Keywords
Generation Z - Plastic Surgery - digital innovation - work-life balance - surgical
education - generational shift - healthcare systems
Schlüsselwörter
Generation Z - Plastische Chirurgie - digitale Innovation - Work-Life-Balance - chirurgische
Ausbildung - Generationswandel - Gesundheitssystem
Introduction
What happens when the surgeons of tomorrow prioritize work-life balance, digital
innovation, and inclusivity over the long-standing traditions of undefined working
hours and hierarchical mentorship? The arrival of Generation Z in working-life and
specially in the field of medicine raises this question, making a significative
shift in how medicine is practiced, taught, and perceived [1]
[2].
Plastic and Reconstructive Surgery is a dynamic and continuously evolving field,
which stands at the intersection point of art, science, and technology, as well as
medical innovation and creativity. As a surgical specialty defined by its potential
for innovation and self-expression, it offers wide opportunities for creativity,
independence, and personal growth. These qualities make it particularly attractive
to Generation Z but also susceptible to transformation among the Generation Z. This
incoming challenges to patient care, resident training and research need to be
addressed.
Generation Z, often referred to as “Zoomers,” is the demographic cohort succeeding
Millennials (Generation Y) and preceding Generation Alpha, which has not yet entered
adulthood or the workforce ([Fig. 1]). Born
between the mid-to-late 1990s and early 2010s, Generation Z represents the
generation currently transitioning into professional life, including the completion
of medical studies and entry into the medical workforce. This contrasts with
Millennials, who are in the mid-stage of their careers, and Generation X, many of
whom are nearing retirement [3].
Table 1 Summary of the Leaders of National Societies of
Plastic Surgery Participating in the Survey. Demographic data were
obtained from the ESPRAS Survey [9]
|
Country
|
National Society
|
Leader
|
Total Members of the society
|
Members of the society/ Million habitants
|
|
Finland
|
Finnish Association of Plastic, Reconstructive, and Aesthetic
Surgeons (FAPRAS)
|
Ilkka Kaartinen (Past President)
|
160
|
26.36 members/million inhabitants
|
|
France
|
Société Française de Chirurgie Plastique, Reconstructrice et
Esthétique (SOFCPRE)
|
Jacques Saboye (Past President)
|
400
|
5.2 members/million inhabitants
|
|
Germany
|
Deutsche Gesellschaft der Plastischen, Rekonstruktiven und
Ästhetischen Chirurgen (DGPRÄC)
|
Marcus Lehnhardt (President)
|
2,119
|
19.6 members/million inhabitants
|
|
Italy
|
Società Italiana di Chirurgia Plastica Ricostruttiva ed Estetica
(SICPRE)
|
Franco Bassetto (Incoming President)
|
1,300
|
20.0 members/million inhabitants
|
|
Spain
|
Sociedad Española de Cirugía Plástica, Reparadora y Estética
(SECPRE)
|
Jaume Masia (Past President)
|
1,000
|
21.09 members/million inhabitants
|
|
Türkiye
|
Türk Plastik Rekonstrüktif ve Estetik Cerrahi Derneği
(TPRECD)
|
Cenk Demirdöver (President)
|
1,030
|
8.3 members/million inhabitants
|
|
United Kingdom
|
British Association of Plastic, Reconstructive and Aesthetic
Surgeons (BAPRAS)
|
Paul McArthur (Incoming President)
|
1,262 (550 consultants)
|
8.54 members/million inhabitants
|
|
United States of America
|
American Society of Plastic Surgeons(ASPS)
|
Gregory R.D. Evans (Past President)
|
Over 8,000
|
20.9 members/million inhabitants
|
Generation Z is the first cohort to grow up entirely immersed in the digital age,
with unprecedented access to technology and information from an early age, and are
also called as “digital natives” [4]. This brings
considerable changes, challenges and opportunities to Plastic Surgery. However, Gen
Z are not necessarily digitally literate and may struggle in a digital workplace.
Moreover, the negative effects of screen time are most pronounced in adolescents,
as
compared to younger children [5].
On the other hand, they share very different values prioritizing mental health and
personal time as much as professional excellence, but without sacrificing their
careers, as well as in addition embracing integration, diversity and acceptance
[6]
[7]
[8].
This generational shift raises important questions for the future of Plastic Surgery:
How can we balance Generation Zʼs preference for structured working hours
accommodate the demands of time-intensive reconstructive procedures? Will Surgery
and especially Plastic Surgery suffer from the arrival of this generation? In an
changing society with a reduced working population, how can we sustain 24-hour
high-quality patient care while respecting surgeonsʼ work-life balance? Can virtual
learning effectively replace the interpersonal mentorship that has for so long been
core to surgical education? How will the domination of social media redefine patient
care and the social perception of surgery? And how will technology, robotics,
artificial intelligence and new work philosophies reshape public healthcare systems
– will Generation Z ultimately improve them?
The aim of this paper is to present the personal perspectives from leaders of
national Plastic Surgery societies in Europe and the United States, which together
provide a comprehensive transatlantic overview of Western societies. These insights
are intended to contribute to ongoing discussions, inform policy-making, and guide
the development of strategies for addressing generational changes in Plastic
Surgery.
Material and Methods
To explore the impact of Generation Z as the new generation of Plastic Surgeons,
insights were obtained from eight past, present, and incoming leaders or presidents
of large national societies for Plastic Surgery in Europe and in the United States.
These leaders were invited to share their perspectives through a structured
questionnaire comprising five open-ended questions. The questionnaire was
distributed in October 2024. Participants were invited to choose one or more of the
questions to provide a comprehensive overview of the current challenges and
opportunities in their respective national societies and countries regarding Gen Z.
Each respondent was given a maximum of two pages to share their responses. The
results focus on the original responses, which were preserved to reflect the
authentic perspectives and views of the leaders. Further, descriptive statistics
were done.
The five questions:
-
What are the main challenges from your perspective?
-
Is the new relevance of work-life balance having any impact upon training in
Plastic Surgery in your country?
-
Have you identified any developments resulting from the influence of social
media and are the digital skills of Generation Z changing practice?
-
What role does the generational shift to Generation Z in Plastic Surgery play
in your national society?
-
What structural changes will be necessary in the future?
