Scientific Abstract Presentations: Practice Management Session 3 Sunday, October 12 Sun, Oct 12 8:00-9:30 a.m. CDT

Purpose: To assess recent trends in salary among academic plastic surgeons and possible disparities in compensation based on gender or race/ethnicity.

Methods: A cross-sectional analysis was performed on deidentified data from the Association of American Medical Colleges (AAMC) Faculty Salary Report (1). Information was collected for full-time plastic surgery faculty at accredited academic medical centers in the United States for fiscal years 2022-2024. Total compensation included contractual salary plus medical practice supplement and bonus/incentive pay. Median salaries were stratified by faculty rank, gender, race/ethnicity, and geographic location.

Results: The AAMC report captured 753 academic plastic surgeons. Median faculty compensation in 2024 was $464,731 (IQR: $403,786-640,231) for assistant professors, $621,684 (IQR: $492,244-818,752) for associate professors, $685,039 (IQR: $523,004-873,505) for full professors, $809,081 (IQR: $690,826-1,090,817) for division chiefs, and $1,080,432 (IQR: $994,727-1,106,143) for chairs. On average, median compensation for all faculty increased by 7.6% in 2022, 5.9% in 2023, and 4.8% in 2024. Male faculty were typically compensated more than women at all ranks throughout the study period, and the salary gap increased at higher academic positions. Female chiefs were paid over $100,000 less than male chiefs ($706,441 vs. $809,823) and almost equivalently to male full professors ($704,390), despite the latter holding a lower academic rank. The median salary for female full professors was roughly $150,000 short of what males at equivalent faculty positions earned ($553,326 vs. $704,390). Black and Hispanic/Latino faculty received lower median compensation compared to their White counterparts at all academic ranks; White and Asian American faculty were compensated similarly. Based on 2024 median salaries, Black associate professors and assistant professors earned $0.91 on the dollar compared to White faculty in the same positions. Hispanic/Latino associate professors and assistant professors earned $0.76 and $0.89 on the dollar, respectively, compared to non-Hispanic White faculty in these positions. Among assistant professors, Hispanic/Latino females had the lowest median salaries, earning about $131,000 less than their White male counterparts (26.4% difference). Median compensation at most faculty ranks was highest in the Northeast; assistant professors received higher pay in the Central region of the United States. Faculty in the South earned the lowest median compensation across all academic ranks.

Conclusion: This study highlights gender- and race-based salary disparities among academic plastic surgeons, which may contribute to and perpetuate the underrepresentation of women and minority groups in this field. Regional salary differences were substantial and largely consistent, with higher compensations in the Northeast across most faculty ranks.

1. Association of American Medical Colleges. AAMC Faculty Salary Report. 2024.

Background Dog bite injuries are a significant cause of pediatric trauma, leading to emergency department visits, surgical interventions, and long-term physical and psychological consequences.[1] Socioeconomic status (SES) influences health disparities, affecting access to care, injury prevention, and treatment outcomes.[2] This study investigates the relationship between pediatric dog bite injuries and three socioeconomic indices: the Area Deprivation Index (ADI), Social Vulnerability Index (SVI), and Child Opportunity Index (COI), to assess their impact on injury incidence, severity, and healthcare utilization.

Methods A retrospective cohort study was conducted on pediatric patients who presented with dog bite injuries at a Level I pediatric trauma center between 2010 and 2024. Demographic data, injury characteristics, management, and outcomes were collected. Socioeconomic indices (ADI, SVI, and COI) were assigned based on residential ZIP codes to evaluate neighborhood-level disadvantage, vulnerability, and opportunity. Statistical analyses were conducted to assess relationships between indices and demographics, management, and clinical outcomes.

Results A total of 430 pediatric patients were included, with a median age of 8.1 years. The majority were male (61.3%), Black (62.3%) and had public insurance (70.3%). Family-owned dogs were responsible 50.8% of cases.

Socioeconomic analysis revealed that 61.5% of patients lived in low or low-medium opportunity neighborhoods based on COI scores, while 78.3% resided in medium-high or high vulnerability areas according to the overall SVI. The average ADI score was 27.24 ± 15.79, with most patients in the low deprivation category (54.42%), followed by moderate (31.16%) and high deprivation (1.63%).

Overall COI scores (lower COI = less opportunity) were significantly associated with return to the operating room (RTOR), operative management (OPM), specialist consultation (SC), infection, scar morphology, interpreter use, and insurance type (P ≤ 0.0001), suggesting a strong relationship between low neighborhood opportunity and poorer clinical outcomes.

