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How Big is Our Piece of the Pie? Perceived Plastic Surgery Scope of Practice Among Physicians and Patients
Cindy Wu, M.D., Kimberly Patterson, M.D., Michelle Roughton, M.D..
The University of North Carolina, Chapel Hill, NC, USA.

PURPOSEPlastic and reconstructive surgery (PRS) has evolved into a broad field, encompassing reconstructive and aesthetic procedures of the head/neck, breast, and body. Such diversity in scope of practice may be confusing for patients and referring providers, who may not be aware of the breath or depth of our discipline. Further contributing to the confusion are other specialties with overlapping clinical expertise: neurosurgery (N), ENT, oral maxillofacial surgery (OMFS), general surgery (GS), orthopedic surgery (O), OB/GYN, and dermatology (D). While currents studies of medicine residents and emergency room patients’ perceptions of plastic surgeons’ scope of practice exist, there has never been a study of referring surgeons in a tertiary hospital and their perceptions of plastic surgeons’ scope of practice. Furthermore, none have used crowdsourcing to survey patients on their perception of surgical expertise. Our study purpose is to compare physician and patient perceptions towards the procedures commonly performed by plastic surgeons.
METHODS
An anonymous, Web-based survey was sent to faculty from all surgical specialties. Respondents were asked to choose which specialist they would consult for various reconstructive and aesthetic problems. Age, gender, specialty, years in practice, and training location was elicited. A simplified survey was sent to an Internet crowdsourcing service, representing potential patients without medical training.
RESULTS
Of 228 faculty, 68 responded (29.8%). The majority were OB/GYN (26.5%), followed by general surgery (GS) (20.6%), then dermatology (D) (13.2%). Most did not receive any part of their training at our institution. Referring surgeons considered plastic surgeons experts in 16/35 (45.7%) reconstructive problems, with the exception of head/neck cancer defects (ENT), myelomeningocoele (N), skin cancer (D), hand fractures (O), upper extremity tendon lacerations (O), tissue biopsies (GS), hernia repair (GS), perineal defects (GS), lower extremity traumatic injuries (O), acute burns (O), and chronic lower extremity wounds (GS) (Table 1). To address aesthetic problems, most referring surgeons chose plastic surgeons with the exception of correction of deviated septum (ENT, 73.5% vs. PRS 35.3%) (Table 2). In contrast, 78 patients recruited via crowdsourcing considered plastic surgeons experts for only 3/32 (9.4%) reconstructive problems (correction of large breasts, breast reconstruction, and burn scar contracture). For aesthetic problems, patients chose plastic surgeons, except for deviated septum correction (ENT, 43% vs. PRS 20.5%).
CONCLUSIONS
Referring surgeons and patients clearly choose plastic surgeons for aesthetic concerns. For hand fractures, upper extremity lacerations, head and neck cancer defects, tissue biopsies, abdominal surgery, lower extremity soft tissue defects, and chronic lower extremity wounds, referring surgeons and patients choose orthopedic, ENT, and general surgeons more often than plastic surgeons. In an era of increasing surgical specialization, plastic surgeons risk losing these important reconstructive fields to other subspecialties. Increased physician and patient outreach and education of plastic and reconstructive surgeon’s breadth of practice may increase referrals in these areas.


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