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PLASTIC SURGERY AND RACE
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The popularity of cosmetic surgery has increased around the world, and whereas in the past, the patient base consisted of mainly Caucasian individuals, interest in this field has grown among persons of varying ethnic backgrounds. Growing interest enables ethnic populations to contribute to the economic growth of the cosmetic surgery industry and impact the direction of the field in the future. Minority populations accounted for 22% of the cosmetic procedures performed in 2007, with the most common being liposuction, Botox® generic botulinum toxin type A (Allergan, Inc., Irvine, CA), and chemical peels. Ultimately, changes in the population characteristics of the plastic surgery patient will alter the techniques of plastic surgeons that treat ethnic patients to cater to their physical differences. Factors such as increased cultural acceptance of plastic surgery, growing ethnic populations, and media emphasis on personal appearance have contributed to the increase in minorities seeking out cosmetic surgery. Escalating economic power within these populations has created an additional potentially lucrative market for interested plastic surgeons. Keywords: Minority, ethnic, economic, cultural, social, acceptance, cosmetic, population, financial, African American, Latin American, Caucasian, Asian American, Middle Eastern The popularity of cosmetic plastic surgery has drastically increased over the past 10 years. This is mainly due to the fact that the public has grown more comfortable and accepting of cosmetic surgical procedures. The American Society of Plastic Surgeons (ASPS) recently reported that cosmetic surgical procedures have increased 142% and nonsurgical procedures have increased 743% since 1997.1 Plastic surgeons nationally and locally say that several factors are behind the trend. Increased media exposure to TV shows such as, “Extreme Makeover” and “Dr. 90210” has influenced the overall growing interest in cosmetic surgery and has sparked discussions in living rooms across the nation. In addition, cosmetic surgery is often viewed as a luxury comparable with that of purchasing a car or taking a costly vacation. In support of this, the American Academy of Cosmetic Surgeons' 2006 Consumer Perception Survey revealed that given the necessary disposable income, 46% of surveyed consumers would prefer cosmetic surgery to luxuries such as expensive vacations and high-end vehicles. It is of no surprise that with the growing popularity of cosmetic surgery in the general population, its interest has trickled over to various ethnic populations. The African American, Latin American, Asian American, and Middle Eastern communities have developed a growing attraction to this field and have the potential to provide an enormous contribution to this industry in the future. According to the American Society for Aesthetic Plastic Surgery (ASAPS), minority patients accounted for 22% of the 11.7 million cosmetic procedures performed domestically in 2007.1 Background: Academic plastic surgery has a history of underrepresentation of ethnic and racial minority groups. Recent policy shifts by national medical groups and plastic surgery societies have focused on reversing these inequalities. This study seeks to measure ethnic and racial representation at academic and leadership positions following recent changes. Methods: A cross-sectional study was conducted in June of 2018, measuring ethnic and racial diversity of U.S. academic plastic surgery faculty. Among faculty, career qualifications, years of experience, faculty positions, and leadership ethnicity were compared. Results: A total of 930 academic plastic surgeons were included in the study. Classified collectively as nonwhite, this group graduated more recently than other academic plastic surgeons (2006 versus 2001; p < 0.0001) and had greater rates of clinical fellowship attainment (OR, 1.62; 95 percent CI, 1.16 to 2.26). Nonwhite individuals were less likely to be employed in the full professor position compared with their white colleagues (OR, 0.6; 95 percent CI, 0.42 to 0.88; p = 0.0077). However, after adjustment for differences in years of postresidency experience, this disparity was no longer significant (OR, 1.06; 95 percent CI, 0.62 to 1.83; p = 0.82), indicating the importance of current cohort experience differences. Assessment of program leadership found that nonwhite chairs employed significantly more nonwhite faculty (42.5 percent versus 20.9 percent; p < 0.0001). Conclusions: Academic plastic surgery continues to face disparities in representation of both ethnic and racial minorities. Current inequalities are most severe at senior academic positions and may be linked to cohort experience differences along with leadership and promotion biases. (Plast. Reconstr. Surg. 145: 268, 2020.) From the Department of Plastic Surgery, University of Pittsburgh Medical Center. Received for publication December 27, 2018; accepted June 13, 2019. An Evaluation of Race Disparities in Academic Plastic Surgery SPECIAL TOPIC Volume 145, Number 1 • Racial Disparities in Academia 269 has sparingly explored the career pathways of minority academics—individuals who serve as a key source of mentorship for budding residents and form a pool of qualified candidates for many senior leadership positions.9 Furthermore, little has been done to establish a timeline of expected positional advancement for these academics or predict when recent policy changes will affect nonwhite representation at the most senior academic and leadership positions. Finally, for minority practitioners already in leadership positions, the downstream effects of minority program leadership toward program diversification have also been poorly explored or quantified. Therefore, the goals of our study were to (1) measure ethnic and racial minority representation among current academic plastic surgeons, (2) compare the qualifications and career pathways of white and nonwhite academics, and (3) quantify the effects of nonwhite leadership on the hiring and advancement of diverse academic groups. METHODS Study Sample Data for this study were collected as part of a cross-sectional analysis of academic plastic surgeons conducted in June of 2018. Plastic surgery programs to be included in this study were identified through 2018 Accreditation Council for Graduate Medical Education program listings for accredited integrated and independent plastic surgery programs. The combined list of independent and integrated programs (n = 140) was further assessed for program duplicates (n = 40), which were removed. Faculty websites were then identified for all but one of the remaining programs (n = 99). Individuals from these websites were included for cross-sectional analysis if they had been listed as clinical, adjunct, tenure-track or non–tenure-track plastic surgery faculty, and had obtained plastic surgery board certification (n = 932). Exclusions included faculty without plastic surgery training, research faculty without medical degrees, and emeritus professors. Data Collection Data collected on academic faculty were primarily obtained from program website listings, but also included private-practice websites, public records websites, Doximity, and LinkedIn. Assessed factors included age, race, sex, plastic surgery training type (independent or integrated), training graduation year, clinical or research fellowship training, additional advanced degrees, academic position (assistant, associate, or full professor), and any leadership positions held (residency director, fellowship director, and/ or chief/chair). Confirmation of board certification was obtained through search of the American Board of Plastic Surgery database.15 Determination of race and ethnic background was accomplished using photographic and surname data at the discretion of data collectors. Ethnic
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