An Analysis of Women's Representation of Plastic Surgery Residency and Fellowship Program Leadership From a National Lens

Background Among all surgical specialties, plastic surgery has had the most significant growth in women trainees and leadership positions from 2008 to 2018. Despite this increase, studies have shown that from trainees to faculty to leadership roles, leakage occurs at all levels in the pipeline. We aim to investigate the gender distribution of leadership positions by plastic surgery program type and geographic region, as well as to compare the leadership representation across plastic surgery subspecialty fellowships. Methods All integrated plastic surgery residency programs and four main subspecialty fellowship programs in the US were identified through the American Council of Academic Plastic Surgeons. Leadership roles, such as program director, assistant/associate program director (APD), fellowship program director, and departmental and divisional level leadership roles, which are occupied by women, were collected from program websites, along with the number of individuals holding additional leadership roles. Programs were classified as either university-based or nonuniversity-based types. Program location was cross-referenced with the US Census Bureau to determine their regions. Categorical variables were compared by χ2 or Fisher's exact tests, as appropriate, using Microsoft Excel 2021. Results A total of 88 integrated plastic surgery residency programs were identified, along with 33 craniofacial surgery, 82 hand surgery, 61 microsurgery, and 47 aesthetic surgery fellowship programs. Overall, women represent 20.9% of program directors, 44.2% of APDs, 10.7% of fellowship program directors, and 18.1% of departmental and divisional level leadership roles. Fewer women are holding additional leadership roles (22.3% vs 77.7%). A significant difference was found in the APD position by program type. The aesthetic surgery fellowship has the lowest women's representation in leadership, while hand surgery has the highest (9.09% vs 17.1%). No significant difference in gender distribution was observed across fellowship types. Conclusions While leadership gender distribution does not appear to be affected by region or program type, women plastic surgeons remain underrepresented at different leadership levels. Providing enhanced career advancement and support for diverse representation is vital to creating an inclusive plastic surgery leadership workforce.