Overall SVI scores (higher SVI = greater vulnerability) were also significantly associated with multiple variables (P ≤ 0.0001), though most correlations were weak and negative, except for specialty consults, which showed a moderate positive correlation (rs = 0.3659), indicating greater specialist involvement in more vulnerable populations.

Higher ADI scores (more deprivation) were significantly associated with increased rates of RTOR), OPM, SC, infection, and scar morphology (P ≤ 0.001). However, insurance type was not significantly associated with ADI (P = 0.3569).

Conclusion This study highlights the disproportionate burden of pediatric dog bite injuries on socioeconomically disadvantaged communities. This analysis not only reinforces the complex relationship between socioeconomic factors and pediatric dog bite injuries but also provides valuable insight into the utility of ADI, COI, and SVI in understanding our patients and the broader socioeconomic influences on healthcare outcomes. These findings emphasize the need for targeted prevention strategies, improved healthcare access, and policy-driven interventions to reduce the injury burden and improve outcomes in at-risk communities.

References 1. Patterson KN, Horvath KZ, Minneci PC, et al. Pediatric dog bite injuries in the USA: a systematic review. World J Pediatr Surg. 2022;5(2):e000281. Published 2022 Feb 7. doi:10.1136/wjps-2021-000281 2. Birken CS, Macarthur C. Socioeconomic status and injury risk in children. Paediatr Child Health. 2004;9(5):323-325. doi:10.1093/pch/9.5.323

Background: Patients with chronic lower extremity (LE) wounds often face pain, reduced mobility, and psychological distress, all of which can diminish quality of life. Although common mental disorders (CMD) may be prevalent in this population, systematic screening in wound care settings is uncommon. Evidence describing the impact of CMD on wound-related patient-reported outcomes is limited. This study aimed to examine how CMD affect patient-reported outcomes in individuals with chronic LE wounds. Methods: We conducted a cross-sectional survey of patients with chronic LE wounds treated at a multidisciplinary clinic from June 2022 to December 2024. Collected data included demographic and clinical characteristics, comorbidities, psychiatric diagnoses, surgical history, and wound care history. Patients completed validated questionnaires assessing mental well-being (Self-Report Questionnaire-20 [SRQ-20]), quality of life (12-Item Short-Form Survey [SF-12]), pain intensity (Patient-Reported Outcome Measurement Information System Pain Intensity [PROMIS-3a]), resilience (Connor-Davidson Resilience Scale [CD-RISC]), and lower-extremity function (Lower Extremity Functional Scale [LEFS]). Results: Among 714 patients, 108 (15.1%) had documented psychiatric diagnoses, primarily depression or anxiety. There were no significant differences between wound type (overall rates of foot ulcer: 44.6%, knee ulcer: 40.9%, above knee ulcer: 2.7%, other: 11.8%) or surgical history (p >0.21). Compared with patients without a psychiatric diagnosis, those with CMD had significantly higher SRQ-20 scores (5.3, IQR 4.1 vs. 3.6, IQR 3.9; p < 0.0001) and a greater incidence of suicidal ideation (8.4% vs. 3.4%; p = 0.023). Patients screening positive for CMD also reported more intense pain (PROMIS-3a T-score 56.2, IQR 13.8 vs. 52.7, IQR 13.5; p = 0.016) and reduced functional abilities (LEFS 42.8, IQR 23 vs. 48.3, IQR 26.4; p = 0.04). They additionally expressed a higher desire to consult a mental health professional (p = 0.005). There were no significant differences in psychological distress between patients' different surgical histories (minor and major amputation or limb salvage procedures, p=0.786). After multivariate regression analysis, history of different amputations or limb salvage procedures were not significant covariates associated with depression or psychological distress (p>0.15). Conclusion: Chronic LE wound patients with CMD exhibit significantly higher psychological distress, more intense pain, and lower functional status, as well as elevated rates of suicidal ideation. Psychological distress did not vary significantly between minor or major amputation or limb salvage procedures. These findings highlight the importance of routine psychiatric screening and the integration of mental health services into multidisciplinary wound care to optimize patient outcomes.

