Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Michael Alperovich

Abstract

Purpose: This study aims to comprehensively delineate gender and racial disparities in academic plastic and reconstructive surgery by analyzing publication authorship and leadership in academic plastic surgery. We also aim to evaluate the impact of mentorship on diverse representation, examine gender distribution in sub-specialties, and explore the influence of race and sex of plastic surgery leadership on resident/faculty composition. Methods: A comprehensive cross-sectional study investigated sex representation in academic PRS, covering editorial boards, faculty, and leadership positions. The study included 1,918 data points from notable journals and societies, examining names and sex of editorial board members, faculty in PRS residency programs, and residents from the 2021 match cycle. We also focused on gender distribution within craniofacial surgery, analyzing 354 data points from editorial boards, academic faculty, and association leadership positions. A more targeted analysis of microsurgeons also assessed the sex of academic U.S. microsurgeon faculty, involving 185 subjects from 32 microsurgery fellowship programs. Additionally, a cross-sectional study explored racial and gender diversity among authors in high-impact PRS journals over the last decade (2012-2022), analyzing 778 publications (~10%) for first and senior author race and ethnicity using a Web of Science database. The impact of race and sex of PRS leadership on resident/faculty composition was also modeled in a study across 84 academic PRS programs. Assessors evaluated the racial and ethnic background of leadership, academic faculty, and residents using publicly available profiles. Finally, a retrospective review of patent filing by 469 academic craniofacial surgeons from 81 institutions considered clinical role, sex, ethnicity, and training specialty using the USPTO online database. Results: A total of 872 plastic and reconstructive surgery academic faculty were analyzed across 86 integrated residency programs. Out of these, 203 (23.28%) were classified as female, and 669 (76.72%) were male. Significant gender disparities were observed across all programs. Among 245 professors, 7.8% were female, while 56.2% of 226 associate professors and 33.4% of 401 assistant professors were female. Analysis based on years since graduation showed variations, with 34.88% of faculty under 10 years being female, compared to 7.63% of those with over 30 years since graduation. Across Aesthetic Surgery Journal, Annals of Plastic Surgery, CPCJ, JCFS, Journal of Reconstructive Microsurgery, and Plastic and Reconstructive Surgery Journal, varying percentages of female board members were observed, ranging from 12.68% to 46.43%. Eight plastic and reconstructive surgery organizations were analyzed, indicating significant gender disparities. Female representation varied across organizations, with percentages ranging from 20% to 47.06%. Notably, the American Society of Plastic Surgeons had 27.59% female board members, while the Plastic Surgery Foundation had 25%. Among 130 faculty from 32 craniofacial surgery programs, a significant gender difference was observed, with 84.6% being male. Notably, only 2.4% of full professors were female, while associate professors and assistant professors had 14.3% and 32.0% female representation, respectively. Analysis of years in practice after completing terminal training indicated variations, with 32.4% of faculty with less than 10 years of experience being female, contrasting with 0% for those with 20 to 30 years since graduation. In the microsurgery specialty, we identified 185 individuals, with 15.7% classified as female and 84.3% as male. Analysis of 32 fellowship program directors revealed only 9.4% being female. Analysis across 83 PRS departments revealed racial distribution among Department Chairs, Program Directors, faculty, and residents. Departments with a Black or Hispanic DC had higher proportions of underrepresented in medicine (URiM) faculty and residents compared to those with a White or Asian DC. The race of the PD also influenced the racial composition of faculty and residents. In the analysis of senior author race in manuscript publications, 64.5% were White, 29.9% Asian, 4.6% Hispanic, and 1.0% Black. First authors displayed a similar distribution with 59.5% White, 32.8% Asian, 5.2% Hispanic, and 2.6% Black. This distribution remained consistent over the 10-year study period. No significant difference was observed in total citation count relative to author race/ethnicity. However, mentorship impact was evident, with a URiM first author being 7 times more likely when the senior author was URiM. From 2012 to 2021, 23.1% of all publications had female first authors, with significant variations across journals. The overall percentage of female senior authors increased from 12.5% in 2012 to 16.1% in 2021. Lastly, a retrospective review of patents filed by 469 academic craniofacial surgeons revealed that the majority were full professors (62%), male (82%), and White (82%). Asian surgeons constituted the only minority group among patent-filing surgeons. Conclusion: The analysis of gender and racial diversity across various facets of the plastic and reconstructive surgery field reveals persistent disparities and challenges. The study identifies a significant underrepresentation of women and URiMs in leadership positions within academic PRS, particularly in editorial boards and society boards. Despite an increase in female and URiM residents, the transition to higher academic positions remains limited. Similarly, the examination of patent filing in craniofacial and oral-maxillofacial surgery unveils gender and racial disparities, with white males dominating the cohort. The study underscores the importance of mentorship, showing a positive association between female and URiM mentors and increased diversity of authorship in PRS publications. Furthermore, the impact of race and sex on PRS leadership is explored, revealing that diverse leadership is associated with increased diversity among faculty and residents. The findings highlight the need for concerted efforts to address implicit biases, enhance mentorship programs, and promote diversity and inclusion within the PRS field to ensure equitable opportunities for all surgeons.

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