Results
Eight leaders were invited to provide their opinions and assessments on the impact
of
the generational shift in Plastic Surgery with the arrival of Generation Z ([Table 1]). Seven of the respondents are leaders or
past leaders of national societies that are members of the European Society of
Plastic, Reconstructive, and Aesthetic Surgery (ESPRAS), while the eighth represents
the American Society of Plastic Surgeons (ASPS) as past president, enabling a
comparative transatlantic analysis ([Table
1]
[Fig. 2]).
Fig.1 Generational distribution in 2024 regarding working life.
Comparison of the working lifetimes of different generational cohorts. Each
generation is represented by overlapping bars, with a red vertical line
marking the year 2024, indicating their past, present, and future working
periods. The chart highlights how workforce participation spans across
multiple generations over time.
Fig. 2 Countries represented by leaders of national Plastic Surgery
societies across Europe, who contributed their perspectives to this study
are highlighted in red.
According to the ESPRAS Survey [9] the
participating national societies represent some of the largest and most influential
Plastic Surgery organizations in Europe. The German Society of Plastic,
Reconstructive, and Aesthetic Surgeons (DGPRÄC) is the largest, with 2,119 members,
followed by the Italian Society of Plastic, Reconstructive, and Aesthetic Surgery
(SICPRE) with 1,300 members, the British Association of Plastic, Reconstructive, and
Aesthetic Surgeons (BAPRAS) with 1,262 members, the Turkish Society of Plastic,
Reconstructive, and Aesthetic Surgeons (TPRECD) with 1,030 members and the Spanish
Society of Plastic, Reconstructive, and Aesthetic Surgery (SECPRE) with 1,000
members. The Finnish Society of Plastic Surgeons (FAPRAS) is the smallest, with 160
members, but it boasts the highest density of members per million inhabitants (26.36
members/million), highlighting its robust representation relative to Finlandʼs
population size.
All respondents are men and currently hold, have held or will hold leadership
positions in their national societies. Their professional focus represents the full
spectrum of Plastic Surgery.
Finland (Ilkka Kartinen, past president to FAPRAS)
Finland (Ilkka Kartinen, past president to FAPRAS)
Generation Z refers to people born between 1997–2012. This means that the oldest
“Zoomers” are now 27 years of age and have just recently started to enter the
Plastic Surgery training. Therefore, some parts of the following thoughts are based
on experience with the previous age groups who have already passed through the
residency, as there are certain differences to be noticed already, compared to the
previous generations.
What role does the generational shift to Generation Z in Plastic Surgery play
in your national society?
In Finland, the residency programs are run by the five medical universities.
Since 2020, the quota of residency positions in medical specialities in each
University is allocated by the Ministry of Health. The number of open residency
positions annually is based on the expected need for new consultants to replace
retired physicians. Based on this data, there is huge variation in the level of
interest in different specialities among Generation Z physicians. There are
fields that have significantly fewer applicants than there are positions
available: For example, certain specialities in internal medicine. On the other
hand, some fields have many more applicants than there are positions, and among
them is Plastic Surgery.
For many years, Plastic Surgery has been one of the most sought-after
specialities. However, we are already seeing less interest in some other
surgical specialities. Unfortunately, there are no surveys done among medical
students or young physicians on their motivations when choosing a specialty, but
talking with medical students one gets a sense that Plastic Surgery might be
considered as an “easier” and “less heavy” surgical speciality, mostly performed
inside office hours. This appears to be the case among current trainees as well
– there is perhaps less interest in demanding reconstructive surgery and
microsurgery compared to previous generations.
For our society, there is no expectation to have a shortage of residents in the
future. However, choosing residents that can be expected to have an interest in
demanding reconstructive surgery in University Hospitals, years of on call duty
etc, is a cause of concern. On the other hand, there seems to be more interest
to shift to private practice early on, and growing competition between private
practitioners can be expected.
What are the main challenges?
One important challenge in recent years is finding people to work in smaller
Central hospitals (especially in rural areas). The University hospitals have
been able to fill the positions quite well so far, but some smaller hospitals
are dealing with lack of work force and must rely on outside consultants. This
is likely to get worse and a part of a larger phenomenon where young
professionals are moving more and more to the largest cities. For the university
hospitals, the challenge seems to be keeping the consultants from shifting to
private practice. To become a fully competent microsurgeon, it often takes years
after the residency, and therefore the hospitals canʼt afford to lose these
highly professional individuals.
What role does the new relevance of work-life balance in coping with everyday
life play for Plastic Surgery?
Anxiety, depression and burnout are a rising concern among young adults. Some
younger doctors have even started to request a part time work even during
residency. Also, workdays are expected to finish inside office hours. This
causes challenges especially in reconstructive microsurgery. Operations in this
field often last beyond normal working hours. Therefore, getting exposure to
this work requires the residents to stay until the operations finish which,
unfortunately less and less residents are willing to do. Unfortunately, it seems
that the general feeling among reconstructive microsurgeons in Finland is that
less and less residents are staying after office hours. This leads to widening
and flattening of the learning curve in microsurgery.
What consequences do you expect for continuing education in Plastic
Surgery?
The growing imbalance between the interest in aesthetic surgery compared to
reconstructive surgery creates challenges. This can be observed in congresses
that have parallel sessions – one can expect a full lecture hall when aesthetic
topics are presented, and meanwhile little interest in reconstructive topics.
Yet, most work in the field of Plastic Surgery in Finland is reconstructive
surgery. Furthermore, the operations are getting more demanding, reconstructive
procedures have been getting more refined, supermicrosurgery has become
mainstream and patients are getting older and sicker. Therefore, higher
competency in reconstructive Plastic Surgery is required.
Shifting to private practice early on is often a poor choice, since opportunities
for continuing education for aesthetic surgery in Finland are poor. There aren’t
many learning positions available, because of the competition among private
practitioners. Mostly, one is responsible for their own education. Fellowships
are expensive to arrange and therefore tend to be short. For the colleagues
working in university hospitals, support from the senior consultants is always
available, and congresses are at least somewhat a part of the curriculum.
However, money for education is unfortunately being cut because of budget
concerns, and therefore opportunities to attend congresses are getting more
limited.