INTRODUCTION: Large Language Models (LLMs) have shown potential to enhance medical practice. One promising application is as a patient resource; however, prompt quality can greatly affect responses, and patients may struggle to express their concerns clearly, especially in the postoperative period. To address this limitation, we implemented Self-Query Retrieval, an advanced Retrieval-Augmented Generation (RAG) technique, to enhance LLMs' performance in providing postoperative recommendations for patients following rhinoplasty. This approach aims to deliver more precise and contextually relevant guidance by automatically refining vague or incomplete queries, ultimately improving patient outcomes.

METHODS: A comprehensive knowledge database on rhinoplasty was compiled and integrated with Gemini 1.0 Pro to create four distinct RAG configurations: a basic RAG with no prompt refinement and three using self-query retrieval to (1) restructure prompts into PICOT format (Patient, Intervention, Comparison, Outcome, Time), (2) restructure into SPICE format (Setting, Perspective, Intervention, Comparison, Evaluation), and (3) incrementally adjust the prompt with Iterative Query Refinement (IQR). Each model was presented with 30 questions addressing typical patient concerns after rhinoplasty, and performance was evaluated in terms of medical accuracy, relevance, precision, recall, and F1 score. A 3-point Likert score (LS) was used to assess medical accuracy and relevance and response metrics were compared using ANOVA and Tukey's post hoc analysis.

RESULTS: The model using IQR demonstrated the highest accuracy of 87% with an average LS of 2.4±0.72, compared to the SPICE model at 77% (LS 2.1±0.79), the PICOT model at 67% (LS 2.0±0.74), and the basic model at 50% (LS 1.63±0.72). The IQR and the SPICE models were statistically superior to the basic model (p<0.01 and p<0.05, respectively). For relevance, the IQR model achieved a perfect 100% score (LS 3±0.0), while the SPICE model scored 93% (LS 2.8±0.55), the PICOT model 87% (LS 2.6±0.72), and the basic model 80% (LS 2.6±0.81). There was only a statistical difference between the IQR and the basic models with a p-value<0.03. The model with IQR obtained the highest precision, recall, and F1 scores of 0.53, 1.00, and 0.70. This was followed by the SPICE model with precision, recall, and F1 scores of 0.53, 0.75, and 0.57. The PICOT and basic models had a precision of 0.39 and 0.17, a recall of 0.56 and 0.39, and an F1 score of 0.46 and 0.24.

CONCLUSION: These findings demonstrate that incorporating Self-Query Retrieval, particularly with IQR, substantially enhances the accuracy, relevance, and overall performance of LLM-generated recommendations for post-rhinoplasty patient care. By consistently outperforming other RAG configurations in precision, recall, and F1 metrics, the IQR approach sets a higher benchmark for safe and effective patient guidance, paving the way for broader, more reliable clinical integration of advanced LLM methodologies. Further refinement and research remain imperative to ensure LLMs evolve into consistently safe and robust tools for clinical support.

Introduction: Patient education is a critical component of surgical care, directly influencing recovery outcomes and satisfaction. In plastic surgery, where patient expectations and post-operative care requirements are particularly nuanced, effective communication becomes even more essential. Traditional methods of providing post-operative instructions are limited to scheduled consultations and printed materials, leaving patients without reliable guidance during critical recovery periods when questions arise. Recent advances in artificial intelligence have enabled the development of virtual assistants to provide round-the-clock patient support. However, most existing systems employ rule-based natural language processing (NLP) that requires precisely formulated questions to generate appropriate responses. This represents a significant limitation, as patients typically express their concerns using natural speech patterns with inherent ambiguity, colloquialisms, and contextual references that confound traditional NLP systems.

Methods: We upgraded an AI virtual assistant (1) using Retrieval Augmented Generation (RAG) methodology, combining a Large Language Model with a specialized knowledge bucket of post-operative instruction handouts, PubMed articles, and publicly available medical knowledge. The system was trained on 10 frequently asked post-operative topics in plastic surgery. To evaluate its ability to handle ambiguity, we created 100 ambiguously worded questions mimicking real-world patient communications. Three independent reviewers assessed responses using Likert scales for factual accuracy, completeness, and empathy (1-5). We also evaluated readability using Flesch-Kincaid Grade Level, Flesch Reading Ease Score, and Hemingway readability assessments.

