Shaping the Future of Plastic Surgery: Training and Career Paths of Residency Program Directors

INTRODUCTION: Diverse residency cohorts are essential to alleviating health disparities and improving patient outcomes. Residency program directors (PD) play a critical role in selecting and mentoring the next generation of plastic surgeons, influencing the academic, clinical, and demographic landscape of the field. Understanding the training background, fellowship pathways, and geographic distribution of current plastic surgery PDs can help guide future workforce development. The goal of this study is to analyze the educational and professional trajectories of plastic surgery PDs across accredited integrated plastic surgery residency programs in the United States. METHODS: PD demographic and training information was extracted from 89 accredited integrated plastic surgery residency programs identified through the American Society of Plastic Surgeons (ASPS) website. Medical school, residency program, and fellowship program data were collected through publicly available sources, including institutional faculty pages and LinkedIn. RESULTS: Among the 89 PDs analyzed, 77% were male and 22% were female. Regarding fellowship training, 24% did not pursue a fellowship beyond plastic surgery residency. Among those who completed fellowships, 24% specialized in hand surgery, 22% in craniofacial surgery, 12% in reconstructive/microsurgery, and 6% in breast/aesthetic surgery. Fellowships in burn, pediatric, critical care, cosmetic surgery, or microvascular surgery were pursued by 2% or fewer PDs. Additionally, 26% of PDs hold advanced degrees, with MBAs (30%) and PhDs (17%) being the most common. 19.1% of PDs completed training before 1990, 32.6% in the 2000s, 42.7% in the 2010s, and 1.1% in the 2020s. 4.5% of PD training years were not publicly available. Geographically, 21% of PDs remained in the state where they completed their plastic surgery residencies. 4.5% of PDs are directors of their medical school alma mater. 15.7% of program directors completed a general surgery residency where they serve as PDs and 22.5% of PDs completed their plastic surgery residency where they serve as PDs. CONCLUSIONS: A majority of PDs are fellowship-trained, with the most common specializations being hand and craniofacial surgery. Female PDs remain underrepresented in program leadership. There is a prevalence of advanced degrees, particularly MBAs and PhDs, among PDs. Additionally, most PDs completed their training after 2000. These findings may inform future efforts to diversify leadership, optimize training pathways, and enhance the residency training experience.