title: Dynamics of hospital-based plastic surgery.
abstract: BACKGROUND
  Legislative regulations, decreasing reimbursements for office procedures, and malpractice premiums have transformed plastic surgery from an office-based specialty into a hospital-based one. Simultaneously, hospital economics has altered, wherein the "business model" has all but subsumed the old "medical care" model. Integration between plastic surgeons and the new hospital structure has been difficult for both. Limited understanding of the financial dynamics of hospital-based practices, unfamiliarity with the administrative processes, and resistance to accept and assimilate changes by both sides pose hurdles, in some situations even forcing plastic surgeons out of hospital settings.
  
  
  METHODS
  Using well-defined financial terminology, changing national development in health care policy, and hospital-based administrative strategies as a backdrop, this study finds common ground for the plastic surgery specialty to coapt with the hospital.
  
  
  RESULTS
  Key missing elements in the interaction between plastic surgeons and hospital administrations and ways of integrating these components are identified. To do so effectively, plastic surgeons must first understand the basic tenets of management that drive hospital administrators, participate at every level they can in guiding these processes, and assume leadership roles that will ultimately dictate the way they work and conduct their professional lives.
  
  
  CONCLUSIONS
  It is critical that plastic surgeons engage in important processes that govern the economics of hospital-based health care delivery. This commitment will also ensure that all three groups (the patients, physicians, and hospital administrators) achieve a degree of satisfaction. The message to plastic surgeons is clear: be proactive and lead a campaign of change.
authors.affiliation: Division of Plastic Surgery and Center for Immunotherapy, University of Connecticut School of Medicine, Farmington, CT 06030-1601, USA. chandawarkar@uchc.edu
authors.forename: Rajiv Y
authors.initials: RY
authors.lastname: Chandawarkar
authors.forename: Satyajit
authors.initials: S
authors.lastname: Dutta
mesh_terms: D005377:Financial Management, Hospital; D018578:Hospital-Physician Relations; D006801:Humans; D007325:Institutional Practice / Q000191:economics / Q000458:organization & administration*; D011216:Practice Management, Medical / Q000191:economics; D019651:Plastic Surgery Procedures / Q000191:economics*; D013518:Surgery, Plastic / Q000191:economics*; D014481:United States