50 Years Since the First Plastic Surgery Unit Achieved Department Status: Where Do We Stand and How Do We Compare to Our Close Competition?

Fifty years has passed since the establishment of the first department of plastic surgery in 1970. One of the perceived benefits of department status is the ability to “level the playing field” with competition.1 Comparatively, departments of otolaryngology–head and neck surgery date back to the early 1900s; this is now a common designation for otolaryngology–head and neck surgery. The authors review trends in achieving department of plastic surgery status while comparing departments of plastic surgery to departments of otolaryngology–head and neck surgery, given the similarity of clinical practices between specialties (e.g., aesthetics, microsurgery, cleft/craniofacial). Plastic surgery and otolaryngology training programs were identified, and affiliated departments of plastic surgery and departments of otolaryngology–head and neck surgery (not divisions) were filtered. Rankings of residency (residency.doximity.com) and hospital/medical school affiliations (www.USnews.com/rankings) were compared. Resident number and training availability were reviewed. Faculty demographics were compared, as were academic measures of productivity including research (www.scopus.com) and National Institutes of Health funding (www.report.nih.gov). Categorical variables were compared using chi-square test/Fisher’s exact test, and continuous variables were compared using the Mann-Whitney U test. A significance value of p ≤ 0.05 was used. Analyses were performed using IBM SPSS Version 25 (IBM Corp., Armonk, N.Y.). There are 20 departments of plastic surgery (21 percent) and 94 departments of otolaryngology–head and neck surgery (88 percent) affiliated with respective training programs, with the remainder considered divisions. Seventeen departments of plastic surgery had a department of otolaryngology–head and neck surgery counterpart at that institution and were compared in subsequent analyses. There was no significant difference in mean rankings of affiliated residency/hospital/medical school and numbers of residents and fellowship programs between groups (Table 1). The number of full-time faculty in departments of plastic surgery (13.7 ± 5.8) and departments of otolaryngology–head and neck surgery (19.7 ± 9) were similar (p = 0.051), as was the distribution of full/associate/assistant professors (p = 0.243) and endowed chairs (p = 0.301) (Table 1). There were two women chairs (11.8 percent) in departments of plastic surgery, but none within departments of otolaryngology–head and neck surgery (p = 0.49). The number of minority chairs/faculty was similar (p > 0.1). Women represented 20.3 percent and 20.1 percent of the full-time faculty (p = 0.93), and 38 percent and 38.7 percent of residents (p = 0.862) in departments of plastic surgery and departments of otolaryngology–head and neck surgery, respectively. Relatively more faculty in departments of plastic surgery hold Ph.D. degrees than those in departments of otolaryngology–head and neck surgery (p = 0.011). Measures of research productivity were all similar between department of plastic surgery and department of otolaryngology–head and neck surgery faculty (Table 1). Table 1. - Comparison of Demographics, Training Programs, and Academic Productivity of Faculty in Departments of Plastic Surgery and Departments of Otolaryngology–Head and Neck Surgery D-PS (%) D-OHNS (%) p No. 17 17 Affiliated medical school rankings 27.7 ± 19 27.7 ± 19 1 Affiliated hospital rankings 7.75 ± 5.5 7.75 ± 5.5 1 Affiliated residency ranking 29 ± 21.8 23 ± 16.2 0.366 Residency training offered 17 (100) 16 (94.1) 1 No. of residents 16.7 ± 6.2 17.4 ± 5.4 0.385 Resident sex 0.862 Male 173 (62) 179 (61.3) Female 106 (38) 113 (38.7) Fellowship training offered 12 (70.6) 9 (56.3) 0.481 No. of fellowships offered 1.8 ± 1.9 3.5 ± 2.7 0.055 No. of faculty 13.7 ± 5.8 19.7 ± 9 0.051 No. of full-time research faculty 1.5 ± 1.8 3.6 ± 3.5 0.064 No. of endowed chairs 0.94 ± 1.3 0.41 ± 0.62 0.301 Faculty sex 0.934 Male 184 (79.7) 259 (79.9) Female 47 (20.3) 65 (20.1) Female chairs 2 (11.8) 0 (0.0) 0.485 Minority/nonwhite chairs 4 (23.5) 5 (27.8) 1 Minority/nonwhite faculty 64 (38.3) 103 (31.8) 0.301 Professorships 0.243 Full professors 61 (26.4) 89 (27.5) Associate professors 62 (26.8) 105 (32.4) Assistant professors 108 (46.8) 130 (40.1) Faculty with Ph.D. 34 (14.7) 25 (7.7) 0.011* Faculty with M.P.H. 2 (0.9) 9 (2.8) 0.133 Faculty with M.B.A. 6 (2.6) 13 (4) 0.48 No. of publications per faculty 46 ± 20.3 46.7 ± 28.1 0.593 No. of citations per faculty 1059.2 ± 666.4 1063.9 ± 857.5 0.57 h-index 12 ± 4.1 12.1 ± 5 0.986 No. of NIH grants 0.27 ± 0.34 0.6 ± 1.1 0.628 NIH funding 56,774.8 ± 93,749.1 20,363.5 ± 25,893.7 0.472 D-PS, department of plastic surgery; D-OHNS, department of otolaryngology–head and neck surgery; Ph.D., Doctor of Philosophy; M.P.H., Master of Public Health; M.B.A., Master of Business Administration; NIH, National Institutes of Health.*Statistically significant. Although the overall number remains small, exponential growth of departments of plastic surgery has occurred. Unsurprisingly, this was mostly in the past 10 to 15 years (Fig. 1). In 2008 to 2009, the Association of Academic Chairmen of Plastic Surgery urged that a “department label” is necessary to achieve equity with other surgical specialties within an institution.2 It was then too that Rohrich1 and Guyuron3 outlined steps for a successful transition from division to department and associated advantages, including financial/administrative autonomy. Still, plastic surgery lags behind other surgical specialties such as otolaryngology–head and neck surgery in achieving this milestone. However, no significant differences in resident numbers and training availabilities between departments exist. Although no significant gender/minority differences exist between the groups, two female chairs in departments of plastic surgery, compared to zero in departments of otolaryngology–head and neck surgery evaluated, perhaps reflects improving gender disparities in academic plastic surgery.4 Most measures of faculty academic productivity were similar between departments; however, departments of plastic surgery had relatively more faculty with Ph.D. degrees. This is the first report to suggest that department status in plastic surgery may indeed “level the playing field” with perhaps our closest competition.Fig. 1.: Transition time points of plastic surgery units from division to department status (the 17 programs included in the analyses are represented in this figure).DISCLOSURE The authors declare no financial or other conflicts of interest related to this article.