Results: The system demonstrated strong performance with ambiguous patient queries, achieving a mean accuracy score of 4.87/5 (SD=0.367) and completeness score of 4.82/5 (SD=0.47). Empathy scores were moderate at 2.93/5 (SD=1.05). For readability, Hemingway analysis showed that 57% of responses fell within the 9th–12th grade level. Flesch-Kincaid analysis showed 44% were at a college level. The mean Flesch–Kincaid Grade Level was 10.52 (SD = 2.93), with a Flesch Reading Ease Score of 45.70 (SD = 16.75). Responses averaged 14.65 words per sentence (SD = 5.37) and 1.73 syllables per word (SD = 0.19).

Conclusion: The RAG-LLM integration significantly enhanced AIVA's ability to interpret ambiguous post-operative queries, demonstrating high accuracy (mean Likert 4.87/5) and completeness (mean Likert 4.82/5). However, moderate empathy (mean Likert 2.93/5) and less than optimal readability (mean Flesch-Kincaid grade 10.52) require further refinement. The Flesch-Kincaid analysis indicated a college-level reading difficulty, highlighting the need for improved accessibility. This technology promises reliable 24/7 post-operative guidance, reduces unnecessary emergency room visits, and allows physicians to focus on building strong patient rapport.

1. Boczar D, Sisti A, Oliver JD, et al. Artificial Intelligent Virtual Assistant for Plastic Surgery Patient's Frequently Asked Questions: A Pilot Study. Ann Plast Surg. 2020;84(4):e16-e21. doi:10.1097/SAP.0000000000002252

Introduction

Pediatric plastic surgery requires significant time and resource investment from both patients and hospitals. Network of Care sites are designed to improve efficiency and reduce costs for patients undergoing less complex procedures. Though limited, some academic pediatric plastic surgery programs offer outpatient surgeries to patients at their main campus and Network of Care sites. The purpose of this study is to examine the efficiency and resource use across surgery locations at an academic pediatric plastic surgery program.

Methods

A retrospective review was performed on all patients who underwent a 30–60-minute lesion excision performed by a single surgeon at our institution from 2023-2024. Case location (main campus vs. Network of Care site), operating room (OR) costs, supply costs, and anesthesia costs were collected. Patient outcomes were assessed based on 30-day infection rate, 30-day admission rate, and 30-day emergency department (ED) visits related to their surgery. Hospital time efficiency was measured as total time spent in the OR, and patient time efficiency was measured as preoperative wait time and total time spent in the facility. Continuous variables were summarized with means and standard deviations, and t-tests were used to compare means.

Results

A total of 72 procedures were identified, 14 at the main campus and 58 at the Network of Care site. The average total OR costs ($11,035.57 vs. $9,528.10, p=0.034) and average materials costs ($79.29 vs. $58.17, p=0.040) were significantly higher at the main campus than the Network of Care site. Although the average procedure duration was not significantly longer at the main campus (27.1 min vs 22.7 min, p=0.344), the average total time spent in OR was significantly longer at the main campus (51.3 min vs 40.0 min, p=0.034). Patient time efficiency was also lower at the main campus with patients spending more time on average waiting for their procedure (156.1 min vs. 87.6 min, p<0.001) and in the facility overall (292.8 min vs. 189.5 min, p<0.001). Patient infection rate (p=0.627) and ED visits (p=0.473) did not differ across locations. No readmissions occurred at either location, so no t-test was performed.

Conclusion

Performing this procedure at the Network of Care site was more time- and resource-efficient for the hospital and patients, while maintaining similar patient outcomes. As the total time spent in the OR was longer, the costs to the hospital and the patients were higher at the main campus. Furthermore, patients waited longer before surgery and spent longer time in the facility at the main campus compared to the Network of Care site. As patient outcomes did not differ between the two surgery locations, academic pediatric plastic surgery departments may preferentially shift outpatient appropriate surgical procedures to Network of Care sites to optimize resource use, enhance patient experience, and provide higher value care to patients.

PURPOSE: The Medicare population is a subset of plastic surgery patients with unique needs and characteristics. Prior studies before COVID-19 have shown decreasing reimbursements and increasing charges. This study aims to characterize changes in Medicare reimbursements and charges in plastic and reconstructive (PR) surgery since the pandemic.

METHODS: The CMS Medicare Physician & Other Practitioners database was used to analyze all procedural codes billed by PR surgeons from 2013 to 2022. Subgroup analysis was conducted based on organ system (integumentary, musculoskeletal, nervous, other). Primary outcomes were the total number of services billed, average Medicare standardized payment, average submitted charge, and average percent reimbursed per visit. An interrupted time series analysis (ITSA) was conducted with the break point set in 2020. All dollar amounts were inflation-adjusted to 2022.

