Poster Presentation NZ Association of Plastic Surgeons & NZ Society for Surgery of the Hand

Skin and all it’s contents - factors affecting subspecialty decision making in plastic and reconstructive surgery (1508)

Malcolm Franke 1 , Bish Soliman 1
  1. Plastic and Reconstructive Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia


Plastic and Reconstructive surgery is a wide surgical field encompassing many subspecialty niches including microsurgical reconstruction, burns, craniofacial, melanoma and surgical oncology, hand surgery and aesthetic surgery. Previous studies have found non-microsurgical reconstruction to be the most popular primary practice type, followed by hand surgery and microvascular reconstruction. We sought to identify factors affecting sub-specialty choice in Plastic and Reconstructive Surgery


A literature review was conducted on articles addressing subspecialty choice in Plastic and Reconstructive Surgery. The search was limited to english language articles from the past 10 years. 


Across the field as a whole the most common factors influencing the choice of Plastic Surgery as a specialty were the immediate effects on patients quality of life, the varied practice and technical intricacy.(1, 2) For surgeons pursuing microsurgical reconstruction as their primary practice, technical confidence was the most important factor. Other factors included marketability for jobs and pursuance of academic appointments.(3) However low reimbursement to time ratio, high stress and on-call commitments were found to be significant demotivational factors. Sreedhan et al looked at factors influencing the choice of burns surgery in career practice in Australia and New Zealand and found the nature of burns care and procedures and on call commitments to be the most common barriers.(4) Hand surgery was found to be decreasingly popular with factors such as reimbursement and inadequate training cited as potential reasons.(5) There was a dearth of literature regarding aesthetic surgery, however factors raised were decreased bureaucratic burden, reimbursement and patient satisfaction.(6, 7)


Factors affecting subspecialty choice are diverse, however recurrent themes of technical confidence, work-life balance and reimbursement appear to be the most influential. Given the increasing shortfall in areas such as Burns and Hand Surgery, more local studies are required to help create initiatives to address this deficit.