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Factors Influencing Post-Training Practice Decisions in Plastic Surgery: A Systematic Review
Nadeem E. Jones^*, Shreyas Rajagopal, Juliana M. Marquez, Lee D. Yang, Jarrod T. Bogue
Columbia University Vagelos College of Physicians and Surgeons, New York City, NY

Introduction:
Career choice in plastic surgery is shaped by personal, institutional, and financial factors, but these influences have not been systematically synthesized across academic, private practice, and fellowship pathways. Identifying these determinants is essential for optimizing mentorship, research opportunities, and training structures to meet the evolving needs of the specialty. This review aimed to identify the factors most consistently associated with post-training career trajectories in plastic surgery.

Methods:
Pubmed/MEDLINE, Embase, and Web of Science databases were searched for studies evaluating predictors of career choice among plastic surgery residents and fellows. Variables were grouped into major domains, including research engagement, mentorship, training pathway, institutional characteristics, financial burden, and demographic or family factors.

Results:
Twenty-five studies including approximately 4,286 individuals met inclusion criteria, with possible cohort overlap. Academic careers were most consistently associated with stronger research engagement, integrated residency training, mentorship, and training at highly ranked or research-oriented programs. Private practice was associated with greater financial prioritization, higher debt, less research exposure, independent training pathways, and preference for smaller communities. Fellowship pursuit was associated with integrated training, research productivity, institutional prestige, and academic interest, whereas older age, family responsibilities, higher debt, and less research exposure were associated with not pursuing fellowship.

Conclusion:
Research engagement and mentorship were the most consistent modifiable drivers of academic and fellowship pathways, while debt and financial priorities were more closely linked to private practice choice. Optimizing structured mentorship, protected research time, and transparent career guidance may better align workforce distribution with trainee aspirations.
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.

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