T. Wurdeman1, P. Truche1, E. Moeller1, K. Zimmerman1, L. Pompermaier1, S. Corlew1 1Harvard School Of Medicine,Program In Global Surgery And Social Change,Brookline, MA, USA
Introduction:
Improving access to high quality plastic surgery care in low (LICs) and lower middle income countries (LMICs) requires an understanding of the global plastic surgery workforce. The aim of this study is to evaluate the scope of practice and workforce capacity of plastic surgeons working in LICs and LMICs.
Methods:
A cross-sectional survey was distributed through a web-based survey link to plastic surgeons identified through country level plastic surgery societies, international plastic surgery societies and web searches in LICs and LMICs. Respondents answered questions regarding demographics, training, finances, surgical practice, patient population and barriers to care.
Results:
In total, 360 plastic surgeons from 10 LICs and 26 LMICs were identified, with 171 responses (34 were from LICs and 137 were from LMICs). There is no difference between the median number of surgeries performed by plastic surgeons annually in LIC and LMICs (300 vs 250, p = 0.32). Practice settings included 87% urban, 17% suburban, and 8% rural, with no significant difference between LIC and LMIC surgeons. 36% of the responses treated only adults, 14% children, and 43% treated both, with no difference in pattern between LIC and LMIC surgeons (p = 0.49). Patient payment scheme differed between LIC and LMIC plastic surgeons, with 46% and 18% of patients using 3rd party insurance, respectively (p < 0.05). Plastic surgeons were more likely to work in private settings in LMICs than LICs (55% vs 27%, p <0.05), while other practice settings showed no significant differences. Furthermore, plastic surgeons in LICs are less likely to perform more purely cosmetic surgeries than colleagues in LMICs (15 vs 42, p<0.05). Plastic surgeons have been practicing longer in LMICs vs LICs (12.5 years vs 3 years, p < 0.05). Most of the respondents (57%) provide also non plastic surgery related procedures within their practice. The SEARO and EMRO regions had the highest percentage of surgeons providing only plastic surgery (67.3% and 56.7%), while surgeons in the PAHO region had the lowest percentage (14%). 18.4% of surgeons receive no income from purely cosmetic procedures, with LIC surgeons significantly more likely to receive no income from cosmetic surgeries (42.3% vs 13.2%, p < 0.05).
Conclusion:
Plastic surgeon practice varies widely across LICs and LMICs. While there is no significant difference between surgical volume, practice setting, and patient population, there are differences in payment scheme of patients, years of practice, the number of cosmetic surgeries, and income from cosmetic surgeries. Assessment of the global plastic surgery workforce and practice patterns is essential as global plastic surgery research continues to focus on empowerment of local surgeons and strengthening of surgical systems.