A. Nayyar1, K. Patterson2, M. C. Roughton2, C. Wu2 1University Of North Carolina At Chapel Hill,Lineberger Comprehensive Cancer Center,Chapel Hill, NC, USA 2University Of North Carolina At Chapel Hill,Plastic And Reconstructive Surgery,Chapel Hill, NC, USA
Introduction:
Plastic and reconstructive surgery (PRS) has evolved into a very broad field, encompassing reconstructive and aesthetic procedures of the head/neck, breast, body and extremities. Such diversity in our scope of practice may be confusing for patients and referring providers, who may not be aware of the full breath or depth of our discipline. Further contributing to the confusion are other specialties with overlapping clinical expertise: neurosurgery (N), otolaryngology/head and neck surgery (OHNS), oral maxillofacial surgery (OMFS), general surgery (GS), orthopedic surgery (O), OB-GYN, urology (U), vascular surgery (V), cardiothoracic surgery (CT), pediatric surgery (P), transplant surgery (T) and dermatology (D). Previous studies have shown variable understanding amongst patients and primary care physicians about plastic surgery scope of practice, however, referral patterns from other surgeons have not been explored. We seek to understand national trends of referring surgeons’ perceptions of plastic surgery scope of practice.
Methods:
An anonymous, web-based survey was administered to members of American College of Surgeons with members of all surgical specialties. Respondents were asked to choose the surgical specialty they would consult for a variety of reconstructive and aesthetic problems.
Results:
Of 890 responses, 376 (42%) complete responses were received. The majority were general surgeons (40.7%), followed by plastic surgeons (13.6%) and otolaryngologists (10.7%). Referring surgeons considered plastic surgeons the expert in 12/35 (34.3%) reconstructive problems with the exception of head/neck cancer defects (OHNS), craniosynostosis (N), myelomeningocele (N), skin cancer (GS/D), hand fractures (O), upper extremity tendon lacerations (O), carpal tunnel syndrome (O), tissue biopsies (GS), hernia repair (GS), perineal defects (GS), lower extremity soft tissue defects/fractures (O), exposed spinal hardware (N), hidradenitis (GS), acute burns (GS) and chronic lower extremity wounds (GS) (Figure 1). For most aesthetic problems, referring surgeons considered plastic surgeons the expert with the exception of deviated septum (OHNS), hirsutism (D) and discolored skin patches (D).
Conclusion:
Referring surgeons consider plastic surgeons the expert for most aesthetic problems. However, ambiguity exists over the best management of a variety of reconstructive procedures with considerable overlap with orthopedics, OHNS, general surgery and neurosurgery. In an era of increasing surgical specialization, plastic surgeons risk losing these important reconstructive fields to other surgical subspecialties. Increased physician outreach and education of plastic surgeon’s breadth of practice may increase referrals in these areas.