Social media
Obviously, there are many professionals from previous generations that have
adopted social media for their main marketing platform and have built a somewhat
strong following on their accounts. However, the Gen Z has been exposed to
social media for their entire life, and thus we are likely to see an influx in
social media presence among Plastic Surgeons of the Gen Z. There are some
concerns about this. Firstly, there is public interest in aesthetic surgery, and
we are already seeing a lot of content put out by people without Plastic Surgery
training, that can be misleading, false, and in some cases, harmful to the
patients. There is no peer review in social media, and very little can be done
to correct false information. The terms cosmetic surgery, aesthetic surgery and
aesthetic medicine are getting mixed up, blurring the lines of Plastic Surgery
as a speciality. Also, social media creates a false impression of our
speciality, since there is almost no content anywhere regarding reconstructive
surgery. It comes as a surprise to even medical students, that the bulk of work
among Plastic Surgery is not aesthetic treatments. Here might be a silver
lining, when some of the Gen Z residents are already publishing interesting and
accurate content on their specialization.
France (Jacques Saboye, past president to SOFCPRE)
France (Jacques Saboye, past president to SOFCPRE)
Born between 1998 and 2012, this generation grew up when the Internet and social
media already existed. They have therefore been immersed in a culture of social
networking, openness to the world and free access to knowledge. This is not the case
for the previous generation, the so-called millennials, who discovered the internet
in their teenage years.
For Gen Z, this openness to the world has enabled rapid, immediate and widespread
access to scientific knowledge, unprecedented in the history of humanity. It has
saved a considerable amount of time in the acquisition of knowledge. This access has
also enabled many human encounters, admittedly more virtual than real, but it has
nevertheless broken down many barriers in human relations. It seems that the lack
of
virtual boundaries online where you can be friends with everyone whatever the status
or the background has caught up the reality where the boundaries can be crossed
despite the hierarchy in place at the hospital.
Today, Gen Z are old enough to be medical students or interns; they passed the main
competitive examinations and are arriving in hospitals. We can see the influence of
online education on the students’ behavior.
The academic hierarchy of some, the companionship of others, learning from the
masters or from books - all these are being called into question by this generation.
The university library or the department staff are less helpful than pubmed,
Wikipedia or other tutorials or internet links.
The levelling of social relations means that this generation does not use the
traditional codes in hospital’s departments. For them, the notion of ‘boss’ is
gradually disappearing. Some current heads of department complain about this,
especially as they were trained to respect the all-powerful boss. Students, interns,
assistants, the head of department - everyone is treated the same way, and the
hospital hierarchy is disappearing.
Companionship, the basis of training for surgeons, with the oldest guiding the
youngest, is also disappearing because virtual reality and simulation allow us to
learn faster and probably better, with less risk. The flight simulator used by
pilots will definitely have its equivalent for these young surgeons.
The passion for books is disappearing in favour of the laptop screen. The previous
generation had to make the effort to seek out and buy the books that would shape
their lives as doctors, and they were called by their authorʼs name: the Perlmuter,
the Rouviere or the Netter. The library was the definitive pride of the doctor
throughout his career, present behind his desk, affirming to the rest of the world
the practitionerʼs level of scientific knowledge.
Gen Z has no interest in investing financially in hardcover books. Knowledge is just
a few clicks away, itʼs gigantic, limitless, accessible in a few minutes on the
basis of ‘key words’...
We can see that all this time saved in learning will also have an impact on the lives
of these young doctors. Hours are no longer wasted going to the university library
to search indexes and thesauri, only to find a few articles after an afternoonʼs
work. Research used to take an incredible amount of time; thatʼs no longer the case.
This generation does not want to invest this time in medicine, but in their personal
lives. They will devote more of their free time to other activities such as sport,
leisure or family.
The previous generation, whose only investment was medicine, for whom medicine was
everything, sacrificing family, leisure and friends in the process, is now finding
it difficult to cope with this phenomenon. This new generation is just as committed
to their profession as doctors on a daily basis, but working hours are defined. If
there is a staff shortage or work overload, they see it as a structural issue and
not a « me » problem: itʼs up to the system to solve the issue, not them.
Thereʼs a real generational conflict here. Will this generation become involved in
time-consuming associative and trade union activities, with no ‘return on
investment’ for the benefit of the collective? We canʼt say for sure, but
face-to-face meetings and congresses in different locations in France and abroad are
not at all suited for them, and the travel they will have to do is not in line with
their personal aspirations or their more ecological vision of society.
So, will they be better doctors? Possibly, because they will have a better balance
between their personal and professional lives. The time they devote to their family,
leisure activities and sport
Thereʼs no reason why they should be any less committed to their patients. They keep
their personal and professional lives completely separate. This does not prevent
them from having a passion for their profession as doctors, but it is no longer
exclusive. For Gen Z, life is not just about work.
Germany (Marcus Lehnhardt, president to DGPRÄC), Yonca Steubing
Germany (Marcus Lehnhardt, president to DGPRÄC), Yonca Steubing
Generation Z, born approximately between 1997 and 2012, is increasingly entering the
workforce, bringing new perspectives and specific expectations to professional life.
Their values and approaches to work differ markedly from those of other employees,
presenting both opportunities and challenges in collaborative clinical settings.
This contribution examines the distinct characteristics of Generation Z from the
German point of view, potential points of tension in the workplace, and strategies
to foster productive collaboration in a modern clinic.
Work Ethics and Values of Generation Z
Shaped by a world dominated digital technologies and heightened social awareness,
Generation Z brings unique priorities and motivations to their professional
engagements: Proficiency in Technology: For Generation Z, the use of digital
tools and modern technologies is a fundamental aspect of their professional
environment. They expect work processes to be streamlined and embrace
innovations such as electronic documentation systems, virtual reality-based
training, and artificial intelligence-supported applications. Emphasis on
Work-Life Balance: Generation Z places significant importance on maintaining a
clear boundary between work and personal life. They are generally inclined
toward structured working hours and demonstrate reluctance to engage in overtime
unless absolutely necessary. Orientation Toward Purpose: Members of Generation Z
seek roles that provide a sense of meaning and contribution. In Plastic Surgery,
this often translates into a keen interest in reconstructive procedures,
socially impactful initiatives, and efforts to enhance the overall patient
experience.
