered by plastic surgeons will continue to distinguish us clinically, in both aesthetic and reconstructive surgery. In addition to building large clinical practices, other potential derivatives from this investment in innovation could include intellectual property with substantial revenue streams. In particular, for the Plastic Surgery Educational Foundation, Plastic Surgery Research Council, American Society of Plastic Surgeons, and American Society for Aesthetic Plastic Surgery, these revenue streams could further promote investments in both clinical care and research. In summary, plastic surgeons should remember that we are innovative problem-solvers and that this differentiates us in a competitive aesthetic market. We must not forget our broad-based training, and we must continue to invest in research that translates into novel therapies. Innovation is our sustainable competitive advantage in a highly competitive and fragmented clinical market. Similarly, our Journal must advance in tandem with innovation in the field, as it has done in the past. That is why we are instituting PRS’ Advance Online, to more rapidly disseminate peer-reviewed information and stimulate further innovation in plastic surgery. Additional innovations and changes in the Journal—both in print and especially on-line—will parallel changes in the specialty as a whole. While these innovations will certainly provide a different look and feel to the Journal, each is primarily intended to be a tool in service to the reader in order to advance plastic surgery. They will enable the reader to receive the most up-to-date information in the most technologically advanced and useful formats. Enhanced videos will provide real-time windows into operating rooms; the traditional method of telling how a technique is done will be augmented by showing how on the Web site with these videos. Exploiting Web publication will not only enable the rapid delivery of information but also provide plastic surgeons with a peer-reviewed forum for a scholarly rapid response to the changes in medicine that are taking place much more rapidly than they have in the past. In the end, as plastic surgeons, we must not forget our roots. Origins matter.