Two Roads to One Specialty: A 9-year National Comparison of 1902 Integrated and Independent Plastic Surgery Resident Case Logs

Background: Plastic surgery residency training in the United States follows 2 primary pathways: the independent and integrated models. Although both aim to produce competent surgeons, differences in surgical case exposure between these two groups remain unclear. This study analyses surgical cases performed by independent and integrated plastic surgery residents across a 9-year span to compare operative experience across training pathways. Methods: A retrospective national cohort study was conducted using Accreditation Council for Graduate Medical Education data from 2015 to 2023, encompassing all graduating plastic surgery residents. Case volumes were categorized into breast, hand/wrist/nerve, craniofacial/head and neck, aesthetic, and other procedures. Descriptive statistics and Welch t tests were used to compare case distributions between independent and integrated residents. Results: A total of 1902 residents (859 independent and 1043 integrated) were analyzed. The number of independent residents declined over time, whereas integrated residents increased. Integrated residents performed significantly more cases overall (2552 ± 404 versus 1988 ± 294, P < 0.001) and across all subspecialties except aesthetic surgery, where no significant difference was observed (251 ± 83 versus 250 ± 84, P = 0.909). Conclusions: Integrated residents log a higher volume of surgical cases than independent residents, likely due to prolonged plastic surgery–specific training. However, aesthetic surgery exposure remains similar between groups, potentially due to case delegation patterns and career interests. Future studies should assess qualitative aspects of training to ensure equitable surgical education and readiness for independent practice across both pathways.