Career Paths After Microsurgery Fellowship: A 10-Year Analysis.

Over the past 10 years, microsurgery fellowship programs and positions have increased by 50%, underscoring the need to understand graduate career paths and provide trainees context about future practice. This study analyzed who pursues microsurgery fellowships and factors associated with academic careers.This cross-sectional analysis examined graduates from the past 10 years from fellowships recognized by the American Society of Reconstructive Microsurgery or graduates of international fellowships who completed residency in the United States. Demographic variables included gender, race, residency location, and integrated versus independent plastic surgery residency. bibliometric indices at the time of graduation and October 2024 were measured. Initial and current practice settings were categorized as academic (full-time faculty), "private affiliated" (involved in teaching but not full-time faculty), or private practice.Overall, 423 graduates were identified. The majority were male (62.9%) and White (63.4%). Most completed Integrated residency (72.6%). Five fellowships accounted for 48.0% of graduates: MD Anderson (80), Memorial Sloan Kettering (46), University of Pennsylvania (38), Stanford University (23), and The Buncke Clinic (16). After fellowship, 68.0% of graduates entered academia, and 63.2% of graduates are in academia currently out of 419 analyzed. Fellowship location was associated with initial academic practice ( = 0.01), many graduates from International (80.0%), and Southern (78.4%) fellowships entering academia. Graduates in initial academic practice had higher median initial -index (13 vs. 10,  = 0.03) and median initial publications (15 vs. 11,  = 0.02). Multiple logistic regression found initial publications and fellowship location to be the best predictors of initial academic practice.While most graduates pursue academia, a significant number enter private practice, indicating it is a viable option. Southern or International fellowships send more graduates into academia, but this is likely influenced by popular fellowships. Nuanced factors like personal preference, financial considerations, and networking likely play a significant role in career choices.