RESULTS: A total of 4,517,291 services for 2,742,082 beneficiaries were billed to Medicare by 3,648 surgeons. Between 2013 and 2022, there were decreases in volume (-30.4%), average Medicare standardized payment (-22.0%), average non-Medicare payment (-13.8%), percent reimbursed (-10.9%), with increases in charge (+13.3%). ITSA revealed a significant drop in volume in 2020 (p < 0.001), and significant changes in slope after 2020 in non-Medicare payment (p = 0.043) and percent reimbursed (p = 0.01).

CONCLUSIONS: Exacerbated by the COVID pandemic, downward trends in Medicare utilization and reimbursements for PR surgery have made it more challenging for surgeons serving Medicare recipients. Acknowledging these trends is vital to prevent increased care barriers to PR surgery and ensure better health for Medicare patients.

Purpose: The American Society of Plastic Surgeons (ASPS) created the Essentials of Leadership (EOL) program to foster leadership skills and networking among current and upcoming plastic surgery leaders. This study aims to qualitatively evaluate the program's impact on participants, identify its strengths and weaknesses, and predict the future direction of leadership. Methods: This study employed a qualitative descriptive design, using semi-structured interviews to explore the experiences of plastic surgeons who participated in the program. The data was analyzed inductively, and codes were reviewed to identify overarching themes. Results: 29 interviews were completed. Participants practiced for an average of 15.5 years (range 7-29) in a range of practice models, including academia (86%) and private practice (14%). Significant themes identified include motivation to build leadership skills and new relationships through the program, a profound impact on career trajectory, and hopes for increased diversity in plastic surgery. Most participants entered the program at a crossroads in their career "I was looking for something more, and I wasn't sure where to get it" (P2); either as new faculty seeking leadership opportunities or searching for purpose through a major career shift, such as entering private practice from academia. Unanimously, surgeons sought to form new relationships, "the heart of what we do is collegiality and collaboration, and it would be a great opportunity to meet like-minded individuals" (P19). The impact on career trajectory was profound, empowering participants with the confidence to start a new leadership position or even to quit a dissatisfying job, "This program changed my life – I left my job… As I grew more confident in who I was, I realized that I could change course" (P27). Participants expressed hope for increased diversity and engagement in plastic surgery, mentioning that the "first step to making [opportunities] accessible is to have visibility [with a] diverse group of leaders so that the rising plastic surgeons see themselves in those individuals" (P2). Surgeons believe that diversity can be enhanced through merit-based leader selection and by the "old guard" (P6) stepping aside to make space for new leaders. Participants mentioned EOL as a "springboard" to leadership positions both within the society and their own institutions, demonstrating that the program levels the playing field by providing leadership opportunities to all involved (P19). Conclusion: In conclusion, surgeons participate in the EOL program seeking leadership skills, networking opportunities, and time for reflection and personal growth. Participants valued the relationships, confidence, and leadership skills developed through the program, demonstrating its role as a springboard for those seeking additional leadership opportunities or profound changes in their careers.

Background

An increasing number of women are choosing careers in the field of plastic and reconstructive surgery (PRS). These evolving surgeon demographics have highlighted the need for parental leave policies, lactation accommodations, and childcare services. Therefore, this study examines the reproductive and childbearing challenges that plastic and reconstructive surgeons encounter. Specific areas of focus include obstetric complications, parental leave, breastfeeding, childcare, and infertility.

Methods

In September 2024, a scoping review was conducted across CINAHL, Google Scholar, MEDLINE, PubMed, and Scopus, following PRISMA-ScR guidelines. Randomized control trials, observational studies, surveys, and interviews that examined pregnancy, parental leave, or family planning in PRS trainees or attendings were included. Abstracts, commentaries, editorials, systematic reviews, and non-English studies were excluded.

Results

Seventeen studies, consisting primarily of surgeon experience surveys (82.35%, n=3,145), were examined. Infertility affected 19.6-50.7% of surgeons, with 9.8-19.6% utilizing assisted reproductive technology. Female surgeons were older at their first live birth than the general population and faced stigma related to pregnancy. Between 39% and 56% experienced obstetric complications. Many reported a lack of lactation spaces and greater childcare burdens. Following the institution of a policy protecting parental leave by the American Board of Plastic Surgery (ABPS), trainees reported a positive affirmation in their selection of the surgical specialty.

