A positive correlation of leadership, faculty, and fellow gender and racial diversity in US academic hand surgery

Gender and racial disparities remain prevalent in academic surgery. Moreover, reports on racial distributions are scarce. We aim to assess the state of diversity among faculty and fellowship trainees in academic hand surgery and identify if program faculty diversity correlates with trainee diversity. Working from the American Society for Surgery of the Hand (ASSH) fellowship list, a database of 84 hand fellowship programs, 622 faculty, and 582 recently graduated fellows was created. ASSH and American Association for Hand Surgery (AAHS) membership databases and clinical and research websites were accessed to determine gender, race (white or person of color [POC]), and practice and training details, for each faculty and fellow. Women comprise 17% of the faculty cohort and 25% of fellows. Gender disparity was similar between orthopedic surgery-trained and plastic surgery-trained faculty and fellows. Women represented 24% assistant, 16% associate, and 9% full professor faculty positions (p = 0.002). White race was assigned to 75% and 71% of faculty and fellows, respectively. POC accounted for 28%, 27%, and 21% of assistant, associate, and professor positions, respectively (p > 0.05). Female and POC leadership correlated with significantly more female and POC faculty/fellows, respectively. Relative to medical school and academic medicine, females and racial minorities are under-represented in academic hand surgery, especially with higher academic rank and in leadership positions. Diversity in leadership and related allyship may be an important strategy for increasing diversity at all levels. •Programs having a female or person of color chair correlates with gender and racial diversity.•Women and racial minorities are under-represented in academic hand surgery.•Gender and racial is lacking with higher academic rank and in leadership positions.•Diversity in leadership may be an important strategy for increasing diversity at all levels

Gynecomastia: Evaluation and Surgical Tips and Tricks

Gynecomastia, excess development of the male breast, is a common deformity encountered by plastic surgeons. It is the most common breast alteration in males, commonly developing without a pathologic basis during periods of physiologic change such as infancy, puberty, and old age. It may accompany a wide variety of systemic and metabolic diseases, and it may be drug induced. Given the number of pathophysiologic mechanisms, detailed presurgical workup is essential prior to determining whether surgical management is appropriate. This chapter highlights different surgical techniques performed in our practice, along with standardized preoperative evaluation and postoperative care. We believe that a dynamic approach to patients with gynecomastia decreases common complications and increases patient satisfaction in various degrees of gynecomastia. This chapter includes some “tricks” we use during our markings, preoperative steps, and intraoperative approaches that help us optimize patient safety, while maintaining operative efficacy and improving aesthetic outcomes in gynecomastia

Operational and Financial Impact of COVID-19: A Survey of Plastic Surgeons in Miami

BACKGROUND: In response to the COVID-19 pandemic, new guidelines were issued cautioning against performing elective procedures. We aimed to assess the impact of the COVID-19 pandemic on operational and financial aspects of plastic surgery in Miami. METHODS: A multiple-choice and short-answer survey regarding practice changes and financial impact was sent to all 67 members of the Miami Society of Plastic Surgeons. RESULTS: A 41.8% (n = 28) response rate was obtained, five responses did not meet the inclusion criteria, and statistical analysis was performed on 34.3% (n = 23) of responses. Of the plastic surgeons who responded, 21.74% operate in an academic setting, 60.87% are in a single practitioner private practice, and 17.39% are in a multi-practitioner private practice. An estimated 60% of academic plastic surgeons had 75% or more of their previously scheduled cases canceled, compared with 57.14% in single practitioner private practice and 100% in multi-practitioner private practice. In total, 64.29% of single practitioner private practices and 50% of multi-practitioner private practices have had to obtain a small business loan. Single practitioner private practice plastic surgeons reported having an average of 6.5 months until having to file for bankruptcy or permanently close their practices, and multi-practitioner private practice plastic surgeons reported an average of 6 months. CONCLUSIONS: Guidelines to support small business must be implemented in order to allow private practice surgeons to recover from the substantial economic impact caused by the pandemic because it is necessary to reestablish patient access and provide proper care to our patients

Reflecting on Plastic Surgery Training During Early COVID-19 Pandemic: Resident Exposure and Telemedicine

Coronavirus disease 2019 (COVID-19) pandemic has been an unprecedented public health crisis. As hospitals took measures to increase their capacity to manage COVID-19 patients, plastic surgeons have also had to modify their routine to continue serving their vital role within the hospital environment. In an effort to reduce exposure to COVID-19 and conserve hospital resources, many plastic surgery programs drastically modified call schedules, restructured inpatient teams, triaged operative cases, and expanded telemedicine encounters. Plastic surgery programs focused on craniofacial procedures were impacted by precautionary preventative protocol and shifts in case load made to protect both the healthcare teams and the patients. At academic centers, plastic surgery trainees of all domains felt the impact of these changes. Recognizing the implications on future craniofacial surgical practice, the pandemic has made, the goal of the authors’ study is to measure initial impacts of COVID-19 on plastic surgery trainees using a nationwide survey. The authors’ results present the first quantitative analysis of plastic surgery trainees’ exposure to COVID-19, deployment to other medical specialties, usage of personal protective equipment, and implementation of telemedicine during the pandemic. While healthcare systems have greatly adapted to pandemic complications and can anticipate vaccination, resurgence of COVID-19 cases linked to the delta variant heightens the authors' urgency in understanding the early pandemic, and its lasting impacts on healthcare. In the months following pandemic onset, telemedicine has become a mainstay in healthcare, trainees have adapted and become integrated in patient care in novel ways, and visits unable to transition to telemedical settings received substantial attention to ensure patient and provider safety

Plastic Surgery Training During Coronavirus Disease 2019 Pandemic: A Quantitative Study on Trainees’ Wellness and Education

Coronavirus disease 2019 (COVID-19) pandemic has had far reaching impacts on all aspects of the healthcare system, including plastic surgery training. Due to reduction in the number of elective surgery cases and need for social distancing, plastic surgery education has shifted from the operating room to the virtual learning environment. Although these changes have been qualitatively described, the authors present a quantitative analysis of plastic surgery training changes due to the COVID-19 pandemic. Our study has identified residents’ greatest impediments and inquired about suggestions for further improvements. Our goal is to help residency programs through the COVID-19 pandemic era and contribute to future guidelines when residency education encounters additional unexpected changes