plastic surgery lifestyle

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I'm an MSII (almost MSIII) seriously considering plastic surgery as a career, but I've had several people try to talk me out of it based on the assumption that I will have no life outside of my job. I'm a female, if it matters, but not the type with my imaginary future wedding planned out and names for my nonexistent children. However, family is something that could potentially be important to me someday, as well as continuing with hobbies, friends, and things I enjoy outside of medicine. I will most certainly choose my specialty based on my passion for it and not simply the lifestyle, but it's still something to consider. I worked with an academic reconstructive plastic surgeon last summer and his hours were variable (16 hours some days, 6 others), but I don't know if that's the norm. Can anyone comment on the lifestyle and hours of a plastic surgeon? Do any of you regret choosing this path because of it?

Originally Posted by dootdoodooo

Can anyone comment on the lifestyle and hours of a plastic surgeon? Do any of you regret choosing this path because of it?

The lifestyle depends on your practice setting, scope of practice, and how much money you want to make.

I think that compared to other surgical fields, ours is relatively low stress. You will have a lot of outpatient surgery, clinic procedures, and a small percentage of inpatients. There are days when I operate from 7:30 am to 9:00pm, and other days where I have a half-day clinic and am home by 1pm. I do about 75% outpatient surgery and 25% inpatient stuff. I ususally do my inpatient cases on Monday so by Friday they are home, and I don't have to round on the weekends.

Plastic surgery call is not stressful. On a typical call w/e I will get 4-10 calls from the EDs that I cover. I will go in to sew a lac, or i&d something occasionally. Most of the stuff I get called about I can triage to my clinic the following week. I have made a concerted effort to get to know the ED physicians so they are very easy to deal with on the phone, and they are generally very helpful and respectful.

The nice thing about plastic surgery as a field is that if you want a very low-stress, 100% outpatient practice, you can do that. If you like free flaps, and big recon cases, trauma, etc... you can have that practice too. Or, you can have a mix. It depends to some degree on your practice location, but I think it depends mostly on your ability, and interests. Last week I did some liposuction, a breast aug, two breast recons with tissue expanders, an abdominoplasty, and a free flap for lower extremity exposed hardware. Next week I have some cosmetic office stuff, some more lipo, 2 metacarpal fxs (ED call), some MOHS closures, and I am helping neurosurgery with a scalp recon for which I am not sure what I am going to do yet.

So to answer your question, the lifestyle is what you want to make it. The hours are dependent on how much money/how hard you want to work. And I definitely do not regret choosing plastic surgery. It was one of the best decisions I ever made.

Originally Posted by igap

The lifestyle depends on your practice setting, scope of practice, and how much money you want to make.

I think that compared to other surgical fields, ours is relatively low stress. You will have a lot of outpatient surgery, clinic procedures, and a small percentage of inpatients. There are days when I operate from 7:30 am to 9:00pm, and other days where I have a half-day clinic and am home by 1pm. I do about 75% outpatient surgery and 25% inpatient stuff. I ususally do my inpatient cases on Monday so by Friday they are home, and I don't have to round on the weekends.

Plastic surgery call is not stressful. On a typical call w/e I will get 4-10 calls from the EDs that I cover. I will go in to sew a lac, or i&d something occasionally. Most of the stuff I get called about I can triage to my clinic the following week. I have made a concerted effort to get to know the ED physicians so they are very easy to deal with on the phone, and they are generally very helpful and respectful.

The nice thing about plastic surgery as a field is that if you want a very low-stress, 100% outpatient practice, you can do that. If you like free flaps, and big recon cases, trauma, etc... you can have that practice too. Or, you can have a mix. It depends to some degree on your practice location, but I think it depends mostly on your ability, and interests. Last week I did some liposuction, a breast aug, two breast recons with tissue expanders, an abdominoplasty, and a free flap for lower extremity exposed hardware. Next week I have some cosmetic office stuff, some more lipo, 2 metacarpal fxs (ED call), some MOHS closures, and I am helping neurosurgery with a scalp recon for which I am not sure what I am going to do yet.

So to answer your question, the lifestyle is what you want to make it. The hours are dependent on how much money/how hard you want to work. And I definitely do not regret choosing plastic surgery. It was one of the best decisions I ever made.

Thank you for the thoughtful response. That's definitely great to hear! Some of my concern stemmed from this Medscape survey: http://www.medscape.com/features/sli...on/2012/public
It makes it seem like plastic surgeons all hate their lives and think they're poor. They were only 1% of the survey respondents, but that's out of 24,000 total so it's still a large group. Perhaps just the 2400 grouchiest plastic surgeons took the survey...or maybe a lot of people went into the field for the wrong reasons.

Originally Posted by dootdoodooo

It makes it seem like plastic surgeons all hate their lives and think they're poor. They were only 1% of the survey respondents, but that's out of 24,000 total so it's still a large group. Perhaps just the 2400 grouchiest plastic surgeons took the survey...or maybe a lot of people went into the field for the wrong reasons.

