Dissemination of Quality-of-Care Research Findings to Breast Oncology Surgeons.

PURPOSE: In this era of rapidly evolving clinical knowledge, clinicians need to be aware of current research and how it might affect their practice. The Internet is a widely available, under-assessed tool for providing this information. In this two-phase pilot study, a novel Web site (www.cansortsurgeons.org) was developed to specifically disseminate relevant clinical information to community breast oncology surgeons. METHODS: The first phase targeted a sample of community surgeons identified from Surveillance, Epidemiology, and End Results catchment areas in Los Angeles, CA and Detroit, MI. The second phase broadened availability by linking the site through the American College of Surgeons (ACoS) Commission on Cancer (CoC) homepage. An eight-question, Web-based survey was used to obtain feedback regarding the Web site's utility and potential application to clinical practice. Journal continuing medical education credit was also offered through ACoS. RESULTS: For phase 1, of the 315 community surgeons invited to view the site, 114 (36%) participated in the study and 98 (86%) responded to the survey. Overall, there was a strongly supportive response, with 79 (81%) recommending the site to other clinicians. For phase 2, of the 516 site hits, 411 came from the ACoS site. Only 10 individuals completed the survey during this phase, but all positively endorsed the utility of the site. CONCLUSION: The implication for clinical practice is that the Internet is a useful tool for providing relevant clinical research to providers. In the future, this could be tailored to an individual's needs, aiding synthesis and, hopefully, improving the quality of clinical care.

Patterns and correlates of postmastectomy breast reconstruction by U.S. Plastic surgeons: results from a national survey.

BACKGROUND: : Concern exists that plastic surgeons have lost interest in postmastectomy breast reconstruction, which has helped enable the oncoplastic movement by general surgery. The authors evaluated patterns and correlates of postmastectomy breast reconstruction among U.S. plastic surgeons. METHODS: A survey was mailed to a national sample of 500 randomly selected members of the American Society of Plastic Surgeons (73 percent of eligible subjects responded; n = 312). The dependent variable was surgeon's annual volume of breast reconstructions (dichotomized into >50 and ≤ 50 cases per year). Logistic regression was used to evaluate factors associated with annual volume, including surgeon demographic and practice characteristics, community support for reconstruction, and surgeons' attitudes toward insurance reimbursement. RESULTS: Ninety percent found doing breast reconstruction personally rewarding, and nearly all enjoyed the technical aspects of the procedure. The majority of surgeons, however, were low-volume to moderate-volume providers, and 43 percent reported decreasing their volume over the past year due to poor reimbursement. Resident availability was significantly associated with high volume (odds ratio, 4.93; 95 percent CI, 2.31 to 10.49); years in practice and perceived financial constraints by third-party payers were inversely associated with high volume (>20 years compared with ≤ 10 years: odds ratio, 0.23. 95 percent CI, 0.07 to 0.71; odds ratio, 0.22, 95 percent CI, 0.08 to 0.56, respectively). CONCLUSIONS: Although plastic surgeons find breast reconstruction professionally rewarding, many are decreasing their practice. Factors associated with low volume include lack of resident coverage and perceived poor reimbursement. Advocacy efforts must be directed at facilitating reconstructive services for this highly demanding patient population.

Plastic surgeons' satisfaction with work-life balance: results from a national survey.

BACKGROUND: Plastic surgery demographics are transforming, with a greater proportion of women and younger physicians who desire balance between their career and personal lives compared with previous generations. The authors' purpose was to describe the patterns and correlates of satisfaction with work-life balance among U.S. plastic surgeons. METHODS: A self-administered survey was mailed to a random sample of American Society of Plastic Surgeons members (n = 708; 71 percent response rate). The primary outcome was satisfaction with work-life balance. Independent variables consisted of surgeon sociodemographic and professional characteristics. Logistic regression was used to evaluate correlates of satisfaction with work-life balance. RESULTS: Overall, over three-fourths of respondents were satisfied with their career; however, only half were satisfied with their time management between career and personal responsibilities. Factors independently associated with diminished satisfaction with work-life balance were being female (odds ratio = 0.63; 95 percent CI, 0.42 to 0.95), working more than 60 hours per week (versus < 60 hours per week; odds ratio = 0.44; 95 percent CI, 0.28 to 0.72), having emergency room call responsibilities (versus no emergency room call, odds ratio = 0.42; 95 percent CI, 0.27 to 0.67), and having a primarily reconstructive practice (versus primarily aesthetic practice; odds ratio = 0.53; 95 percent CI, 0.30 to 0.93). CONCLUSIONS: While generational differences were minimal, surgeons who were female, worked longer hours, and had emergency room call responsibilities and primarily reconstructive practices were significantly less satisfied with their work-life balance.

Satisfaction with career choice among U.S. plastic surgeons: results from a national survey.

BACKGROUND: The authors' purpose was to describe patterns and correlates of satisfaction with career choice among U.S. plastic surgeons. METHODS: A mailed, self-administered survey was sent to 708 U.S. plastic surgeons who were randomly sampled from the American Society of Plastic Surgeons registry (71 percent response rate, n = 505). The dependent variable was satisfaction with the decision to become a plastic surgeon, which was created from a scale of four validated questions measuring decisional satisfaction and decisional regret. The independent variables included surgeon and practice characteristics. Logistic regression was used to evaluate associations between satisfaction with the decision to become a plastic surgeon and independent factors. RESULTS: Few respondents (4 percent) regretted becoming plastic surgeons. Factors independently associated with greater satisfaction with the decision to become a plastic surgeon included group practice compared with solo practice (odds ratio, 1.65; 95 percent confidence interval, 1.0 to 2.71), resident educator (odds ratio, 1.88; 95 percent confidence interval, 1.06 to 3.31), and a highly cosmetic practice mix: primarily cosmetic versus primarily reconstructive (odds ratio, 2.42; 95 percent confidence interval, 1.25 to 4.66) and mixed versus primarily reconstructive (odds ratio, 1.59, 95 percent confidence interval, 0.92 to 2.76). Demographic factors such as age and gender were not associated with surgeon satisfaction. CONCLUSIONS: Overall, the majority of plastic surgeons are satisfied with their career choice despite the current health care and economic environment. Factors significantly associated with greater satisfaction with career choice included group practice, involvement in resident education, and a highly elective cosmetic practice.