Introduction Methods Results

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1 Introduction Times. So, too, should the expectations of facial plastic surgeons entering the workforce. Preparing for a shifting professional and competitive landscape is difficult. The early experiences of a fellowship mentor may be vastly different from those of new American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) fellowship graduates. The Young Physicians Committee (YPC) works to provide young AAFPRS members with useful information during the transition from fellowship to early practice. In 2014, the YPC conducted a poll to determine how early practice experiences of facial plastic surgeons have d over time. Methods A questionnaire was generated using Survey Monkey ( and the link was ed ( to all members of the AAFPRS. The survey was completed anonymously and respondents received no compensation. Respondents were queried about years in practice, practice composition, practice setting, balance of facial plastic surgery versus general otolaryngology, cosmetic versus reconstructive surgery, and overall practice satisfaction. All questions required participants to choose between multiple options. Results Eighty-two AAFPRS members completed the survey. For the purposes of comparison, respondents were stratified into those less than 5 years into practice, the (EPG, N = 39), and those greater than 5 years into practice, the (APG, N = 43). Practice Composition Most respondents desired a practice comprised mostly or entirely of facial plastic and reconstructive surgery (FPRS) immediately following fellowship (69% and 88% in the EPG and APG, respectively) (Figure 1). However, fewer of those in the EPG seemed able to achieve that goal. Only 32% of EPG respondents indicated that their practice was composed mostly or entirely of FPRS in the first year versus 51% of the APG (Figure 2). Respondents were also asked to quantify how much of their first year of practice was devoted to FPRS versus general otolaryngology. Again, a disparity exists with over 50% of the APG reporting that % of their practice was devoted to FPRS versus 35% of the EPG (Figure 3). Of those performing FPRS, the balance of cosmetic and reconstructive surgery in the year following fellowship was similar between groups. The number reporting that their first-year practice was composed mostly or entirely of cosmetic FPRS was 9% versus 18% in the APG and EPG, respectively (Figure 4). The proportion reporting that their early practice was comprised of mostly or entirely of reconstructive surgery was also equivalent (70% versus 66% in the APG and EPG, respectively).

2 Practice Setting Numerous practice setting options exist for graduating fellows. Members of the APG were evenly divided among the choices for ideal initial practice setting (Figure 5). Most in the ACG desired an academic/university appointment (33%) and the fewest sought to join general otolaryngology practice as the facial plastic surgeon (12%). The top two actual first-year practice settings in the APG were academic/university (44%) and FPRS within a general ENT practice (23%) (Figure 6). Comparably, the top two ideal positions following fellowship in the EPG were academic/university appointment (46%) and facial plastic surgeon in a multispecialty group (21%). However, the top two practice settings attained in this group were academic/university (44%), solo FPS practice (23%). When responses to the ideal versus actual initial practice setting are tracked individually, a difference is noted. Only half of those in the EPG succeeded in attaining their ideal practice following fellowship versus 70% of those in the APG. Satisfaction The vast majority of survey respondents in both groups were pleased or highly pleased with their current practice (Figure 7). As might be expected, a higher rate of the EPG (10%) are unsatisfied and actively seeking a. Overall, only 7% of all respondents are dissatisfied with their current practice. Discussion Tracking job market and FPRS practice trends is valuable as this type of information helps young physicians generate realistic expectations. While our survey begins to shed light on differences over time, it has several limitations. Foremost among these are the small sample size and the strong reliance of the data on participant recollection. While the answers to some questions are straightforward to recall (e.g. what was your actual practice setting following fellowship?), others are less so (e.g. what was your ideal practice setting following fellowship?). Facial plastic surgery practice composition data are presented in Figures 1-4. Predictably, most respondents desire to perform FPRS predominantly. However, one interesting finding was that the EPG is far more tolerant of performing general otolaryngology in their ideal practice. In fact, 5% of the EPG would perform mostly general otolaryngology in their practice, versus no respondents in the APG. Recall bias, increased profitability of general otolaryngology, fellow training dissatisfaction or a shift in the type of resident seeking FPRS fellowship may all be speculated as explanations. Perhaps congruently, more of those in the EPG perform a substantial amount of general otolaryngology in their current practice. In the first year of practice, less of those in the EPG than the APG report that over 40% their practice is devoted to FPRS. This data may indicate deliberate decisions of recent graduates. Alternatively, it may reflect a real in the employment marketplace or in the number of FPRS patients available. Is the supply of new plastic surgery practitioners outpacing the demand for facial plastic surgery?

