Plastic surgery, a vital branch of medicine, has undergone rapid growth in China. With rising social and economic standards, alongside an increasing emphasis on aesthetic enhancement, the demand for plastic surgeons has grown considerably. The professional and personal circumstances of practitioners influence the sustainable development of plastic and cosmetic surgery. However, comprehensive research regarding the professional practices and living conditions of plastic surgeons remains limited, particularly in areas, namely, burnout, work–life balance, marital status, reproductive choices, health conditions, and career development. Furthermore, distinctions between male and female surgeons employed in public and private hospitals have not been thoroughly investigated. In nations with advanced plastic surgery sectors, such investigative studies are prioritized.1–6 However, a comprehensive study of this scale has not been conducted domestically. To this end, the Plastic and Aesthetic Surgery Professional Committee of China Medical Women’s Association (CMWA) conducted an extensive survey to investigate the personal and professional situations of Chinese plastic surgeons. To promote enhanced professional fulfillment among medical practitioners, the current study intends to elucidate the working environment of these surgeons and to provide empirical evidence that may guide policy formulation. On September 01, 2023, CMWA’s Plastic and Reconstructive Aesthetic Specialized Committee launched an anonymous, 60-item survey addressing topics relevant to plastic surgeons, particularly those in early and mid-stages of their profession. The questionnaire encompassed eight sections: “baseline information”, “burnout”, “career and family”, “personal economic situation”, “marriage and childbearing”, “health status”, “personal achievement”, and “challenges in the practice of female doctors”. Both single- and multiple-choice questions were included. The survey was distributed through the official WeChat account “Chinese Plastic and Reconstructive Surgery”, with strict confidentiality protocols in place to protect participant privacy. As of October 01, 2023, a total of 532 plastic surgeons, comprising 280 men and 252 women, completed the survey Supplementary Tables 1–9, https://links.lww.com/CM9/C816. The results revealed significant differences between male and female surgeons across multiple dimensions, including burnout, work–family balance, marriage and childbearing, and personal achievement. Additional comparative analyses between plastic surgeons worked in public and private hospitals are provided in Supplementary Tables 10–16, https://links.lww.com/CM9/C816. Selected data were visualized in Supplementary Figures 1–4, https://links.lww.com/CM9/C816. This study elucidates the professional environment of plastic surgeons in China while providing empirical evidence for policy development aimed at promoting professional fulfillment within healthcare settings. The survey results suggested that burnout levels among both male and female plastic surgeons predominantly ranged from “none” to “moderate”, whereas job satisfaction levels primarily ranged from “fair” to “satisfied”. Therefore, despite significant occupational pressures, plastic surgeons maintain moderate levels of job satisfaction. They demonstrate lower burnout rates than other specialties, which may be attributed to the stable health conditions of their patient population.7 In this study, the primary burnout factors included excessive administrative responsibilities, inadequate compensation, research demands, and physician–patient relationships, affecting both sexes equally. Female surgeons experienced particularly pronounced research-related pressure, possibly caused by additional challenges in career advancement. Extended work hours, a high volume of on-call duties, nonsalary-based compensation structures, and subspecialization in microsurgery or cosmetic surgery have been identified as independent predictors of burnout in plastic surgeons.8 Female practitioners often face financial constraints, work–life imbalance, and a lack of access to academic mentorship on their path to academic advancement.9 West et al10 reviewed 15 randomized controlled trials and 37 observational studies; they concluded that physician burnout can be reduced by both individual-focused interventions (including positive thinking, stress management training, and group sessions) and organizational measures (such as modified on-call schedules and workflow processes). Sex-based differences were observed in views on career–family balance. Male surgeons tended to prioritize family over career, whereas female doctors placed equal importance on both. Furthermore, female surgeons were more inclined to remain within established systems, whereas male surgeons were more inclined to establish independent medical facilities. These differences may correlate with traditional sex-based family roles, where women often have more family responsibilities that affect their career choices. Jolly et al11 reported minimal change over the last 20 years in the amount of time women with children spent on childcare or household chores, compared with men, in highly educated, affluent households. Notably, female surgeons frequently perceived inequitable job opportunities and reported that their male counterparts were more likely to receive career advancement opportunities, reflecting persistent sex-based disparities in professional development. This survey did not suggest income disparities between male and female plastic surgeons. However, male physicians earn substantially more than their female counterparts when working equivalent hours.12 Women still face obstacles because of implicit discrimination and preconceptions. Traditional prejudices make working conditions challenging for women, even in professions with a high proportion of female