Conclusions

The implementation of protected parental leave has positively influenced workplace culture in PRS. However, significant gender-related challenges remain, particularly stigmas surrounding pregnancy and parental leave.

Objective: This study examines the prevalence of prohibited questions encountered during the 2024 integrated plastic and reconstructive surgery (PRS) residency interview process. Methods: An anonymous 13-question minimum REDCAP survey was distributed to 2024 cycle applicants to PRS integrated residency programs in the United States. The survey covered personal characteristics and the frequency, type, context, and source of prohibited questions. Results: A total of 74 applicants completed the survey, yielding a 23.1% response rate. 52.7% of respondents reported being asked at least one prohibited question while on the interview trail. 90% of respondents reported answering these questions, usually truthfully, and 43.3% stated that prohibited questions affected their ranking of particular programs. Female applicants were 5.8 times more likely to be asked about program ranking than males (43.2% vs 7.4%, p=0.001). Nonwhite applicants (Hispanic/Latino + Asian) were 5.88, 4.13, and 3.08 times more likely to be asked specific prohibited topics such as family planning (p=0.004), career balance (p=0.038), and marital status (p=0.025) respectively compared to White applicants. Additionally, programs in the U.S. South and Northeast were 1.52 times more likely to ask prohibited questions compared to programs in the West and Midwest combined. Conclusion: Prohibited questions continue to be a prevalent issue in PRS integrated residency interviews. Even when not malicious, such questions may introduce potential bias into the process and can be unethical or illegal. Programs and applicants must work to highlight and eliminate these questions from the application process.

Introduction 30% of all practicing surgeons are women and specifically, 17% of all practicing plastic surgeon are women. Within plastic surgery, these trends are shifting towards gender equality as 47% of residents are now women and will likely lead to an equal distribution in practice in the coming years. Many female surgeons delay pregnancy due to lengthy training, leading to higher infertility and pregnancy risks. As more women enter plastic surgery, addressing the challenges of pregnancy and parenthood during training is crucial to reducing stigma and improving support systems to create a better environment for practicing physicians.

Summary of findings Currently, about 40% of residents anticipate becoming a parent during residency and at least 1 in every 5 female residents are mothers. However, female plastic surgeons face higher infertility rates (50.7%) compared to the general population (12.9%), leading to increased reliance on assisted reproductive technology (ART).[1] While ART can extend childbearing years, it is costly, time-intensive, and difficult to access during training. Furthermore, female plastic surgeons carry high risk pregnancies, with increased rates of gestational hypertension and preterm delivery. [2–4] Occupational exposures, such as radiation and antineoplastic agents, pose a threat to both the fetus and the mother. After delivery, residents must compromise between taking parental leave and graduation requirements. Surgical residents also struggle to balance lactation with clinical responsibilities due to limited time and distant facilities. Childcare costs are high, and many physician parents struggle to find adequate, affordable care. Some institutions offer on-site childcare or subsidies, but demand often exceeds availability, leaving many to rely on various costly options that cause financial stress. Very few programs have established concrete policies and guidelines addressing these issues leaving residents with uncertainty. More women than men reported that childcare was impacting their work (32.9% vs 19.0%, p<0.01), and physicians who reported that their childcare responsibilities impacted their work had substantially higher odds of reporting burnout (OR=2.19), even after controlling for age and gender. [5]

Conclusion Residency programs should establish clear policies for fertility, pregnancy, and postpartum care to support resident parents. Recommendations include fertility treatment coverage, pregnancy accommodations, protected prenatal appointments, and improved lactation and childcare options. Employers should work with their residents and attendings to allow for equitable and reasonable family benefits. Increasing awareness, flexibility, and institutional accommodations can improve maternal and fetal health as well as overall physician stress and burn out. A cultural shift toward acceptance and transparency is essential to help parent physicians in all specialties balance their careers and family life.