I think most of us went into the field for the right reasons, but we are getting tired of being nickel and dimed by the insurance companies. None of us (expect maybe for the big cosmetic guys) are making as much money as we did 10 or twenty years ago. And while I certainly will admit that money isn't everything, when you're 300k in debt and working your butt off, and third party payers are constantly trying to find ways not to pay you, it gets tiresome.

While I have only been practicing for 4 years, I have seen payment issues escalate, particularly over the past 2 years. I'm working harder now than I was 4 years ago just to keep up with my current salary. As for lifestyle, it really will depend on where you practice, the kind of practice, and how hard you want to work. For me, I'm in an academic setting and I put in 60-80 hour weeks (rounding, operating, clinic, call, paperwork, paperwork, paperwork, teaching and paperwork). When I was resident, I used to watch the attendings go home at 5 or 6. Now that I'm an attending, I watch the residents go home at 5 or 6.

I will go on record saying that I love what I do and I don't do it for the money, but I don't think it's unrealistic to want to get paid for your services, especially after you went to school and trained for 15 years.

Do I sound grumpy? Maybe just a little.

It is like in Nip/Tuck series, maybe with less drama in your personal life!

Originally Posted by dootdoodooo

Thank you for the thoughtful response. That's definitely great to hear! Some of my concern stemmed from this Medscape survey: http://www.medscape.com/features/sli...on/2012/public
It makes it seem like plastic surgeons all hate their lives and think they're poor. They were only 1% of the survey respondents, but that's out of 24,000 total so it's still a large group. Perhaps just the 2400 grouchiest plastic surgeons took the survey...or maybe a lot of people went into the field for the wrong reasons.

1% of 24,000 is 240 not 2400. Pretty big difference....I think it would be hard to argue that is an accurate representation, I think the "grouchiest surgeons responded" theory holds more water.

Oh my gosh how did I screw up that math? haha, I'm going to blame Step 1 studying for messing with my mind. I'm not sure how that survey worked exactly, but like restaurant/hotel/product ratings, people often only bother to respond to things if they really loved something or hated it.

Moravian, that makes a lot of sense. I'm obviously brand new to the world of medicine so I don't know what things were like years ago. I don't even know what it's like to be a surgeon right now! If I had a well-paying job with certain freedoms that were later taken away along with some of the pay, I might be less than satisfied as well.

Originally Posted by Moravian

I think most of us went into the field for the right reasons, but we are getting tired of being nickel and dimed by the insurance companies. None of us (expect maybe for the big cosmetic guys) are making as much money as we did 10 or twenty years ago. And while I certainly will admit that money isn't everything, when you're 300k in debt and working your butt off, and third party payers are constantly trying to find ways not to pay you, it gets tiresome.

While I have only been practicing for 4 years, I have seen payment issues escalate, particularly over the past 2 years. I'm working harder now than I was 4 years ago just to keep up with my current salary. As for lifestyle, it really will depend on where you practice, the kind of practice, and how hard you want to work. For me, I'm in an academic setting and I put in 60-80 hour weeks (rounding, operating, clinic, call, paperwork, paperwork, paperwork, teaching and paperwork). When I was resident, I used to watch the attendings go home at 5 or 6. Now that I'm an attending, I watch the residents go home at 5 or 6.

I will go on record saying that I love what I do and I don't do it for the money, but I don't think it's unrealistic to want to get paid for your services, especially after you went to school and trained for 15 years.

Do I sound grumpy? Maybe just a little.

I was dead-set on academics when I entered my plastics residency, but by the end of it I was largely disillusioned with academia. I watched brutal political battles, bickering over very minor issues, complaining about the residents not having it as hard "these days", complaining about pay... Some attendings had serious entitlement complexes and relied on the residents to do everything for them with very little in return. I heard the line "in the old days..." one too many times.

My fellowship was pretty sweet and I had very little non-op responsibility.

I have to admit that I was worried when I left the familiar comfort of academia. No one encouraged me to go into private practice. In fact I was told that I would "ruin my career" if I didn't take a massively underpaid position as a junior attending at a "name" institution. I even went to a city that was supposedly "saturated".

What I found out is that in private practice, I make a ton of money, work great hours that I set, do everything that I was trained to do, am respected and valued by my community and the hospitals I work in, and I am super happy. Financially my peers in academia cannot believe what I am doing. When they hear about keeping overhead low, keeping my margins high, and taking 3 day weekends whenever I want, they just look at me with blank stares. I have a friend who is a junior attending at a name place who works harder than I do, is under a lot of pressure to publish, has essentially no vacation, and makes 25-30% what I do. He is totally unhappy but he is convinced that he is "supposed" to be in academics.

I say all of this because if any of you guys are thinking about the private route, then don't be afraid. It's actually pretty great, and it is a heck of a lot less stressful, and more lucrative, and I think more fun than academia. I think, looking back, that a lot of the academic culture is about getting you to drink the kool-aid about academics being superior to private practice. I think that we all know that's a fallacy, but it somehow gets promulgated in spite of all of the misery that is on display in academia every day.