Challenges in an Intergenerational Workplace
The divergence in values and work approaches between Generation Z and other
employee groups can lead to challenges, particularly in the following areas:
Generation Z favors concise, informal, and technologically facilitated
communication methods, which may contrast with the more traditional or formal
communication practices prevalent among their colleagues. These differences can
result in misunderstandings or inefficiencies in coordination.
Younger employees tend to prioritize efficiency and clearly defined structures.
In contrast, others may place greater value on flexibility and adaptive
problem-solving. This divergence can lead to disagreements about workflows and
priorities. Generation Z often exhibits a preference for collaborative work
environments with flat hierarchical structures. This perspective can lead to
friction when it challenges established systems or traditional decision-making
processes.
Strategies and Perspectives for Clinics
Integrating Generation Z into clinical workflows effectively requires a
thoughtful approach. It also presents an opportunity to modernize practices and
enhance operational efficiency. The strong technological aptitude of Generation
Z provides clinics with an opportunity to integrate modern innovations into
daily routines. Training programs that utilize virtual reality simulations or
artificial intelligence can engage both younger and experienced staff, fostering
collaboration and enhancing skills. Clearly defined roles, transparent
communication about work schedules, and equitable access to professional
development opportunities are critical to meeting the expectations of Generation
Z. Additionally, adopting a participative leadership style that encourages input
from all employees can strengthen engagement and team cohesion. Structured
initiatives to promote the exchange of knowledge between younger and more
experienced staff members can create valuable synergies. While seasoned
professionals impart practical expertise, Generation Z contributes fresh
perspectives and innovative ideas. Mentorship programs and interdisciplinary
training sessions can serve as effective platforms for this exchange. Flexible
work arrangements, such as guaranteed time for personal activities or hybrid
options for administrative tasks, can enhance job satisfaction for Generation Z
employees while maintaining operational continuity.
Conclusion
Generation Z introduces a transformative dynamic to clinical practice in Plastic
Surgery. Their strengths include a willingness to embrace innovation, a
collaborative approach to teamwork, and a focus on efficiency and sustainability.
These attributes provide clinics with opportunities to modernize workflows and
establish an attractive environment for future talent. To fully harness the
potential of Generation Z, it is essential to address the differences in work styles
and expectations with a strategic and thoughtful approach. By adopting transparent
communication practices, integrating advanced technologies, and fostering
intergenerational collaboration, clinics can minimize potential conflicts and
cultivate a productive and harmonious work environment. Ultimately, such efforts
benefit not only the clinical team but also the patients, who receive care from a
motivated and cohesive group of professionals.
Italy (Franco Bassetto, incoming president to SICPRE)
Italy (Franco Bassetto, incoming president to SICPRE)
What role does the generational shift to Generation Z in Plastic Surgery play
in your national society?
The generational shift to Generation Z has played an important role in our
national Society in terms of a different approach to social media and online
courses. In recent years there has been a constant increase in the use of social
media to inform the population and in the number of online courses (as e. g.
webinars) to train the residents. Finally, there has been much interest in the
use of artificial intelligence both to train the surgeons and to inform the
population as well.
What are the main challenges from your perspective?
The correct and ethical use of social media. Increasingly social media is used as
a showcase by colleagues attempting to influence the population and to “generate
customers”. The challenge will be to identify these behaviours in order to stop
them converting the social media into a tool to “trap” the vulnerable.
What role does the new relevance of work-life balance in coping with everyday
life play for Plastic Surgery?
It is becoming evermore difficult to balance work and life, especially because
both the number of patients and their expectations are constantly increasing
What consequences do you expect for continuing education in Plastic
Surgery?
More and more educational courses will take place in the coming years due to the
constant evolution of products and surgical techniques. Many of these will be
online in order to promote the continuing education and to ensure the normal
performance of the surgical activities.
What role do the digital skills of Generation Z and social media
play?
It’s a major role as Generation Z intuitively promotes the use of social media in
our society in order to train itself and to inform the population.
What structural changes will be necessary in future?
Our society has to become more digitally aware.
Spain (Jaume Masia, past president to SECPRE)
Spain (Jaume Masia, past president to SECPRE)
In many countries, social change is creating new challenges that will also impact
upom the practice of medicine and make adjustments essential. Generation Z has also
arrived in Plastic Surgery and the constantly evolving challenges in patient care,
continuing education and research need to be mastered. The generational shift to
Generation Z (born roughly between 1997 and 2012) in Plastic Surgery in Spain
reflects broader global trends, but with nuances influenced by Spanish culture,
societal attitudes, and healthcare systems.
The emergence of Generation Z Plastic Surgeons in Spain is poised to reshape the
future of the specialty, bringing fresh perspectives, technological adeptness, and
evolving priorities. Their unique traits and generational experiences influence how
the field is practiced, taught, and perceived.
Generation Z Plastic Surgeons will face unique challenges and opportunities as they
navigate careers in Spain’s public healthcare system. Their approach will likely be
shaped by their values, technological fluency, and a commitment to systemic
improvements.
Here’s a closer look at the potential impacts of this shift:
-
Advocating for Better Resources and Infrastructure
Addressing Resource Constraints:
Public hospitals in Spain often face budget limitations, leading to long
wait times and limited access to advanced techniques in Plastic Surgery. Gen
Z surgeons are likely to push for increased funding and better
infrastructure to modernize public healthcare.
Technology Integration:
They may advocate for the adoption of state-of-the-art tools like 3D
imaging, robotic surgery, and advanced microsurgical instruments in public
hospitals.
-
Embracing Holistic Patient Care
Balancing Aesthetic and Reconstructive Work: Public hospital Plastic
Surgery often prioritizes reconstructive cases (e. g., trauma, cancer
reconstruction, congenital deformities) over purely aesthetic procedures.
Gen Z surgeons will likely embrace the opportunity to make meaningful
impacts on patients’ quality of life while balancing this with innovation in
aesthetic surgery.
Patient-Centered Approaches: This generation is sensitive to
individual needs and will focus on personalized care plans, even within the
constraints of public systems.
