1. Reconstructive or cosmetic plastic surgery: factors influencing the type of practice established by Canadian plastic surgeons Colin W. McInnes 1, Cynthia G. Verchere 2, Douglas J. Courtemanche 2, Kevin Bush 2, Jugpal S. Arneja 2 1 Faculty of Medicine, University of British Columbia, Vancouver, BC. 2 Division of Plastic Surgery, British Columbia Children’s Hospital, Vancouver, BC. Recently, some in organizational plastic surgery have voiced concerns that the specialty is facing an identity crisis. Challenged by factors such as increasing competition in the cosmetic marketplace and decreasing reimbursement for reconstructive procedures, many American plastic surgeons have adopted increasingly cosmetic-focused practices. This study will investigate the currently unknown practice profiles of Canadian plastic surgeons to determine the reconstructive-cosmetic mix, as well as factors which influence the type of practice to see if a similar pattern is occurring in Canada. Background Variables Overall % (N = 120)Reconstructive % (N = 91)Cosmetic % (N = 29) Gender Male Female 86 14 82 18 100 0 Age (years) 30-39 40-49 50-59 60+ 20 22 42 16 22 23 43 12 14 17 38 31 Master’s Degree or PhD Yes No 29 71 33 67 17 83 Educational Debt Following Residency $0 <$24,000 $24,000-$49,000 $50,000-$99,000 $100,000+ 48 17 14 10 11 43 19 14 13 11 62 14 0 10 Hours Worked per Week <40 40-49 50-59 60+ 8 29 25 38 8 26 40 10 38 21 31 Days Emergency Call per Month 0 1-4 5-7 8-13 ≥14 12 10 46 25 7 4 6 53 29 8 38 21 24 14 3 VariablesOverall % (N = 120)Reconstructive % (N = 91)Cosmetic % (N = 29) Academic Opportunities Mild/No Influence Moderate/Strong Influence 55 45 51 49 69 31 Opportunity to Perform Favorite Procedures Mild/No Influence Moderate/Strong Influence 13 87 12 88 14 86 Financial Considerations Mild/No Influence Moderate/Strong Influence 53 47 62 38 26 74 Non-Financial Considerations Mild/No Influence Moderate/Strong Influence 45 55 56 44 11 89 Location of Practice Mild or No Influence Moderate or Strong Influence 42 58 42 58 43 57 Methods An anonymous online survey was distributed to all 352 Canadian plastic surgeons with email accounts registered with the Canadian Society of Plastic Surgeons (CSPS) and/or the Canadian Society for Aesthetic Plastic Surgery (CSAPS) which contained questions regarding practice profiles. Reconstructive plastic surgeons were defined as those who spend at least 50% of their time on reconstructive procedures. Figure 1. Proportion of reconstructive and cosmetic procedures performed by Canadian plastic surgeons. Figure 2. Type of practice established by Canadian plastic surgeons in the first few years following the completion of their training compared to their current practice. Conclusions 1.Reconstructive plastic surgery appears to be thriving in Canada despite the increased demand for cosmetic surgery. 2.The vast majority of Canadian plastic surgeons initially establish a reconstructive practice, and a substantial proportion of them switch to a cosmetic practice later in their career. 3.Reconstructive plastic surgeons work relatively long hours and spend more days on emergency call. 4.Female gender, older age, advanced degrees (Master’s and/or PhD), and greater educational debt all appear to be associated with a future reconstructive practice. 5.A greater proportion of cosmetic plastic surgeons were influenced by financial and non-financial (lifestyle, autonomy) factors when deciding to establish a reconstructive or cosmetic practice. Conversely, a greater proportion of reconstructive surgeons were influenced by academic opportunities. Collectively, most surgeons were influenced by the opportunity to perform their favorite procedures and to work in their desired practice location. Table 2. Influence of the Following Factors in Determining the Type (Reconstructive or Cosmetic) of Practice Among Canadian Plastic Surgeons Table 1. General Demographics and Practice Profile of Canadian Plastic Surgeons Results 120 surgeons completed the survey (34% response rate), of which 91 (76%) currently have reconstructive practices and 29 (24%) have cosmetic practices (Figure 1). 23% of respondents transitioned into a cosmetic practice from a previous reconstructive practice (Figure 2). Variables that appear to be associated with a reconstructive practice were female gender, younger age, research based degree’s, and having children and/or relatively high educational debt after residency, among others (Table 1). Reconstructive surgeons work longer hours, take more emergency call, and were less influenced by financial and non-financial (eg. flexible schedule) considerations (Table 2).