Is Plastic Surgery Training Equitable? An Analysis of Health Equity across US Plastic Surgery Residency Programs

Abstract

Background: Achieving health equity includes training surgeons in environments exemplifying access, treatment, and outcomes across the racial, ethnic, and socioeconomic spectrum. Increased attention on health equity has generated metrics comparing hospitals. To establish the quality of health equity in plastic and reconstructive surgery (PRS) residency training, we determined the mean equity score (MES) across training hospitals of US PRS residencies. Methods: The 2021 Lown Institute Hospital Index database was merged with affiliated training hospitals of US integrated PRS residency programs. The Lown equity category is composed of three domains (community benefit, inclusivity, pay equity) generating a health equity grade. MES (standard deviation) was calculated and reported for residency programs (higher MES represented greater health equity). Linear regression modeled the effects of a program's number of training hospitals, safety net hospitals, and geographical region on MES. Results: The MES was 2.64 (0.62). An estimated 5.9% of programs had an MES between 1-2. In total, 56.5% of programs had an MES between 2 and 3, and 37.7% had an MES of 3 or more. The southern region was associated with a higher MES compared with the reference group (Northeast) (P = 0.03). The number of safety net hospitals per program was associated with higher MES (P = 0.02). Conclusions: Two out of three programs train residents in facilities failing to demonstrate high equity healthcare. Programs should promote health equity by diversifying care delivery through affiliated hospitals. This will aid in the creation of a PRS workforce trained to provide care for a socioeconomically, racially, and ethnically diverse population.

Diversity, Equity, and Inclusion in Plastic Surgery

“…A total of 138 publications were identified 3–140 Figure 1. demonstrates the number of publications appearing annually in the 6 journals from January 2018 to September 2023.…”

Is Plastic Surgery Training Equitable? An Analysis of Health Equity across US Plastic Surgery Residency Programs

“…An Analysis of Health Equity across US Plastic Surgery Residency Programs.” The authors found that around two-thirds of plastic surgery programs train residents in facilities that are less inclusive, provide less benefit to their communities, and have larger pay discrepancies between workers and executive officers. 1 These findings serve as a poignant call to action by Cevallos et al to examine the health equity of residency programs across the country. It is pivotal that diversity, equity, and inclusion preside as topics of continued investigation and intervention within plastic surgery training.…”

“…1 Chagnoor et al echo this, describing the importance of developing this crucial skillset required to care for patients from diverse sociocultural backgrounds. 4 They specifically advocate for cultural "dexterity" training, which may serve as a valuable tool for plastic surgery programs at institutions with poor healthcare equity and limited ability to improve resident exposure to equitable care via affiliated hospitals, as was suggested by Cevallos et al 1,4 Further, ensuring that residency programs exist in equitable settings has implications for recruitment. Residency applicants prioritize programs that serve diverse populations.…”

“…1 They highlight that training at institutions with healthcare inequity may negatively impact training quality, as these systems fail to provide skills in professionally navigating the needs of patients from diverse backgrounds. 1 Chagnoor et al echo this, describing the importance of developing this crucial skillset required to care for patients from diverse sociocultural backgrounds. 4 They specifically advocate for cultural "dexterity" training, which may serve as a valuable tool for plastic surgery programs at institutions with poor healthcare equity and limited ability to improve resident exposure to equitable care via affiliated hospitals, as was suggested by Cevallos et al 1,4 Further, ensuring that residency programs exist in equitable settings has implications for recruitment.…”

“…They examined the facilities at which residents train to ascertain their social responsibility with regard to their commitment to equity, inclusion, and community health. 1 They highlight that training at institutions with healthcare inequity may negatively impact training quality, as these systems fail to provide skills in professionally navigating the needs of patients from diverse backgrounds. 1 Chagnoor et al echo this, describing the importance of developing this crucial skillset required to care for patients from diverse sociocultural backgrounds.…”