-
Driving Efficiency and Reducing Backlogs
Streamlining Workflows: Gen Z surgeons are adept at leveraging digital
tools to optimize scheduling, streamline patient pathways, and reduce
administrative burdens.
Innovative Techniques: Their preference for minimally invasive and
hybrid approaches can reduce operating times and recovery periods, easing
patient throughput in public hospitals.
-
Promoting Equity and Access
Expanding Services for Underserved Groups: Gen Z surgeons are likely
to focus on ensuring equitable access to reconstructive and aesthetic
procedures for all patients, including marginalized populations.
Addressing Regional Disparities: They may champion programs that bring
advanced Plastic Surgery services to underserved regions of Spain, reducing
the urban-rural healthcare gap.
-
Tackling Burnout and Work-Life Balance
Cultural Shift in Work Practices: Generation Z values work-life
balance and mental health. They may advocate for more sustainable working
hours, better staffing ratios, and improved support systems within the
public hospital environment.
In Spain public hospitals often have restricted budgets, limiting access to
cutting-edge tools and materials. Salaries continue to be very low compared
to most EU countries. This situation, together with a high demand for
cosmetic surgery, means that currently only a small number of residents who
complete the specialty want to stay in the public health system and in
university hospitals.
If we take into account that in the next 5 to 10 years there will be a very
high number of retirements, the lack of Plastic Surgeons in the public
health system will be dramatic. Currently we are already importing many
doctors from Eastern European countries such as Romania and Poland, as well
as from countries that for years have had an overproduction of specialists
such as Italy. The fact that most professionals want to maintain a balance
between work life and family or personal life means that many Plastic
Surgeons do not want to extend their daily work hours and therefore it is
increasingly difficult to perform long surgeries such as reconstructive
microsurgery.
-
Evolution of Medical Education and Training
Adoption of New Learning Modalities: Gen Z surgeons are likely to
transform medical education by incorporating virtual reality (VR),
simulation-based training, and collaborative learning platforms.
Focus on Work-Life Balance: They may advocate for reforms in training
that promote better work-life balance, addressing burnout and mental health
challenges common in the medical field.
-
Advocating for Public-Private Collaboration
Leveraging Private Resources: Gen Z surgeons may seek innovative
public-private partnerships to bring advanced technologies and techniques
into public hospitals, such as sharing surgical innovations or training
opportunities across sectors.
Addressing Patient Overflow: By collaborating with private clinics,
they can help manage high patient volumes and reduce wait times in the
public sector.
-
Embracing Diversity and Inclusivity
Cultural Sensitivity: Generation Z’s focus on inclusivity will lead
them to champion policies and practices that respect the diverse cultural,
gender, and socioeconomic backgrounds of Spain’s population.
Expanding Gender-Affirming Surgeries: They are more likely to advocate
for increased access to gender-affirming procedures within the public
system.
-
Global Collaboration and Medical Tourism
Collaboration Across Borders: Comfortable in a globalized world, Gen Z
surgeons may forge international collaborations, learning and sharing techniques
with peers worldwide.
Boosting Spain’s Medical Tourism: By leveraging Spain’s reputation for quality
care and affordability, they can attract more international patients, especially
those seeking state-of-the-art procedures.
Conclusion
Generation Z Plastic Surgeons in Spain are likely to bring a fresh perspective to
the
public hospital system, advocating for modernization, equity, and holistic patient
care. While challenges such as resource constraints and administrative hurdles
persist, their adaptability, technological fluency, and commitment to systemic
improvements position them as agents of positive change within the Spanish
healthcare landscape. It’s an emergency to advocate for reforms in public hospital
structures and funding.
Türkiye (Cenk Demirdöver, president to TSPRAS)
Türkiye (Cenk Demirdöver, president to TSPRAS)
When discussing the generational shift to Generation Z in the current practice of
Plastic Surgery, it’s important to consider not only the broader global trends but
also how they manifest in specific societies, such as Turkey, where cultural,
economic, and social factors influence both the practice of Plastic Surgery and the
expectations of patients. Due to the geopolitical position of Turkey, The Turkish
Society of Plastic Reconstructive and Aesthetic Surgeons (TSPRAS) faces unique
challenges and opportunities compared to Plastic Surgery societies in other
countries.
In Turkey, as in many other countries, Generation Z’s growing interest in Aesthetic
Surgery has had a significant impact on the field of Plastic Surgery. However, the
role of this shift in Turkey may be influenced by cultural, social, and economic
factors that differ from other nations.
Increased Demand for Aesthetic Procedures
As social media and influencer culture gain traction in Turkey, especially on
platforms like Instagram and TikTok, younger people are increasingly exposed to
beauty standards that emphasize aesthetic enhancement. This has led to a rise in
demand for both surgical and non-surgical procedures. The TSPRAS must therefore
adapt to meet these demands, balancing aesthetic trends with ethical
considerations.
Balancing Demand and Ethical Responsibility
There is a growing trend among younger patients who want procedures that may not
always align with their best interests or long-term health. For instance, the
trend of seeking overly dramatic facial modifications for Instagram-style beauty
can lead to unrealistic expectations. Plastic Surgeons in Turkey will need to
focus on patient education and psychological screening, ensuring that patients
are making informed decisions and are not motivated by fleeting trends or body
dysmorphia.
Influence of social media
Social media influencers in Turkey, like in other countries, can shape beauty
standards and promote Plastic Surgery. Turkish Plastic Surgeons may need to
navigate the influence of these personalities, ensuring that patients are
well-informed and that trends promoted online align with responsible medical
practices.
Social media platforms like Instagram, TikTok, and YouTube set beauty trends, and
Turkish patients, especially younger ones, often come in with specific images
from influencers. This can lead to both positive and negative outcomes, as some
may desire unrealistic or overly edited looks. Surgeons must manage these
expectations and educate patients on what is achievable and healthy.
Plastic Surgeon Well-Being
Plastic Surgeons themselves are under increasing pressure to balance their work
with personal time. Long working hours, frequent surgeries, and a high volume of
patients, especially with the influx of medical tourism, can lead to burnout.
Fostering a better work-life balance for surgeons can lead to better mental
health and improved patient care.
