Evolution in Craniofacial Practice: Perspectives From the Surgeons Themselves

Background: There is a perceived shortage of craniofacial surgery jobs, related to beliefs that they are limited to the pediatric population and academic institutions. Craniofacial fellowship graduates were surveyed to assess the accuracy of this notion. Methods: An anonymized 14-item REDCap survey was emailed to 310 surgeons who have completed craniofacial fellowships in the U.S. or Canada. Demographics, desired and actual practice type, case exposure, job changes, and perceived negative factors were collected and analysed descriptively. Results: Number of responses was 107 (34.5% completion rate). At graduation, 81.3% sought a craniofacial career and 78.5% obtained this position. Of those who started working in craniofacial practice, 88.1% indicated that was their primary goal. Only 33.3% of those starting in craniofacial practice changed positions, whereas 71.4% beginning in noncraniofacial practice did. Limited job opportunities was the most cited drawback initially (65.9%) and currently (17.8%), regardless of practice type. Comparing fellowship exposure with present practice revealed marked contraction of orthognathic (−41.1 percentage points) and pediatric craniosynostosis work (−36.4) and expansion of facial esthetic (+15.9) and gender-affirming (+14.0) surgery, with 19.6% devoting time to other esthetic or reconstructive procedures such as breast surgery. Conclusions: Contrary to earlier reports, this study indicates that craniofacial fellows often secure and retain their desired practice; however, the scope of practice has broadened toward adult esthetic and gender-affirming realms. Prospective craniofacial surgeons and fellowship directors alike should recognize growing opportunities within the specialty as graduates increasingly apply their unique skillsets to broader populations including adults and the transgender community.