Demographic status and training needs of aesthetic plastic surgeons in government and private hospitals: evidence from Guangdong, China

Ethics

Ethical approval for this study was obtained from the Ethics Committee of the Guilin Medical University Hospital (approval number: 21-216). Since this research is carried out in the field of continuing medical education (CME) program or in a workshop, informed verbal consent was obtained from all participants.

Study design

A mixed study combining a self-administered questionnaire survey with CME participants and in-depth interview with key informants was used.

Study site

The study site was conducted from January to December, 2022 in Guangdong, China. As a coastal province in South China, Guangdong’s GDP in 2021 surpassed 1.5 trillion US dollars, which ranked first in China.¹¹ In this developed economic region, it is estimated that there are more than ten government hospitals with aesthetic plastic departments and two hundred private plastic hospitals with almost eight hundred aesthetic plastic surgeons in total.

Study population

Various CME key informants were identified in consultation with specialists at the department of plastic and aesthetic surgery in Nanfang hospital, Southern Medical University, which is the organizer for many CME programs. This list was expanded after the initial interviews, as the earlier interviewees suggested more informants. Recruitment stopped after the data were considered to be saturated by the researchers. The final informants were the directors of the plastic departments, the heads of medical associations, CME providers (affiliated hospitals of universities), CME users (plastic surgeons). The survey population of CME users included doctors, graduate students when they were attending a continuing medical education program or in a workshop. However, participants who had been employed for less than six months or would retire within a year were excluded.

Data collection method and instruments

Based on literature reviews and experts’ consultation, we adapted a questionnaire which was reviewed by a statistician, two epidemiologists, four dermatologists, and two plastic and aesthetic surgeons to ensure its validity. The questionnaire included their demographic information on plastic surgeons, their frequency in attend CME, their preferred contents, type of CME, an barriers and facilitators in attending CME. A small pilot study was conducted to verify suitability of the questions before survey.

In-depth interviews were conducted with multiple key informants, including the directors of the plastic departments, the heads of medical associations, CME providers (affiliated hospitals of universities), CME users (plastic surgeons). The interview topics included comments on the current status of aesthetic plastic surgeons, current continuing training programs, potential problems, and solutions for the improvement. All interviews were taped and transcribed verbatim for thematic analysis.

Statistical methods

All data analyses were performed using R version 3.5.2 and EpiDisplay package. Categorical data were given as counts and percentages, to compare the difference in demographic information and training needs assessment, the chi-square test, Fisher’s test, were used as appropriate for categorical variables. Mann-Whitney U-test was use to compare the knowledge gap for major aesthetic surgical procedures between surgeons in private and government hospitals. Statistical significance was set at 5%.

Demographic information and needs assessment on aesthetic plastic surgeons

Demographic data of aesthetic plastic surgeon 290 out of 356 attendees completed the questionnaire survey, the responding rate was 81.5%. 240 surgeons were practicing aesthetic plastic surgery after excluding those cosmetic dermatologists, and cosmetic doctors in traditional Chinese medicine.

Shown in Table 1, the distribution of gender, age groups, and years of practice, professional technical titles, and original working department among the 144 surgeons from government hospitals and 96 from private hospital was nearly the same. In general, over sixty percent of the surgeons were under 40 years of age, one third of the surgeons had less than three years of working experience with junior professional technical titles. Almost two thirds of surgeons’ original working departments were not aesthetic plastic surgery. The distribution of educational degree between these hospitals was statistically different. There were more doctors with a graduate degree in government hospitals.

Table 2 summarized the current training status and study objectives for surgeons. Overall, there were some similarities between surgeons of government and private hospitals, half of the surgeons attended training less than three times with an affordable expense of 1000-5000RMB, surgeons in private hospitals were more likely to spend more than 10,000 RMB in training. The majority of them had strong willingness to attend training to improve their practical skills, gain clinical experience, and learn latest technologies.

Table 3 concluded the surgeons’ favorable training methods and reported obstacles. Further study in a tertiary hospital, short training course focusing in specific topic by corresponding experts, and operation demonstration were regarded as the top three favorable choices. The number one obstacle was “nobody replaces me at work”, however, training expenses was the second obstacle for doctors in governmental hospitals and the third one for doctors in private hospital, in converse, “I cannot learn the skills I want” was second obstacle and third one for doctors in private and government hospital respectively.

Table 4 summarized their interest in major surgical procedures and self-assessed knowledge gap. For surgeons in private hospitals, 69.2% of them intended to learn rhinoplasty, and eye plastic surgery. Fat transplant was their third interesting procedures, which coincided with their self-assessed knowledge gap. For surgeons working in government hospitals, their top three interesting surgical procedures were eye plastic surgery, rhinoplasty, and minimally invasive plastic surgery, in terms of knowledge gap, they believed that they had more knowledge gap in external genitalia, perineal surgery, rather than eye plastic surgery.

Qualitative analysis on the current continuing training system for aesthetic plastic surgeons

Continuing medical education programs are under the management and organization of medical associations at municipal or provincial levels. Doctors in government hospitals are required to abstain a minimum credit by attending different continuing education programs. However, the doctors in private hospitals are not compulsory required to get the credits. In-depth interviews revealed that most continuing training conferences were co-organized by government and private hospitals. As non-profit medical organizations, the department of aesthetic plastic surgery in most government hospitals, were merged with burn surgery, therefore, they focused more on their social responsibility in repair and reconstructive surgery. Meanwhile, as a base to train medical students, government hospitals paid more attention on academic development and research on basic and clinical technologies. By contrast, private aesthetic plastic hospitals were for-profit originations and laid more emphasis on improving customers’ experience. Since aesthetic plastic procedure were not covered by insurance schemes, customers were more likely to visit private hospitals for operations owing to more comfortable environment and individualized services. These organizational differences between government hospitals and private hospitals determined the different requirements of aesthetic plastic surgeons in their respective institutions, reflecting their needs difference in continuing medical training.