DOI: 10.1097/gox.0000000000007847 ISSN: 2169-7574

Geography and Opportunity: The Influence of Residency Location on Plastic Surgery Resident Case Volume—A 9-year Review of 1902 Graduates

Priya Bhardwaj, Hassan ElHawary, Molly A. Olson, Chris Fox, Yoon Soo Park, Sean O. Hogan, Jeffrey E. Janis
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Background:

Although geography has been shown to impact trainee operative experience in other specialties, its effect on plastic surgery case volumes remains unknown. This study aims to assess whether a program’s geographic region influenced resident case volumes.

Methods:

This retrospective cohort study used Accreditation Council for Graduate Medical Education case logs of all graduating plastic surgery residents in Accreditation Council for Graduate Medical Education–accredited plastic surgery residency programs in the United States from 2014 to 2023. Primary variables included program geographic region (Northeast, South, Central, or West) and total number of cases logged.

Results:

A total of 1902 graduates (859 independent, 1043 integrated) were included. Overall mean case volumes were similar across geographic regions ( P = 0.200) and remained stable during the study period. No detectable geographic differences were observed among independent residents ( P = 0.645). In contrast, integrated residents demonstrated significant regional variation, with the highest mean total case volumes in the West and the lowest in the Northeast ( P < 0.001). Subspecialty analysis revealed significant geographic differences in aesthetic ( P = 0.007), hand/nerve ( P = 0.004), and “other” ( P = 0.003) case volumes, whereas breast ( P = 0.364) and craniofacial/head and neck ( P = 0.209) volumes were comparable across regions. Despite the expansion of integrated programs nationally, average resident case volumes did not decline over time.

Conclusions:

Although total operative exposure in plastic surgery training remains robust nationwide, geographic variation among integrated residents and certain subspecialty categories persists. Our findings may help residency programs develop targeted educational strategies to create more balanced training across regions.

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