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A Nine-Year Comparison of Practice Profiles of Candidates for the Primary and Recertification Examinations of the ABPS Relative to Economic Indicators
Michelle Lee, M.D.1, Arun K. Gosain, M.D.1, Harold Haller, Ph.D.2, Terry M. Cullison, RN, MSN3, R. Barrett Noone, M.D.3.
1University Hospitals Case Medical Center, Cleveland, OH, USA, 2Case Western Reserve University, Cleveland, OH, USA, 3American Board of Plastic Surgery, Philadelphia, PA, USA.

PURPOSE: The present study was performed to compare the practice profiles of candidates for Recertification or Maintenance of Certification (MOC-PS) and Primary Certification by the American Board of Plastic Surgery (ABPS) over the past 9 years. In addition, comparisons to unemployment data were made as a reference measure by which to further evaluate changing trends in practice profile.
METHODS: Case-logs from candidates for both Primary certification and Recertification/MOC-PS by the ABPS were examined from exam years 2003 through 2011. De-identified data were utilized for each case submission including operative year, CPT codes, and the candidate’s designation of the case relative to 1) cosmetic or reconstructive; 2) the MOC-PS module (Comprehensive, Cosmetic, Craniomaxillofacial, and Hand). Case collection periods for Primary candidates ranged from 7 to 9 months, and that for Recertification candidates was 6 months. To equalize for these differences each candidate’s data were expressed as the median number of cases per six months. The Department of Commerce Unemployment Data were collated on a quarterly basis from 2003-2011 to serve as an economic indicator. Data were compared using multiple regression and shift-away analyses.
RESULTS: A statistically significant downward trend for the 6-month median in the number of cases per candidate was observed for both Primary and Recertification groups from 2003 to 2011 for Cosmetic, Reconstructive, and Total number of cases (p<0.002; Fig. 1). This downward trend correlates with the unemployment data collected over the same time period (p<0.05). With every 1% increase in unemployment rate, Recertification candidates demonstrated an increased downward shift in the number of cosmetic cases relative to Primary candidates (4 versus 2-case decrease per 6 months, respectively; p<0.05), and an accelerated decline in the number of reconstructive cases per candidate starting in 2007 (p<0.002).. Distribution of the four MOC-PS modules demonstrated a negative trend for Cosmetic and Comprehensive modules in both groups (p<0.0001; Fig. 2). Hand and Craniofacial modules consistently comprised about 20% of modules for Primary Candidates and 14% of modules for Recertification Candidates. However, there was a shift away from Hand modules and shift towards Craniofacial modules in both groups from 2003-2011 (p<0.05).
Figure 1:
Figure 2:
CONCLUSIONS: This report represents the first time practice trends of candidates for the MOC-PS have been analyzed. These data demonstrate that there has been a statistically significant downward trend in the number of cases reported by both Primary and Recertification candidates over the past 9 years. Recertification candidates are more leveraged in cosmetic cases, losing cosmetic cases more rapidly as overall caseloads declined, and experiencing an accelerated decreased in reconstructive caseload from 2007 onwards correlating with a sharp upturn in unemployment. In contrast, Primary candidates appear to have maintained a more stable practice profile despite negative economic trends.


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