Each year, the American Society of Plastic Surgeons (ASPS) brought together the largest group of domestic and international plastic surgeons to Chicago for collaboration among 3,600 attendees and nearly 300 industry exhibitors. I have attended this meeting almost every year since my residency training in Seattle. As the premier educational event for a diverse group of specialty surgeons, ASPS has packed 24.50 AMA Category I credits into 4 days, not including multiple satellite symposia and the obligatory networking events.
I was fortunate to participate as a speaker during the Residents Day Program, giving practical advice to graduating residents about the physician job search. I learned some valuable tips from my fellow speakers about contract negotiation, compensation structures, engaging with industry partners, and how to convert cosmetic fees into work RVUs. Needless to say, I received very little of this information throughout formal medical education, and the changing healthcare environment demands continuing education on the business of running a practice or being fairly employed.
Due to the nature of our specialty, it is impossible to become an expert in every niche. ASPS offered tracks for the major practice categories such as Craniomaxillofacial, Hand, Breast, Reconstructive, and Aesthetic. I was happy to see 2 panels discussing hot topics in surgical treatment of lymphedema. Because very few plastic surgeons practice lymphatic microsurgery at a high volume, most audience members know each other. Our colleagues and mentors on each panel were glad to engage in lively, informal discussions about controversies in our field. These include how to select patients for a specific procedure (lymphaticovenular bypass, vascularized lymph node transfer, liposuction), when to offer these procedures, when to combine these procedures, and how to follow outcomes postoperatively. Because lymphedema is an inherently heterogenous disease, there is no consensus about many of these details, though all surgeons agree that quality of life can be improved and maintained in a majority of patients who suffer from chronic lymphedema. Prophylactic lymphovenous bypass at the time of axillary node dissection appears to be catching on across the country. One plastic surgeon also aptly commented that lymphatic supermicrosurgery is the easy part, but getting paid by insurance companies for these “experimental” procedures continues to be challenging. Nevertheless, it was inspiring to see my esteemed colleagues remain passionate and optimistic about helping patients with this debilitating disease.
In addition to the usual scientific and practice guideline updates at ASPS, a few sessions provided expert perspectives on running a successful reconstructive practice. I learned concepts about demonstrating value proposition, contribution margin, downstream analysis, in-network versus out-of-network insurance billing, the disappearance of insurance carve-outs for autologous breast reconstruction. We cannot ignore our outcomes and quality measures in the coming era of value-based payment and disease-specific bucket reimbursement.
In the world of breast reconstruction, we continue to see incremental innovation in new implant models and tissue expanders. Prepectoral breast reconstruction, which I have been performing for over 2 years, is now considered commonplace although not quite standard of care. We are witnessing a trend away from textured devices due to the ubiquitous awareness of Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). An important panel on Shared Decision-Making for breast reconstruction featured well-known plastic surgeons and two courageous patient advocates, which is far more nuanced than the traditional “informed consent” process that many of us learned.
On a personal note, it was wonderful to catch up with old friends and colleagues from my training program and prior practices. Since I began using social media (Twitter mainly) for patient education, I have built an international network of phenomenal friends that get together at these meetings. It was a pleasure to meet plastic surgeons from Mexico, Spain, Canada, United Kingdom, Kenya, and South Korea who all share a common passion. I’m looking forward to next year’s #PSTM19 meeting in San Diego.
You can find the author on twitter at @danielzliu.
