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Referrals of Plastic Surgery Patients to Integrative Medicine Centers

A Review of Resource Utility

Ruan, Qing Zhao MD; Chen, Austin D.; Tobias, Adam M. MD; Fukudome, Eugene Y. MD; Lin, Samuel J. MD, MBA; Lee, Bernard T. MD, MBA, MPH, FACS; Singhal, Dhruv MD

doi: 10.1097/SAP.0000000000001761
Circumspectus Medicinae: Texts and Contexts

Background Integrative medicine (IM) centers are becoming more established nationwide and provide an expansive range of therapeutic services. Given the high prevalence of IM usage among plastic surgery patients, we sought to define referrals rates to IM centers by plastic surgeons to investigate (1) the role of IM in the continuous care process of plastic surgery patients and (2) whether IM centers are being effectively utilized.

Methods Institutions with plastic surgery residency programs were identified using the American Medical Association's Fellowship and Residency Electronic Interactive Database Access System in January 2017. Data on the presence of a named IM center, director/administrator contact information, and types of therapeutic services offered were extracted. The total number of IM services at these centers was summed and tabulated for preliminary analyses. A survey questionnaire was sent to the center to ascertain referral patterns in February 2017.

Results Of 96 institutions with plastic and reconstructive surgery residency programs in North America, 49 (51%) provide IM services, and 24 (25%) have affiliated named IM centers of which we attained a survey response from 13 (54.5%). Of these centers, 10 (76.9%) evaluate more than 50 patients per week. Patient referrals to these centers were primarily from the department of medicine (73.8%) as opposed to surgery (13.1%) (P < 0.0001). An average of 0.77% of surgical referrals, or 0.077% of all referrals, arose from plastic and reconstructive surgery.

Conclusions Plastic surgeons appear to infrequently refer patients to IM centers. Given the high prevalence of IM usage among our patient population, IM centers are an underutilized adjunct in the care of our patients. Further study into specific IM services that may benefit our patients would be helpful in increasing IM utilization in our field.

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Received August 19, 2018, and accepted for publication, after revision October 17, 2018.

Presented at the Society of Asian Academic Surgeons 2017, September 21 to 22, 2017, in Birmingham, AL; and American Society of Plastic Surgery, Plastic Surgery the Meeting 2017, October 6 to 10, 2017, in Orlando, FL.

Conflicts of interest and sources of funding: none declared.

Reprints: Dhruv Singhal, MD, Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Suite 5A, Boston, MA 02215. E-mail:

Online date: January 10, 2019

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