Oculofacial plastic surgery fellowship director perspectives on accreditation council for graduate medical education (ACGME) accreditation

Introduction: Currently, the American Society of Ophthalmic Plastic and Reconstructive Surgery is considering a transition to Accreditation Council for Graduate Medical Education accreditation for oculofacial plastic surgery fellowships. We evaluated fellowship directors' perspectives and identified perceived benefits and barriers to this change. Methods: A cross-sectional, national survey was conducted in October 2025 of all American Society of Ophthalmic Plastic and Reconstructive Surgery fellowship directors. A three-question electronic survey assessed support for Accreditation Council for Graduate Medical Education accreditation (yes/no), with predefined response options for opposition and an open-ended field for support. Results: Forty-four directors completed the survey (83.0%). Nine (20.5%) supported transitioning to Accreditation Council for Graduate Medical Education accreditation, and 35 (79.5%) opposed. Among those opposed, the most frequently cited concerns were the burden of regulation (n=33, 94.3%), duty-hour restrictions (n=29, 82.9%), decreased training (n=23, 65.7%), cost (n=25, 71.4%), limitations on fellows' billing ability (n=24, 68.6%), and lack of institutional support (n=21, 60.0%). Supporters of the change cited the credibility of Accreditation Council for Graduate Medical Education oversight as the "gold standard" in graduate medical education and the potential pathway toward American Board of Medical Specialties certification. Discussion: Most fellowship directors oppose transitioning to Accreditation Council for Graduate Medical Education accreditation due to regulatory and financial concerns, while a minority view it as an avenue for enhanced legitimacy and board certification.