J Reconstr Microsurg
DOI: 10.1055/a-2483-5337
Original Article

Microsurgeon Development, Attrition, and Hope for the Future: A Qualitative Analysis

1   Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
,
Yasmeen M. Byrnes
2   Department of Plastic and Reconstructive Surgery, Geisinger Medical Center, Danville, Pennsylvania
,
Alesha A. Kotian
3   University of Michigan Medical School, Ann Arbor, Michigan
,
Hannah Z. Catzen
3   University of Michigan Medical School, Ann Arbor, Michigan
,
Mary E. Byrnes
4   Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
5   Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
,
Paige L. Myers
1   Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
› Author Affiliations

Abstract

Background The field of microsurgery continues to grow, yet barriers to practice still exist. This qualitative study aims to elucidate factors both strengthening and threatening this subspecialty through structured interviews with fellowship-trained microsurgeons.

Methods An interview guide was designed, and structured interviews were conducted with practicing fellowship-trained microsurgeon members of the American Society of Reconstructive Microsurgeons between August 2021 and May 2022. Three independent reviewers transcribed, content-coded, and thematically analyzed the interviews. Themes and subthemes were discussed and finalized.

Results Twenty-one practicing microsurgeons were interviewed, hailing from all four Census geographical regions of the United States. The most common practice model was academic (43%, n = 9). Five overarching themes emerged: a passion for microsurgery, training and mentorship, practical considerations, team support, and hope for the future. Microsurgeons reported early exposure to microsurgery as catalyzing their passion, whereas a strong training foundation and lifelong mentors sustained it. Practical challenges arose when establishing and maintaining a microsurgery practice, such as poor reimbursement and unfavorable referral patterns. Team support from staff and other microsurgeons (e.g., a co-surgeon model) was crucial to success. Finally, microsurgeons hoped that future advances would expand access to microsurgical reconstruction for patients and plastic surgeons.

Conclusion This unique, qualitative description of the current landscape of microsurgery revealed that though practical barriers exist, team-based models can alleviate some difficulties. Future advances that increase accessibility may further strengthen this unique and versatile field.



Publication History

Received: 01 July 2024

Accepted: 10 November 2024

Accepted Manuscript online:
25 November 2024

Article published online:
24 December 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Mohan AT, Saint-Cyr M. Recent advances in microsurgery: an update in the past 4 years. Clin Plast Surg 2020; 47 (04) 663-677
  • 2 Mueller MA, Pourtaheri N, Evans GRD. Microsurgery training resource variation among US integrated plastic surgery residency programs. J Reconstr Microsurg 2019; 35 (03) 176-181
  • 3 Statistics - Microsurgery Fellowship - SF Match - Residency and Fellowship Matching Services. Accessed November 20, 2022 at: https://sfmatch.org/specialty/microsurgery-fellowship/Statistics
  • 4 Cooper MN, Daneshgaran G, Yu R. et al. Analysis of the microsurgery match from 2014 to 2018 reveals increased competition for microsurgery fellowship positions. J Reconstr Microsurg 2019; 35 (09) 662-668
  • 5 Albornoz CR, Bach PB, Mehrara BJ. et al. A paradigm shift in U.S. breast reconstruction: increasing implant rates. Plast Reconstr Surg 2013; 131 (01) 15-23
  • 6 Panchal H, Matros E. Current trends in postmastectomy breast reconstruction. Plast Reconstr Surg 2017; 140 (5S): 7S-13S
  • 7 Toyserkani NM, Jørgensen MG, Tabatabaeifar S, Damsgaard T, Sørensen JA. Autologous versus implant-based breast reconstruction: a systematic review and meta-analysis of breast-Q patient-reported outcomes. J Plast Reconstr Aesthet Surg 2020; 73 (02) 278-285
  • 8 Panchal H, Shamsunder MG, Sheinin A. et al. Impact of physician payments on microvascular breast reconstruction: an all-payer claim database analysis. Plast Reconstr Surg 2020; 145 (02) 333-339
  • 9 Odom EB, Schmidt AC, Myckatyn TM, Buck II DW. A cross-sectional study of variations in reimbursement for breast reconstruction: is a healthcare disparity on the horizon?. Ann Plast Surg 2018; 80 (03) 282-286
  • 10 Alderman AK, Atisha D, Streu R. et al. Patterns and correlates of postmastectomy breast reconstruction by U.S. plastic surgeons: results from a national survey. Plast Reconstr Surg 2011; 127 (05) 1796-1803
  • 11 Mericli AF, Chu CK, Sisk GC. et al. Microvascular breast reconstruction in the era of value-based care: use of a cosurgeon is associated with reduced costs, improved outcomes, and added value. Plast Reconstr Surg 2022; 149 (02) 338-348
  • 12 O'Cathain A, Goode J, Drabble SJ, Thomas KJ, Rudolph A, Hewison J. Getting added value from using qualitative research with randomized controlled trials: a qualitative interview study. Trials 2014; 15: 215
  • 13 Hunt MR. Strengths and challenges in the use of interpretive description: reflections arising from a study of the moral experience of health professionals in humanitarian work. Qual Health Res 2009; 19 (09) 1284-1292
  • 14 Beck CT. ed. Routledge International Handbook of Qualitative Nursing Research. Routledge;; 2013.
  • 15 “Writing Interview Protocols and Conducting Interviews: Tips for Stude” by Stacy A. Jacob and S. Paige Furgerson. Accessed December 20, 2022 at: https://nsuworks.nova.edu/tqr/vol17/iss42/3/
  • 16 O'Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med 2014; 89 (09) 1245-1251
  • 17 Kania K, Chang DK, Abu-Ghname A. et al. Microsurgery training in plastic surgery. Plast Reconstr Surg Glob Open 2020; 8 (07) e2898
  • 18 Elver AA, Egan KG, Phillips BT. Assessment of microsurgery simulation course access in plastic surgery training programs. J Reconstr Microsurg 2024; 40 (06) 482-488
  • 19 DeCoster RC, Bautista Jr RF, Burns JC. et al. Rural-urban differences in breast reconstruction utilization following oncologic resection. J Rural Health 2020; 36 (03) 347-354
  • 20 Sheckter CC, Yi D, Panchal HJ. et al. Trends in physician payments for breast reconstruction. Plast Reconstr Surg 2018; 141 (04) 493e-499e
  • 21 Sheckter CC, Panchal HJ, Razdan SN. et al. The influence of physician payments on the method of breast reconstruction: a national claims analysis. Plast Reconstr Surg 2018; 142 (04) 434e-442e
  • 22 Momoh AO, Griffith KA, Hawley ST. et al. Postmastectomy breast reconstruction: exploring plastic surgeon practice patterns and perspectives. Plast Reconstr Surg 2020; 145 (04) 865-876
  • 23 Eltahir Y, Krabbe-Timmerman IS, Sadok N, Werker PMN, de Bock GH. Outcome of quality of life for women undergoing autologous versus alloplastic breast reconstruction following mastectomy: a systematic review and meta-analysis. Plast Reconstr Surg 2020; 145 (05) 1109-1123
  • 24 Xue EY, Chu CK, Winocour S, Cen N, Reece E. Establishing a telemedicine program for breast reconstruction. Plast Reconstr Surg Glob Open 2020; 8 (03) e2594
  • 25 Bauermeister AJ, Zuriarrain A, Newman M, Earle SA, Medina III MA. Impact of continuous two-team approach in autologous breast reconstruction. J Reconstr Microsurg 2017; 33 (04) 298-304
  • 26 Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res 2016; 26 (13) 1753-1760