Patient Expectations
As younger patients, particularly Generation Z, prioritize mental health and a
balanced lifestyle, they may expect more flexible scheduling, shorter recovery
times, and less invasive options. Non-surgical procedures like fillers, Botox,
and laser treatments, which require less downtime, could grow in demand as
patients seek quick results without interrupting their busy lives.
Workplace Flexibility and Technological Advancements
Telemedicine and virtual consultations may become increasingly important as
patients demand more flexibility in managing their time. Surgeons may need to
integrate these technologies into their practice, providing consultations or
follow-ups remotely, which could align with work-life balance needs for both
patients and surgeons.
Continuing education and Emphasis on Modern Techniques
Surgeons will need to stay up to date with minimally invasive procedures, such as
Botox, fillers, and laser treatments, which are growing in popularity. Training
programs will need to be updated to incorporate these technologies alongside
traditional surgical methods.
Digital Literacy
Surgeons will need to improve their digital literacy, not just in patient care
(e. g., telemedicine, virtual consultations) but also in marketing and managing
their online presence. Given the role of social media in shaping patient
desires, Plastic Surgeons must learn how to engage ethically with patients and
understand the digital tools that influence their practice.
In conclusion, the generational shift toward Generation Z will have a significant
impact on Plastic Surgery in Turkey. The Turkish Society of Plastic
Reconstructive and Aesthetic Surgeons (TSPRAS) will need to adapt by embracing
technological advancements, strengthening ethical practices, and addressing the
unique demands of younger patients while ensuring that surgeons maintain a
sustainable work-life balance. These changes, when properly managed, can ensure
that Plastic Surgery continues to thrive in Turkey while prioritizing patient
well-being.
United Kingdom (Paul McArthur, incoming president to BAPRAS)
United Kingdom (Paul McArthur, incoming president to BAPRAS)
What role does the generational shift to Generation Z in Plastic Surgery play
in your national society?
Within our national society (BAPRAS) we fully support, both with member input and
financially a standalone trainee association - PLASTA (Plasta.org.uk). PLASTA
has within its own organisation a full committee structure. As such we, in
BAPRAS request trainee representation on all our committees from council down.
This has proven invaluable in providing an insight into the needs of the trainee
both in their professional development and understanding the generational
differences between the established consultant body and the up and coming ‘Gen
Z’. This important interaction and contribution has also allowed the established
- baby boomer - generation to understand more fully the value of the need to
make time for their own extra professional development to facilitate a more
balanced approach to life in general.
What are the main challenges from your perspective?
The main challenges come from recognising the impact that several changes have
made to the amount of time available for training. The introduction some years
ago of the European working time directive (EWTD) had a significant impact on
the time trainees had available to them to gain the required competencies. It
has also resulted in the loss of the the old style “firm” in which trainees
would be part of a fixed team for 3–6 months. The EWTD lead to the introduction
of shift patterns in which trainees have lost that direct “team” connection.
This, together with a reduction in the time spent in a training program (now 6
years). As a consequence, we have moved towards a competency based rather than
apprenticeship style training program. This has of course brought about further
challenge with increased paperwork for the trainee, rigorous annual review and
less time / exposure to on all emergency / trauma management. Moreover, most
trauma surgery in now delivered during daytime rather than through the evening
and into the night. This can impact on the trainers and trainees’ availability
and the conflict between elective and trauma opportunities.
What role does the new relevance of work-life balance in coping with everyday
life play for Plastic Surgery?
Gen Z understand the value and appreciation of Work-Life-Balance and perhaps
older generations can learn from this. However, we must also consider the impact
that the covid pandemic had on all of us. We spent many months working a in very
different way and so even the baby boomers saw the value of time away from work
- this is highlighted by a number of early retirements. We are increasingly
becoming aware and accepting of the concept of “burn out” in surgeons. Adopting
a more balanced approach may help many of us to be more productive for
longer.
What consequences do you expect for continuing education in Plastic
Surgery?
In relation to continuing educational requirements. We are reviewing how
education in delivered nationally, regionally and in the respective hospitals.
BAPRAS provides a national on-line training programme that trainees are expected
to complete. We have also developed and deliver an additional on-line resource
available to all trainees eLPRAS – also made available to low- and middle-income
countries. Online learning has the advantages of greater geographical reach - as
noted with our national training programme but can lack the interaction and
direct social networking associated with the coffee breaks etc.. It is also a
cheap alternative for the trainee as there are no travel or accommodation
expenses. The limited number of years in training combined with the reduced
hours per week also limits the specific opportunities for trainees but they have
to work around this to gain their indicative numbers (logbook) which forms one
requirement for completion of higher surgical training.
What role do the digital skills of Generation Z and social media
play?
As a group the ‘Gen Z’ trainees are using their digital skills to great effect,
not only in communications but also through innovation. There are many apps
developed by trainees on the Apple Store, an example of this is the Merseyburn
App®. There is a greater acceptance of social media within
medicine by Generation Z and at the same time, concern among the boomers due to
the limited regulation of acceptable content and the potential risk to patient
confidentiality.
What structural changes will be necessary in the future?
In recent years we are beginning to see the impact and benefits of medical school
recruitment with the gender balance changing within surgery and therefor in
Plastic Surgery. For more than 10 years BAPRAS has conducted a national work for
planning survey. This provides detailed information on the surgeons of all
grades, the gender split, whole or part time, the subspeciality activity and a
host of other data points as from every plastic surgery unit in the UK. The data
has demonstrated a number of year on year trends, including the rise in the
total number of Plastic Surgeons, a change in the whole time part time ratios,
an increasing number of female colleagues. There is a growing acceptance that
families require maternity/paternity time together with days for family. With
this comes a greater change in working patterns when one or both partners´
choose to work less than full time. This can have significant impact upon any
departments activity or requirement to fill the activity with additional staff.
Going forward we will need to be more flexible in our planning, perhaps more
creative with the use of our physical resources - out patient / theatre capacity
- with an increasing change in job planning e. g. weekend working with time off
in the traditional week - Mon to Friday. There is a balance to found, hopefully
between the need for a department to provide a full service to our patients and
support our colleagues enjoying a full and well balanced but productive
life.
United States of America (Gregory R.D. Evans, past president to ASPS)
United States of America (Gregory R.D. Evans, past president to ASPS)
What are the main challenges from your perspective?
