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The Plastic Surgeon as Employee: A Pilot Survey of the California Society of Plastic Surgeons

Patel, Nirav Bipin MD, MS, JD; Coombs, Demetrius M. BS; Arsalai, Mena JD; Li, Chin-Shang PhD; Liu, Yu MS; Stevenson, Thomas R. MD; Pu, Lee L.Q. MD, PhD

doi: 10.1097/SAP.0000000000001050
Research Papers

Introduction Plastic surgeons endure years of training yet remain poorly equipped to negotiate first employment contracts. Our aims were to evaluate typical plastic surgeon employment contracts and assess contract comprehensiveness. We sought elements that should be included to better preserve varied interests.

Methods A brief, anonymous, e-mailed survey was sent to California Society of Plastic Surgeons members and responses collected over 2 months. We collected information such as years in practice, geographic area, types of practices and number of surgeons within them, and legal standing of partnerships. We asked whether respondents sought legal assistance and specific elements were elaborated. We asked how content they were with their contracts while allowing commentary.

Results Our survey generated 113 responses. 50.0% of respondents reported being in practice for at least 20 years; 2.68% had been in practice for up to 5 years. 62.5% reported being in private practice and 27.7% reported being in academia. In-state geographic distribution of respondents accounted for 85.6%, whereas 14.4% reported practicing out-of-state.

Practice size was diverse, with 41.4% of respondents having worked in a group practice of 3 or more, 27.9% in partnership, and 23.4% in solo practice. For partnerships, 29.9% had made formal legal arrangements, whereas 20.6% had made informal arrangements. 74.5% of respondents did not seek legal assistance.

Malpractice coverage varied from 51.6% with claims-made, to 21.7% with tail, to 33.0% with no coverage at all. 63.9% reported having no group disability policy. 26.4% reported annual income of less than US $100,000; 49.1% reported US $101,000 to US $200,000; 17.9% reported US $201,000 to US $300,000; 6.60% reported greater than US $300,000. Using a 5-point scale, 7.69% of respondents reported being “extremely dissatisfied” with their first employment contracts (score of 1), whereas 24.0% were “perfectly happy” (5).

Eighty-two respondents offered advice. Common themes included seeking legal counsel; considering eventual solo practice; planning long-term; seeking mentorship; and cautioning against third party interests.

Conclusions New plastic surgeons will find themselves employed by institutions. Seeking attorneys familiar with the profession is advisable. Lack of awareness regarding malpractice options and disability coverage are 2 areas of concern. We reveal critical contract elements that surgeons should negotiate to ensure smooth transition to practice.

From the *Division of Plastic Surgery, University of California, Davis, Sacramento, CA; †Drexel University College of Medicine, Philadelphia, PA; ‡McGeorge School of Law, University of the Pacific; and §Department of Statistics, University of California, Davis, Sacramento, CA.

Received August 5, 2016, and accepted for publication, after revision December 28, 2016.

Conflicts of interest and sources of funding: C.-S.L. and Y.L. are currently supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), through grant UL1 TR000002. For the remaining authors none were declared.

Presented at the 66th Annual Meeting of the California Society of Plastic Surgeons, Santa Monica, CA on May 28, 2016.

This is a California Society of Plastic Surgeons paper. This is to be reviewed by the CSPS Scientific Committee to be published in the special CSPS edition set for May 2017.

Reprints: Lee L.Q. Pu, MD, PhD, University of California Davis Medical Center, 2221 Stockton Blvd, Suite 2123, Sacramento, CA 95817. E-mail:

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