The Economics of Volunteering Abroad: Results from a Comprehensive Survey of American Society of Plastic Surgery (ASPS) Members.

INTRODUCTION: While it is commonly understood within our specialty that each year hundreds of plastic surgery volunteer trips work abroad, the demographics of this significant workforce has been inadequately studied in the medical literature, forming a major barrier to improving international delivery systems for surgical services, cultural competency in US surgical education and sustainable models for international surgical education. In this presentation we report key economic and demographic data related to surgeons who volunteer abroad and those who do not and present calculations related to the monetary value in US dollars of the surgical services these surgeons provide internationally. METHODS AND MATERIALS: A validated email survey tool was delivered via email in October 2014 by the ASPS to all board certified plastic surgeons to “biopsy” the current care being provided internationally. RESULTS: The survey response rate was 15% (745 total respondents.) 314 surgeons traveled on a volunteer trip in the last 5 years, 173 surgeons have volunteered internationally but not in the last 5 years and 253 surgeons never volunteered abroad. 21.1% (62) volunteer surgeons contributed more than $3,000 to participate in their last trip, 24.1% (71) contributed $1,000-$2,000. Surgeons who do not volunteer abroad most commonly site as their reason, “Unable to take time from my practice in the US” (69.2% 148.) On their most recent volunteer trip, 293 surgeons provided a total estimated 2,368 days of surgical services internationally. Based on the 293 surgeons self reported case mix of cleft, burn, craniofacial and general reconstructive surgeries, the sum value of surgeons’ fees on their last trip (in US Medicare dollars) exceeded $8 million dollars or ~$27,000 per surgeon. A conservatively calculated, fixed office overhead cost for surgeons traveling on their last trip, in sum, was $2.2 million dollars (~$7500 per surgeon.) Aggregate deferred facility contribution margin while surgeons were volunteering abroad on their last trip was calculated as over $30 million dollars.1 CONCLUSIONS: Financial considerations are a significant factor for plastic surgeons considering volunteer work, both in direct cost for travel abroad and the opportunity cost of time away from their primary practice. On their last trip alone, surgeons who volunteered internationally in the last 5 years provided an estimated total of 2,368 days of surgical services abroad.