Craniomaxillofacial Surgery Job Opportunities

BACKGROUND: Craniomaxillofacial (CMF) fellowship training increasingly spans pediatric, adult reconstructive, and aesthetic domains, yet the job market is perceived as constrained. We performed a longitudinal analysis of craniofacial-aligned plastic surgery job postings and compared trends with fellowship capacity and program director-reported competencies. METHODS: The American Council of Educators in Plastic Surgery (ACEPS) and the American Society of Plastic Surgeons (ASPS) postings (2007 to 2024) were extracted, deduplicated, and classified as Tier 1 (pediatric/transcranial cleft craniofacial), Tier 2 (adult or mixed craniofacial reconstruction), or Tier 3 (all remaining plastic surgery postings without craniofacial content). Linear regression assessed temporal trends, and multivariable logistic regression tested predictors of Tier 1 postings. SF Match reports (2007 to 2024) described positions offered/filled, and program directors completed a binary survey across 13 of the American Society of Craniofacial Surgeons (ASCFS) competency domains. RESULTS: Of 4566 unique plastic surgery postings, 170 (3.7%) were Tier 1, 317 (6.9%) were Tier 2, and 4079 (89.3%) were Tier 3 (Tier 1+2: 10.7%). Tier 1 increased by 1.51 postings/year (P<0.001) versus 33.08/year for Tier 3 (P<0.001). Tier 1 increased significantly in 11 states; 19 states had 0 Tier 1 postings. Tier 1 was associated with children's hospital affiliation (OR=74.33; 95% CI: 48.03-115.05; P<0.001) and academic setting (OR=2.57; 95% CI: 1.43-10.80; P<0.01) and inversely associated with level I trauma centers (OR=0.41; 95% CI: 0.25-0.68; P<0.001). SF Match reported 500 positions offered and 372 filled. All 35 PD's responded; 91.4% endorsed competency in all 3 core domains, with over half offering adult/aesthetic competencies. CONCLUSIONS: Recent years have seen a modest increase in pediatric craniofacial positions, with notable opportunities for applicants to pursue pediatric and adult craniofacial-aligned positions (Tier 1+Tier 2). The growth potential of the craniofacial fellowship lies in increasing adult craniofacial competencies that align with job-market trends.