3 The employment opportunities available to graduating fellows have inarguably d over the last several years. Today, nearly every training institution has at least one fellowship-trained facial plastic surgeon faculty member. Despite this fact, most of those in the EPG indicated that they filled academic positions following fellowship. An explanation of this may lie in the precise description of that position. In both in the private and academic sectors, fellowship-trained facial plastic surgeons are often hired as general otolaryngologists as well. Whether this differs from past employment experience was not examined. This finding may also be reflected in a higher percentage of those in the EPG opening solo practices or performing FPRS in a multispecialty group (Figure 6) as a means of practicing FPRS primarily. Despite the challenges facing facial plastic surgeons, satisfaction with their current practice is extremely high. Those who were unsatisfied with their current practice and actively considering were mostly from the EPG (Figure 7). As this was not seen in the APG, one hopes that after initial shuffling, surgeons are eventually able to find a satisfactory practice setting. Conclusion This non-scientific report provides a brief insight into the current experiences of young physicians. The Young Physicians Committee will regularly conduct this poll to better characterize the generational differences that exist among facial plastic surgeons and the changing FPRS workplace landscape. We hope this information is used to maintain a high satisfaction with a career in facial plastic surgery.

4 Figure 1. Ideal Practice Composition Following Fellowship 5% 26% Even mix gen oto and FPS Most/all FPS Most gen oto 69% 0% 12% Even mix gen oto and FPS Most/all FPS Most gen oto 88%

5 Figure 2. Actual Practice Composition Following Fellowship 11% Even mix gen oto and FPRS 32% 58% Most/all FPRS Most gen oto 5% 44% Even mix gen oto and FPRS Most/all FPRS 51% Most gen oto

6 Figure 3. FPRS in the First Year of Practice 39% 46% 0-40% 41-60% % 30% 0-40% 51% 41-60% % 19%

7 Figure 4. Cosmetic versus Reconstructive Facial Plastic Surgery in First Year 3% Entirely Cosmetic Majority Cosmetic Equal Mix Majority Reconstructive Entirely Reconstructive 51% 7% 2% 21% Entirely Cosmetic Majority Cosmetic Equal Mix Majority Reconstructive 70% Entirely Reconstructive (0%)

8 Figure 5. Ideal Practice Setting Following AAFPRS Fellowship 10% Solo Private 21% 8% FPS within Gen Oto Practice Academic/University FPS in multispecialty Private with part time Academic appt 46% 26% 16% Solo Private FPS within Gen Oto Practice 14% Academic/University 12% FPS in multispecialty Private with part time Academic appt 33%

9 Figure 6. Actual Practice Setting Following AAFPRS Fellowship 13% 3% 23% Solo Private FPS within Gen Oto Practice Academic/University FPS in multispecialty 44% Private with part time Academic appt 16% 14% 2% Solo Private FPS within Gen Oto Practice 23% Academic/University FPS in multispecialty Private with part time Academic appt 44%

10 Figure 7. Satisfaction with Current Practice EPG 10% 10% 31% Highly pleased, no future Pleased, but would consider Somewhat displeased, considering Unsatisdied, considering (0%) Unsatisdied, actively seeking 49% 2% 2% Highly pleased, no future Pleased, but would consider 40% 55% Somewhat displeased, considering Unsatisdied, considering Unsatisdied, actively seeking (0%)