What is Generation Z? It is often defined as the social generation that grew up
with access to the Internet and portable digital technology from a very young
age – They has been dubbed as digital natives. Some of the negative effects of
screen time causes Generation Z to live more slowly than their predecessors,
having a lower rate of teenage pregnancies and consuming less alcohol.
Generation Z teenagers are more concerned than older generations with academic
performance and job prospects and are better at delaying gratification than
their counterparts in the 1960s. Their youth subcultures have not disappeared,
but they have been quieter. Globally there is evidence that girls in Generation
Z are experiencing puberty at a younger age compared to previous generations.
Allergies are more prevalent than the general population. Around the world,
members of Generation Z are spending more time on electronic devices and less
time reading books, with implications for their attention span, vocabulary,
academic performance and future economic contributions.
Websterʼs online dictionary define Generation Z as the generation of people born
in the late 1990s and early 2000s. The Oxford dictionary defines Generation Z as
a group of people who were born between the 1990s and early 2000s and are
regarded as being very familiar with the Internet. Generation Z is more
educated, well behaved but also stressed, compared to previous generations. The
most important personal values for Generation Z were helping their families and
themselves by honesty and looking beyond their local communities.
The Covid-19 pandemic was difficult. For older members of Generation Z, they were
just joining the workforce while the rest were still in school. While Generation
Z proved to be less resilient than the older cohort, their fundamental values
did not change. They remained open to change with an easier transition to a
hybrid school and remote work environment. Generation Z prefer staying at home,
watching television or browsing social media as opposed to visiting museums or
galleries.
Data from statistics from North America (Canada) demonstrated that generation Z
comprises about 18% of the Canadian population. As consumer members of
Generation Z, they typically rely on the Internet to research their options and
to place orders. They tend to be skeptical and will shun firms whose actions and
values are contradictory. Their purchases are heavily influenced by trends
promoted by influencers on social media as well as the fear of missing out
(FOMO) and peer pressure.
Teenagers and young adults are especially vulnerable to depression and anxiety
during adolescence. Generation Z appears to have an increase in potential
depression. General sleep deprivation, along with a lower mood, worsens
emotional regulation of anxiety and depression. Generation Z is the least
religious generation in history. Generation Z is concerned about climate
sustainability and animal welfare, where 79% of Generation Z will go meatless
between once and twice a week. It is the first cohort to have Internet
technology readily available at a very young age with increasing use of mobile
devices growing exponentially with time. This leads to less face-to-face
interactions. Personally, I have noted this characteristic in my interaction
with Generation Z, being more apt to text and prefer zoom meetings than sitting
down for a face to face or even picking up the phone for discussion. Cyber
bullying is not uncommon and has been evident by several of our resident
interactions.
Information from the American Society of Plastic Surgeons (ASPS) indicate that
Generation Z only accounts for about 6% of the cosmetic surgery and non-surgical
intervention across the United States. Generation Z has certainly taken a
different stance from older generations when it comes to how cosmetic surgery
impacts your looks with almost 2/5 revealing they found cosmetic surgery made
people look less attractive. However, Generation Z believes in proactive aging
as opposed to anti-aging. They have grown up in a world where social media is
ubiquitous and therefore thereʼs a pressure to constantly look “great at all
times.” They are more real than millennials and Xers when posting but want less
curated interactions with social media rather than using fake fillers.
Generation Z has a unique experience and outlook with social media. They have
normalized anti-aging treatments and brought them into the mainstream. They have
truly grasped the notion of proactive healing, have spent time and money on
regenerative and preventative treatments such as active skin care and
injectables. They have a significant adverse tendency to go under the knife when
you look at options for cosmetic surgery. However, if Generation Z trend toward
procedures, they include rhinoplasties, toxins and lip augmentation along with
dermal fillers and other non-surgical skin treatments.
When teaching generations Z residents, our approach should change. One
traditionally has always utilized articles and books and journals for teaching
procedures. Now, YouTube videos or “surfing” frequently prior to surgery to
determine what is the best surgical option are common. Generation Z are more
aggressive regarding obtaining “marketers” and a social media presence when
developing a practice than building and determining the amount of office staff
that is required while obtaining and developing a business manager. They assume
that most of their patients will come from social media and that their presence
on social media is a key component to not only marketing but also attracting
patients. Our traditional approach of practicing surgery, and taking care of
patients at all hours, has progressed more to shift work mentality – managing
patients during set time frames. Generation Z do have their uniqueness and
talent. One of the interesting things about Generation Z is that they are and
remain enthusiastic and willing to learn. It is how we teach and change our
approach with different generations that is important. Each generation learns
differently and this will soon become the norm to develop and change the
practice of Plastic Surgery. Plastic Surgery has become a great deal more
marketing and social media than actual referrals of traditional patients and or
referrals by your colleagues. Regardless of what generation you are from or your
background, the challenge to all of us in Plastic Surgery is maintaining our
core principles, delivering safe and excellent patient care and demanding that
people do not only get sick from 8:00 AM to 5:00 PM but throughout the entire
24-hour period of the day. I have been stimulated and educated by our Generation
Z residents. They have helped me with my social media presence and are not shy
in discussing their concerns or their unwillingness to perform actions just
because someone in authority asked them to. We all will continue to develop and
progress in this specialty. And as things change, we must remain ahead of the
curve. Iʼm sure the next generation will have their own challenges which we will
need to adjust. Keeping an open mind, communication and accepting of different
approaches will allow our specialty to continue to grow and expand.
Discussion
This paper provides an overview of the expectations, challenges, and solutions
associated with the generational shift in Plastic Surgery, as seen through the
perspectives of leaders from the largest national Plastic Surgery societies in
Europe and the United States. The authors agree that social changes and demographic
trends will significantly influence the field of Plastic Surgery. Additionally, the
rapid transition to an increasingly digitalized society needs rigorous changes in
patient care, the modernization of digital infrastructure and a shift in mindset and
work-philosophy.
