A Survey of Program Directors in North American Craniofacial Surgery Fellowships: An Insight into Training Programs and Their Leaders

Background: Since the establishment of craniofacial (CF) fellowship programs in North America, the specialty has expanded in scope and complexity. This study aimed to characterize current fellowship program structure, examine workforce trends, and capture directors’ perspectives on the future of the specialty. Methods: An 82-item electronic survey was distributed to 34 CF fellowship program directors (PDs) participating in the 2025 match cycle. The survey covered 4 domains: demographics, institutional/practice characteristics, workforce and hiring trends, and perceptions of the field. Responses underwent descriptive analysis. Results: Twenty-five PDs (73.5%) completed the survey. Most PDs identified as male (80%) and Caucasian (64%), and all had completed CF fellowship training in North America. Over two-thirds (68%) of programs were based in stand-alone children’s hospitals, and 44% of PDs worked at academic institutions. The majority (88%) trained plastic surgery residents, with additional collaboration with otolaryngology, oral surgery, and other specialties. Programs reported 64 hires over the past decade, driven by surgeon departure (50%) and clinical volume growth, with 40 additional hires anticipated in the next 10 years. The greatest perceived threats were competition from other surgical specialties (92%), salary limitations (64%), and intra-specialty competition (48%). While directors expressed concern over stagnant job growth, most supported maintaining current fellowship graduate numbers and endorsed initiatives such as formal program accreditation and the Certificate of Added Qualification. Conclusion: This survey provides a timely snapshot of CF fellowship leadership and training structures in North America. While hiring data suggest a moderately healthy job market, challenges remain in recruitment, diversity, institutional recognition, and inter-specialty competition. Ongoing refinement of training pathways, clearer specialty identity, and stronger societal advocacy remain essential for the sustainability of the field.