1. Hemal K, Chen W, Bourne DA. Fertility and Childbearing Outcomes of Practicing Female Plastic Surgeons. Plast Reconstr Surg. 2023;151(6):1327-1337. doi:10.1097/PRS.0000000000010119
2. Behbehani S, Tulandi T. Obstetrical complications in pregnant medical and surgical residents. J Obstet Gynaecol Can. 2015;37(1):25-31. doi:10.1016/S1701-2163(15)30359-5
3. Cai C, Vandermeer B, Khurana R, et al. The impact of occupational shift work and working hours during pregnancy on health outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol. 2019;221(6):563-576. doi:10.1016/J.AJOG.2019.06.051
4. Kader M, Bigert C, Andersson T, et al. Shift and night work during pregnancy and preterm birth-a cohort study of Swedish health care employees. Int J Epidemiol. 2021;50(6):1864. doi:10.1093/IJE/DYAB135
5. Dillon EC, Stults CD, Deng S, et al. Women, Younger Clinicians', and Caregivers' Experiences of Burnout and Well-being During COVID-19 in a US Healthcare System. J Gen Intern Med. 2022;37(1):145-153. doi:10.1007/S11606-021-07134-4

Purpose: The subspecialty of hand surgery is unique in that multiple training pathways exist, with the most common being orthopaedic and plastic surgery residencies. Patients increasingly rely on online resources to find a doctor. (1, 2) In this study, we analyze the composition of Google search results when querying for a hand surgeon across the 50 largest cities in the United States (US). We aim to assess the accuracy of online representation and identify potential discrepancies in public accessibility to qualified hand surgeons.

Materials and Methods:

Google search engine was queried for the following terms: "hand surgeon", "upper extremity surgeon", and "hand microsurgeon" for the fifty largest cities by urban population within the US. The top twenty search results were recorded for each search, resulting in 3,000 distinct search results reviewed. Sponsored results were not included as these were not city specific. Physician gender, training history, practice information was collection. ChatGPT-4o (San Francisco, CA) was utilized for this demographic data extraction and this was verified manually. Board certification was verified using publicly available certification tools for each specialty. Regions were determined by the American Association of Medical Colleges (AAMC) determined regions. Statistical analysis with Statistical Package for the Social Sciences (SPSS) (Armonk, NY) was performed with descriptive statistics and chi-square tests. Ad-hoc analysis was performed with standardized residuals.

Results:

A total of 1,497 unique physicians were identified, nearly all self-identified as a hand surgeon (98%), the majority were male (84%), and most attended medical school in the US (96%). The majority of surgeons completed orthopaedic surgery residency (73%), a minority completed plastic surgery residency (15%), and few (8%) completed general surgery training only. More than a third (39%) did not hold a Certificate of Added Qualification (CAQ) in surgery of the hand. Across all surgeons, those in academic practice were more likely to have a CAQ (p<0.001), attended orthopaedic surgery residency (p=0.03), be board certified in orthopaedic surgery (p=0.02), and have attended a hand fellowship (0.017). Those who attended a general surgery residency were less likely to be in academic practice (p=0.002). Those practicing in the northeast were more likely to be in academic practice (p=0.01) and those in the south were more likely to be in private practice (p=0.02).

Conclusions: Plastic surgeons represent a minority of search results when searching for a hand surgeon on Google. Nearly two fifths of surgeons identified did not hold a CAQ in surgery of the hand. Those in academic practice appear to have undergone additional training compared to their private practice counterparts. Academic surgeons appear more likely to have completed additional fellowship training compared to their private practice counterparts, suggesting differences in training pathways between practice settings. Furthermore, geographic region may influence practice environment. As search engines play a growing role in healthcare decision-making, understanding how surgeon representation varies online is essential for improving transparency, patient education, and access to appropriately trained specialists.

References: 1. Awad SK, Cowen J, Patel J, Aluri AK, Ananthasekar S, Singh NP, et al. Plastic Surgeons Are Underrepresented When Searching Hospital Websites for a Hand Surgeon. Plast Reconstr Surg. 2023;151(6):1055e-8e. 2. Singh NP, Boyd CJ, Aluri A, Kovac S, Mainali B, Girardi A, et al. One in Three Chance of Finding A Plastic Surgeon on Major Hospital Websites. Plastic and Reconstructive Surgery – Global Open. 2023;11(1):e4781.

Introduction

The past two decades have seen a trending decrease in physician reimbursements from the Center for Medicare & Medicaid Services (CMS) across many specialties [1]. There is limited literature on longitudinal reimbursement trends for core pediatric plastic surgical operations for physicians and care facilities, despite CMS establishing standardized base rates for pediatric procedures. The purpose of this study is to evaluate trends in physician fees and facility pricing reimbursement rates for pediatric plastic surgery within the past two decades.