The dynamics of the workforce in Plastic Surgery are shifting, particularly among
younger surgeons, who bring new qualifications, expectations, and goals to the
field. Many young applicants prioritize work-life balance, leading to an increased
focus on pursuing careers in aesthetic surgery [1]
[6]. Furthermore, the increasing
presence of social media and high demand for aesthetic procedures promote this
orientation, leaving reconstructive surgery in a second plane. This generational
shift is likely to impact in resident training models as well. Members of Generation
Z demonstrate lower resilience compared to Generation X but exhibit greater openness
to change, self-improvement, and flexible learning [2]. Although younger surgeons increasingly favour aesthetic surgery due
to better working conditions, a study examining generational differences and digital
experience found Generation Z demonstrated significant precision advantages on the
Da Vinci Skills Simulator (p = 0.019). Frequent two-thumb smartphone typing
correlated with improved Glass Movement skills (p = 0.006), suggesting that early
robotic surgery training during residency could enhance skill development and that
younger generations may find robotic surgery easier due to their familiarity [10].
Following the trend of prioritizing work-life balance and mental health, many young
surgeons trend to shift toward private practice early in their careers, leaving
public healthcare systems with staffing shortages, particularly in rural or
underserved areas. Coupled with the increasing demand for aesthetic procedures
driven by social media, this shift raises concerns about the future workforce for
reconstructive surgery in public hospitals [11].
Burnout remains a critical issue in medicine, particularly among surgeons. According
to the Medscape National Physician Burnout & Depression Report 2018, burnout
rates among physicians reached up to 42%, with surgical specialties being among the
most affected [12]. General surgeons reported the
highest rates, while Plastic Surgeons experienced burnout levels of up to 36%, a
figure that demands serious attention [13].
Burnout often leads to reduced professional engagement and, in some cases, permanent
withdrawal from the workforce [14]. Generation Z,
however, may hold the potential to improve these issues.
Residents beginning their careers often expect an ideal working environment and have
specific workplace preferences aimed at promoting their well-being [15]. A survey of over 700 members of the American
Society of Plastic Surgeons revealed that while more than three-quarters were
satisfied with their careers, only 50% were content with their work-life balance,
with lower satisfaction linked to female gender, working over 60 hours per week,
on-call emergency duties, and a focus on reconstructive practice [16].
The increasing predominance of women in training programs has influenced the daily
routines among residents, but this shift appears to have no measurable impact on the
quality of training or workload 15. For male residents, work-life balance
remains the most important factor influencing job satisfaction, whereas for female
residents, dissatisfaction is primarily driven by financial compensation [7]. Despite women now representing the majority of
medical graduates, only a small proportion choose to pursue careers in surgery,
favoring specialties such as internal medicine. This trend contributes to a growing
shortage of young talent in surgical disciplines, which may negatively impact
medical care in surgical clinics [17].
All interviewed leaders agreed that traditional learning models are increasingly
being replaced by virtual simulations and online resources. Generation Zʼs immediate
access to abundant information and advanced research tools has facilitated rapid
knowledge acquisition while diminishing their use of traditional books and in-person
mentorship. Leaders from Spain and Turkey highlighted that this generation’s digital
fluency is transforming medical education through the integration of
simulation-based training and virtual platforms. This shift has the potential to
provide high-quality education to future surgeons in rural areas or from lower
socioeconomic backgrounds. Additionally, this approach promotes a broader exchange
of knowledge, reducing tunnel vision and enhancing patient care quality through
international collaboration. Therefore, it is essential to ensure that online
resources are rigorously developed and validated to maintain high standards of
education and training.
The “digital natives” generation utilizes the internet and technology not only for
knowledge acquisition but also for communication, promotion, and advertising through
social media. While the widespread use of social media offers undeniable advantages,
concerns about its misuse have become increasingly prominent. In the field of
Plastic Surgery, this misuse is particularly alarming. Unqualified individuals,
celebrities, and influencers often disseminate misinformation about Plastic Surgery,
fostering unrealistic patient expectations and contributing to conditions such as
body dysmorphia [18]
[19]. Ironically, many qualified Plastic Surgeons fail to leverage the
potential of social media to provide accurate information, despite its significant
influence on societal perceptions [20]. Leaders in
the field emphasize the ethical responsibility of Plastic Surgeons to engage on
social media platforms in a manner that upholds professional credibility and
educates the public. Such efforts could help mitigate the spread of misinformation
and improve public understanding of Plastic Surgery [18]. Additionally, the integration of social media into public hospital
settings and medical education could further enhance its utility. Platforms like
Instagram and TikTok, which are widely used by younger generations, could also serve
as valuable tools for academic teaching. By presenting accurate and educational
content, these platforms have the potential to clarify complex concepts for medical
students, patients and improve public health literacy [19].
The growing influence of digital tools aligns with more changes in the medical field,
including shifts in workplace relationships and generational attitudes toward
hierarchy and collaboration. Society leaders from countries like Finland, France,
and Germany observe a decline in adherence to traditional hierarchies and a
preference for more collaborative, and egalitarian relationships. This “leveling”
of
social relations is particularly evident in hospitals, where Generation Z interacts
with their superiors and peers with less formality than previous generations, what
can lead to generational tensions. The German society highlights the need for
strategies to bridge these differences, promoting a collaborative environment that
combines Generation Zʼs innovation with the experience of senior professionals.
To gain more detailed insights, additional data and broader international discussions
are essential. Conducting an online questionnaire through an ESPRAS survey
could address this need, providing a foundation for further dialogue within the
ESPRAS European Leadership Forum (ELF).
Conclusion
The generational shift represented by Generation Z is bringing transformative changes
to the field of Plastic Surgery, reshaping education, professional priorities, and
the dynamics of patient care. This potentially marks a key moment also for Plastic
Surgery, requiring rapid and proactive adaptation to the changing values,
technologies, and professional expectations. This shift is also an opportunity to
rethink traditional models and embrace innovation, looking for a more inclusive,
balanced, and digitally integrated approach to surgery, patient care and education.
Success will depend on collaboration across generations, international leadership,
and a commitment to addressing both emerging challenges and undiscovered potential.
The competition to get human resources into medicine, surgery and Plastic Surgery
has already begun. It will be key to keep all positions attractive to entice those
with the greatest potential into academic Plastic Surgery. By embracing these
changes with visionary thinking and proactive as well as anticipatory planning, it
should be possible to shape a dynamic and sustainable future for Plastic
Surgery.
