Analysis of Career Outcomes and Practice Patterns After Microsurgery Fellowship

Background: Microsurgery fellowships provide advanced training in reconstructive procedures; career trajectories and practice patterns postfellowship are not well studied. Understanding these outcomes may be helpful for residents and training programs. Methods: Microsurgery fellowship graduates were identified from 1990 to 2023. First position, current position, and practice types after fellowship were determined. Fellow characteristics included sex, fellowship region, advanced degrees, additional training, bibliometric indices, and time to practice changes. Residency characteristics (residency type, association with a fellowship program, top-ranked program, affiliation with top-ranked research institution) were also analyzed. Fellows were compared based on initial job setting (academic versus private practice PP), transitions between practice types, and practice of microsurgery. Results: Over 33 years, 416 fellows were analyzed. Of the graduates, 55% began in academia. Fellows in the Southwest were more likely to accept academic positions, whereas those in the Northeast, Midwest, and West were more likely to accept PP positions ( P < 0.001). Fellows who entered academia had greater h-indices at fellowship completion ( x̄ =10.5 versus 7.9, P = 0.004) and overall (14.4 versus 10.2, P < 0.001). Of fellows who began in academic positions, 20% transitioned to PP at a mean time of 7.3 years. Nearly 90% of surgeons in the study continue to practice microsurgery in their current position, regardless of employment type. Those who completed training internationally were less likely to practice microsurgery ( P = 0.019). Conclusions: Approximately half of former fellows hold academic positions. Fellowship location and h-index were associated with employment setting. About one-fifth of those in academic jobs transitioned into PP. Despite this attrition, most surgeons continue to perform microsurgical procedures.