Methods National reimbursement data from 2007 to 2024 was obtained through the Medicare Physician Fee Schedule Look-Up (MPFS) tool provided by the Center for Medicare & Medicaid Services (CMS). Select craniofacial reconstruction and cleft lip/palate procedures of interest were identified through Current Procedural Terminology (CPT) codes.

The following values were queried from MPFS under the National Payment Amount which includes relative value units for work, practice expense, and malpractice. The Geographic Practice Cost Indices were set at 1.000 to account for national payment values. Conversion factors were directly obtained through available spreadsheets from CMS. Physician fee calculations were conducted using the established physician fee reimbursement equation [2].

Medicare facility pricing set at the National Payment Amount for the select CPT codes were also obtained. Both physician fee and facility pricing values were adjusted for inflation using the Bureau of Labor Statistics Consumer Price Index [3]. Subsequent percentage change (PC) and year-over-year (YOY) analyses were conducted.

Results Physician Fee Reimbursements Five common CPT codes for cleft lip/palate procedures and seven craniosynostosis CPT codes were identified. All 12 of the pediatric plastic surgery codes (100%) experienced an average net decrease of -26.57% (±9.85) (Figure 1). CPT 61558 experienced the smallest decrease (-5.08%), while CPT 42200 experienced the greatest decrease in physician fee reimbursement (-45.70%).

Facility Fee Reimbursements Overall, 4 out of 12 CPT codes (33.33%) experienced an increase in facility pricing reimbursements while 8 out of 12 CPT codes (66.66%) experienced a decrease in facility pricing reimbursements (Figure 2). Facility pricing increased by a net average of 31.29% (±54.55) for 4 out of 12 CPT codes, while 8 out of 12 CPT codes decreased by a net average of –26.29% (±18.41). CPT 21175 experienced the greatest increase, while CPT 42200 experienced the greatest decrease in facility pricing reimbursement.

Conclusion Overall, physician fee and facility pricing reimbursements demonstrated a down-trending pattern for the majority of common pediatric plastic surgery procedures, from 2007-2024. Variable fluctuations occurred year-over-year at certain periods, possibly due to significant economic changes.

References 1. American Medical Association. Medicare physician pay has plummeted since 2001. Find out why. 2024. https://www.ama-assn.org/practice-management/medicare-medicaid/medicare-physician-pay-has-plummeted-2001-find-out-why#:~:text=The%20big%20problem%20is%20that,reform%20the%20Medicare%20payment%20system.

2. Seidenwurm DJ, Burleson JH. The medicare conversion factor. AJNR Am J Neuroradiol. 2014 Feb;35(2):242-3. doi: 10.3174/ajnr.A3674. Epub 2013 Jul 18. PMID: 23868163; PMCID: PMC7965749.

3. Bureau of Labor Statistics, United States. Consumer Price Index. 2024. https://data.bls.gov/cgi-bin/surveymost

Background: Breast reconstruction is a critical component of post-mastectomy care. Language barriers may limit shared decision-making and utilization of surgical options. Non-English-speaking (nEN) patients face challenges, including restricted communication and cultural differences in reconstruction preferences. This study evaluates differences in breast reconstruction rates and modalities between English-speaking (EN) and nEN patients to elucidate language-based disparities in surgical decision-making. Methods: The TriNetX health research database queried ISO and CPT codes to identify patients with language preferences who underwent mastectomy from 2013 to 2024. 68 variables controlled for demographics, mastectomy type, cancer diagnosis, and comorbidities to propensity-score match patients to EN and nEN cohorts. Risk analysis evaluated differences in rates of autologous, implant-based, and any breast reconstruction. Results: 204,982 EN and 12,029 nEN patients met criteria. 12,029 patients matched to each cohort. EN patients underwent any type of breast reconstruction more frequently than nEN patients (10.3% vs. 9.2%, p = 0.005; RR = 1.116, 95% CI: 1.033–1.205). Implant-based reconstruction rates were also significantly higher in EN patients (5.3% vs. 3.5%, p < 0.001; RR = 1.508, 95% CI: 1.338-1.700). There was no significant difference between cohorts for autologous breast reconstruction (6.2% vs. 6.4%, p=0.571; RR = 0.972, 95% CI: 0.881-1.072). Conclusion: EN patients had higher rates of implant-based and overall breast reconstruction compared to nEN counterparts, despite comparable autologous reconstruction rates. These disparities underscore potential socioeconomic or systemic barriers that warrant further investigation to achieve equitable reconstructive care.