Background
The lack of underrepresented in medicine (UIM) physicians in academic plastic surgery is emerging as a critical issue. Lack of diversity has a negative effect on patient care and on the culture of our health care system. This study reports the current status of ethnically UIM physicians in the plastic surgery pipeline, starting from the medical student level and progressing to national leadership positions.
Methods
The Electronic Residency Applications Service, National Resident Matching Program, Association of American Medical Colleges, and professional Web sites for journals and national societies were accessed for racial demographic information from 2008 to 2019.
Results
Over the past decade, there has been no change or a slight decrease in representation of Blacks among plastic surgery residency applicants, trainees, and academic faculty, at half or less than expected, compared with US Census data. The first point of drop-off occurs at the resident (3.8% of integrated and 5.6% of independent residents) to faculty level (<2.8%). Two percent of program directors and department heads/division chiefs are Black. The next point of drop-off occurs at the national level: there has never been a Black president of American Society of Plastic Surgeons or Plastic Surgery Foundation, and there are no Black editors-in-chiefs of major plastic surgery journals.
Following LatinX American surgeons down the pipeline over the past decade, there has been no change or a decrease in representation among plastic surgery residency applicants, resident physicians, and academic faculty, at one-third or less than expected, compared with US Census data. The first point of drop-off occurs at the faculty (4.8%) to local leadership level (0% of program directors and department heads/division chiefs) where there is no representation of LatinX. Once this drop-off occurs, there is no recovery at the national leadership level.
Conclusions
In order for our profession to reflect our nation's demographics, academic plastic surgery is in need of a paradigm shift now. Attrition of UIM physicians in plastic surgery begins at medical school graduation and persists through surgical training, faculty appointments, and attainment of leadership positions. Creative and innovative commitment to diversity and inclusion is necessary.
Introduction: On January 1, 2019, in an effort to improve price transparency, the Centers for Medicare and Medicaid Services (CMS) mandated that hospitals display chargemasters and pricing for diagnosis-related groups (DRGs) online. We examined the compliance of the 50 top orthopaedic hospitals, ranked by US News, with CMS's mandate and compared pricing. Methods: The chargemaster and pricing of DRG codes related to total knee arthroplasty (TKA) and total hip arthroplasty (THA) (469, 470, 461, 462, 466, 467, and 468) were evaluated in the top 50 orthopaedic hospitals in the United States. Spearman rank correlation coefficients (r) were used to evaluate the association between DRG 469, 470, and 467 prices with geographic practice cost index (GPCI) work and practice expense values. Results: Thirty-six of the 50 hospitals reported DRG pricing for THA and TKA. Of these hospitals, 15 had prices for all seven DRGs of interest; only 467, 469, and 470 were reported across all the 36 hospitals. Of the 14 hospitals without DRG information, 12 had nothing and two had unsatisfactory reporting. Prices for DRGs 469, 470, and 467 were moderately or weakly correlated with both GPCI work and GPCI practice expense. All correlation analyses were statistically significant (P , 0.05). Discussion: In summary, compliance with CMS's 2019 rule was poor overall. Fourteen of the 50 hospitals did not adequately report any DRG pricing, and only 15 of the hospitals were fully compliant with the mandate. In addition to poor compliance, the reported costs had variation not strongly accounted for by established geographic differences.
Healthcare expenditure in the United States continues to rise and is projected to account for 20% of the gross domestic product by 2028. 1 Healthcare pricing is difficult for the average consumer to obtain Kovid Bhayana, BS
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