Rapid economic development and “selfie culture” have driven the Chinese plastic surgery market to grow extremely fast in recent years. ^{1 , 2} It is expected that the total amount of spending on plastic procedures has increased up to approximately 122 billion US dollars by 2019, which ranks third in the world following United States and Brazil. ³ As a result, the past decade has witnessed drastic development of private aesthetic plastic hospitals, owing to high demand for all kinds of cosmetic plastic surgeries. ⁴ Meanwhile, surgical doctors area transferring their original practicing specialty into aesthetic plastic surgery after obtaining a training certificate from a tertiary government hospital recognized by the provincial health commission. The government hospitals serve as a training base for medical students who pursue a master degree or PhD degree in plastic surgery and also play pivot roles in continuing training for these doctors who’ve switched from other surgical specialties. ⁵ Private hospitals tend to develop even faster than government hospitals due to more flexibility in management and favorable government policies. The total number of aesthetic plastic procedures in private hospitals has exceeded that of government hospitals. ⁶ Our first hypothesis is that the difference of demographic status between aesthetic plastic surgeons in government hospitals and private hospitals would have different continuing medical training needs.

It has been documented that continuing medical training programs are significant to improve their serving quality for health professionals. ^{7 , 8} There have been various training programs available for the aesthetic plastic surgeons in recent years, which include conference sessions, further clinical education, operation demonstrations, and online training courses. But almost all those programs are organized and dictated by hospitals or organizations, the needs of learners have rarely been assessed. ⁹ As Goldstein training mode suggests that training candidates, training contents, organizational requirements be the three important factors while in designing a good health training program. ¹⁰ Our second hypothesis is the difference between private and government hospital in medical service would lead to different training needs.

Objectives: To date, there is a paucity of data investigating the current demographic status of aesthetic plastic surgeons both in government hospitals and private hospitals in China, and their respective needs in continuing training. To test the above two hypotheses, this study aims to survey the demographic status of aesthetic plastic surgeons from both governmental and private hospitals, and investigate their continuing medical training needs in contents, methods, and barriers within.

This study suggested that after decades of rapid development of Chinese plastic surgery, the demographic data in private hospitals were quite similar to that of the government hospitals in such an economic developed province. In general, the plastic surgeons were young, with comparatively limited experience. In addition, almost two-thirds of them transferred from other specialties. The only difference was almost half of the doctors in government hospitals had a graduate degree, whereas, a quarter of them had a graduate degree in private hospitals. From the demographic data we concluded that it would be imperative to reinforce continuing training for aesthetic plastic surgery, meanwhile, considering the difference in demographic status.

In this study, the fact that half of the surgeons attended continuing training no more than three times in a year with limited affordable expense had great significance on planners in designing programs. Although most surgeons preferred to further their studies in a tertiary hospital, the chances were very limited. ^{12 , 13} This study suggested that a short course focused on specific topic with operation procedures demonstrations by experts would be a favorable training method, a similar finding to other research in surgical education. ¹⁴ Meanwhile, more attention should be laid on skills improvement in designing training curriculum, and with more consideration of reasonable price and flexible time for attendees.

This study also revealed a fact that rhinoplasty and new technologies such as fat transplant, minimally invasive plastic surgery were greatly concerning procedures for surgeons either in government hospitals or in private hospitals. To a certain extent, these training needs reflect the needs of the aesthetic market. Since the study site is located in southern China, and there is a big percentage of population with low nasal deformity, the focus on rhinoplasty has also increased accordingly. Minimally invasive cosmetic surgery has grown significantly in the world in recent years, and fat grafting technology is a hot spot in the current market in facial rejuvenation and breast augmentation. The results of self-assessed knowledge gap showed surgeons in government hospitals intend to acquire more continuing medical training in genitoperineal surgery, a newly popular surgical procedure in recent years while the surgeons in private hospitals believed more improvement should be made on plastic surgery for eyes, since blepharoplasty is the most popular procedure in China. The difference in training objectives was due to the different customer groups and social roles for government and private hospitals. Specifically, the government hospitals also took social responsibility for reparative and reconstructive surgery, while, the private hospitals were more market-oriented, mainly focusing on aesthetic plastic surgery.

This study tested the hypothesis that the demographic difference for aesthetic plastic surgeons between government and private hospitals were getting narrower. However, the organizational difference had influence on their respective training needs, which coincided with the Goldstein training mode. ^{12 , 13}

The study was conducted in Guangdong province, the most economically developed province in China. Since the development of the plastic and cosmetic surgery industry is closely related to socio-economic development, the conclusions drawn from this study are somewhat representative. The continuing education needs of plastic surgeons change with the needs of society. This study suggests that we should fully consider the nature of public and private institutions, the characteristics of the population, and so on, when planning continuing education and carrying out corresponding reforms. However, due to the limitation of time and funding when we conduct research, our research group mainly comes from the people who attend academic conferences. Therefore, there may be some selection bias in this study. We need to be cautious when drawing further conclusions.

The demographic disparity of aesthetic plastic surgeons between government hospitals and private hospitals was small. Continuing medical training is very important to improve the training and education of the large number of young aesthetic plastic surgeons in China. To design the training curriculum focused on practical skills, especially a short training course elicited by experts in rhinoplasty, eye surgery, and new technologies such as fat transplant, minimal invasive plastic surgery would be favorable. Meanwhile, the demographic status of aesthetic plastic surgeons and organizational needs should be taken into consideration.