practitioners.13,14 Marriage and childbearing status considerably influence the career development of plastic surgeons. Female surgeons encounter greater professional challenges after marriage and childbirth, particularly regarding the duration of maternity leave. Some may return to work as early as one month postpartum. The childbearing timing among female physicians remains a critical concern, because many delay marriage and parenthood to avoid compromising surgical training and practice. This delay may increase pregnancy-related complications and risks.15,16 A study in cardiothoracic surgery suggested that 98% of women (vs. 50% of men) delayed pregnancy, 82% of women (vs. 60% of men) believed pregnancy would negatively impact their careers, and 61% of women (vs. 16% of men) anticipated unfavorable peer reactions to pregnancy.17 Additionally, female surgeons more frequently relied on parental assistance for household responsibilities, but male surgeons typically shared these duties with spouses. When addressing domestic labor and childcare, male surgeons commonly cited support from their spouses, whereas female surgeons more often relied on external support. Although “relationship status” did not significantly differ between male and female surgeons (P = 0.207), these patterns reflect persistent sex role distinctions in family dynamics, placing women at a disadvantage in balancing career advancement with family obligations. Regarding health status, over half of surgeons from both sexes report suboptimal health conditions, with female surgeons reporting slightly poorer health outcomes than their male counterparts. This disparity may stem from women’s prolonged exposure to both professional and domestic pressures. Furthermore, research demands affect female surgeons more substantially. Conversely, some male surgeons reported “no research demands, no pressure”, suggesting the uneven distribution of research-related stress. Additional obstacles to women’s career development may cause this disparity. Women receive less start-up research funding than men, a disparity not attributable to differences in qualifications, experience, or institutional factors.18 A survey of mid-career faculty researchers suggested that male sex was an independent predictor of salary, even after adjusting for specialty, academic rank, hours worked, research hours, and other factors.19 These disadvantages further result in lower research productivity among women. Regarding practice support, the most crucial needs identified by female surgeons were “opportunities for professional training and advancement”, “opportunities for academic exchanges and collaborations”, and “career development guidance and planning”. These results necessitate greater job security and professional assistance for female surgeons during career progression. Historically, many female doctors have left the field because of insufficient mentoring, a lack of departmental integration, and underrepresentation in leadership positions.20 Increasing the proportion of women among residents, colleagues, and management is the most frequently proposed solution for enhancing the quality of training for female trainees21 The key competencies requiring enhancement for women’s career development primarily include “clinical, technical, and operational ability”, “academic research and scientific research ability”, and “management and leadership ability”. Furthermore, an “assertiveness gap” exists between men and women across professions.22,23 “imposter syndrome” and “stereotype threat” are more prevalent among female physicians, which puts them at a disadvantage in surgical fields that require a high level of confidence.24,25 Improving this condition requires focused efforts to improve women’s competence, guidance, and communication. These programs will help female physicians to access more opportunities and advance in their profession. Collectively, major sex-based differences exist among plastic surgeons regarding research pressure, family responsibilities, career advancement, and health status. Female surgeons face greater challenges in professional advancement, particularly concerning equitable career opportunities, research demands, and work–life balance. Therefore, to assist plastic surgeons in striking a better balance between their personal and professional lives, comprehensive measures are required, such as enhanced career development opportunities, government-supported programs, and societal adjustments in perspectives. This study provides systematic insights into the professional circumstances and living conditions of Chinese plastic surgeons, particularly emphasizing sex-based differences and diversity. Understanding these differences can help policymakers develop measures to enhance physicians’ self-worth within the medical community and public health sectors. Future studies should investigate how legislative support, cultural transformation, and cross-institutional mentorship networks may enhance career stability and expand opportunities for female physicians. Acknowledgments We acknowledge the Plastic and Aesthetic Surgery Professional Committee of CMWA for conducting and sponsoring the questionnaire and the Chinese Society of Plastic Surgery of the Chinese Medical Association for its cooperation in distributing the survey. We appreciate the 9th World Congress for Plastic Surgeons of Chinese Descent, 2024 Oriental Aesthetic and Plastic Art Conference for its opportunity in presenting the results of this questionnaire. We would like to thank TopEdit (www.topeditsci.com) for its linguistic assistance during the preparation of this manuscript. Funding This work was supported by grants from the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (No. 2021-I2M-1-001) and Beijing Clinical Research Ward (No. BCRW202202). Conflicts of interest None.
Jiang et al. (Wed,) studied this question.