title: Evolution of practice patterns in plastic surgery using Current Procedural Terminology mapping: a 9-year analysis of cases submitted by primary and recertification candidates to the American Board of Plastic Surgery.
abstract: BACKGROUND
  Understanding plastic surgery practice patterns allows the specialty to detect subtle shifts in the market and develop proactive strategies to maintain market share.
  
  
  METHODS
  Current Procedural Terminology codes from American Board of Plastic Surgery recertification and primary certification candidates from 2003 to 2011 were examined. Statistical analyses identified significant changes (p < 0.05) in the percentage of surgeons performing each type of procedure and trends in average case volume per surgeon.
  
  
  RESULTS
  The overall number of procedures decreased from 2003 to 2011. There was a statistically significant (p < 0.05) decrease in the percentage of recertification and primary certification candidates performing facial cosmetic and facial malignancy procedures. Both groups also experienced statistically significant decrease in facial plastic surgery case volume. The percentage of surgeons performing breast reconstruction remained stable for the recertification group and increased significantly for primary certification surgeons. Breast reconstruction volume increased significantly for both groups. Craniofacial surgery remained stable in the percentage of surgeons performing the cases and case volume. Hand surgery experienced a significant loss of recertification surgeons performing hand surgery; however, hand surgery case volume remained stable for both groups.
  
  
  CONCLUSIONS
  From 2003 to 2011, plastic surgery lost market share in facial cosmetic, facial malignancy, and hand surgery and maintained market share in breast and craniofacial surgery. CPT mapping enables us to analyze these trends to better train plastic surgeons to adapt to changing pressures both from economic recovery and from competing specialties seeking to benefit from redistribution of case loads.
authors.affiliation: Cleveland, Ohio; and Chicago, Ill. From Case Western Reserve University; Harold S Haller & Company; and the Division of Pediatric Plastic Surgery, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lee
authors.forename: Harold S
authors.initials: HS
authors.lastname: Haller
authors.forename: Arun K
authors.initials: AK
authors.lastname: Gosain
mesh_terms: D002568:Certification / Q000592:standards*; D002983:Clinical Competence / Q000592:standards*; D006801:Humans; D019651:Plastic Surgery Procedures / Q000193:education*; D012189:Retrospective Studies; D012955:Societies, Medical; D013044:Specialty Boards; D013518:Surgery, Plastic / Q000193:education*; D009626:Terminology as Topic; D014481:United States