Finally, I hear a lot of people say that "I didn't get into this for the money", or something along those lines. That's the kool-aid talking too. I don't know about you guys, but I worked much harder in college, med school, and residency than nearly all of my peers. Part of the motivation to do so was knowing that I would be financially rewarded for the expense and sacrifice of the journey. If you think like that, like I do, then you just cannot stomach the thought of after all of that work, getting paid minimally for what you do. I actually got an offer for 150k + a really hard to break into bonus, for an academic job. That's no joke. By comparison I had multiple offers for 400-550k to start in the pp world. Granted those jobs were in mid-size towns, but you can be a baller on that kind of cash coming out of training in a town like Tucson, or Sacramento. Ultimately I took neither of these and selected a major city and have done much better than I ever thought that I would.

Just food for thought... washed down with some kool-aid.

Amen brother, Amen.

According to me Plastic Surgery is a good carrier option. It is good respectful profession to become a good plastic surgeon one should do lot of hard work during their study session he has to go on deep study about the different and related facts of the plastic surgery. As a plastic surgeon there is a responsibility on the surgeons of their patients. Because patients are fully dependent on their doctors who operating them. So i should say plastic surgeon is a good reputed profession for all who are interested to do it.

Originally Posted by igap

I was dead-set on academics when I entered my plastics residency, but by the end of it I was largely disillusioned with academia. I watched brutal political battles, bickering over very minor issues, complaining about the residents not having it as hard "these days", complaining about pay... Some attendings had serious entitlement complexes and relied on the residents to do everything for them with very little in return. I heard the line "in the old days..." one too many times.

My fellowship was pretty sweet and I had very little non-op responsibility.

I have to admit that I was worried when I left the familiar comfort of academia. No one encouraged me to go into private practice. In fact I was told that I would "ruin my career" if I didn't take a massively underpaid position as a junior attending at a "name" institution. I even went to a city that was supposedly "saturated".

What I found out is that in private practice, I make a ton of money, work great hours that I set, do everything that I was trained to do, am respected and valued by my community and the hospitals I work in, and I am super happy. Financially my peers in academia cannot believe what I am doing. When they hear about keeping overhead low, keeping my margins high, and taking 3 day weekends whenever I want, they just look at me with blank stares. I have a friend who is a junior attending at a name place who works harder than I do, is under a lot of pressure to publish, has essentially no vacation, and makes 25-30% what I do. He is totally unhappy but he is convinced that he is "supposed" to be in academics.

I say all of this because if any of you guys are thinking about the private route, then don't be afraid. It's actually pretty great, and it is a heck of a lot less stressful, and more lucrative, and I think more fun than academia. I think, looking back, that a lot of the academic culture is about getting you to drink the kool-aid about academics being superior to private practice. I think that we all know that's a fallacy, but it somehow gets promulgated in spite of all of the misery that is on display in academia every day.

Finally, I hear a lot of people say that "I didn't get into this for the money", or something along those lines. That's the kool-aid talking too. I don't know about you guys, but I worked much harder in college, med school, and residency than nearly all of my peers. Part of the motivation to do so was knowing that I would be financially rewarded for the expense and sacrifice of the journey. If you think like that, like I do, then you just cannot stomach the thought of after all of that work, getting paid minimally for what you do. I actually got an offer for 150k + a really hard to break into bonus, for an academic job. That's no joke. By comparison I had multiple offers for 400-550k to start in the pp world. Granted those jobs were in mid-size towns, but you can be a baller on that kind of cash coming out of training in a town like Tucson, or Sacramento. Ultimately I took neither of these and selected a major city and have done much better than I ever thought that I would.

Just food for thought... washed down with some kool-aid.

Would you not agree that if practicing at "name" institution, one may have somewhat limited resources and thus, able to offer less to their patients? I'm talking equipment, certain diagnostic evals, lab tests, out-of-dept consultations, allied staff....seems that in PP one would not have as swift access to these kinds of things as they would in a hospital....

Originally Posted by NonTraditional3

Would you not agree that if practicing at "name" institution, one may have somewhat limited resources and thus, able to offer less to their patients? I'm talking equipment, certain diagnostic evals, lab tests, out-of-dept consultations, allied staff....seems that in PP one would not have as swift access to these kinds of things as they would in a hospital....

I actually would disagree with this statement but obviously as I am only a medical student and not an attending, fellow or even a resident, it's just an opinion. A close mentor of mine whom I've been rotating with is a plastic/hand surgeon who is PP but is affiliated with a plethora of hospitals and there has been so many different things that I have seen. Since he's on call for three trauma 1 centers, works at the VA, Shriners, medical director of a med spa, etc. while being pp, he's has access to all of the things that you have listed above as well as the freedom and autonomy of being his own boss. From interactions with his partner and alot of his colleagues who are also PP, many of them choose to focus on only one thing ie. breasts, carpal tunnels, etc. and they're happy with that. He prefers to do mainly cosmetic procedures at his PP and frequently does cases for cleft palates, scar removals, fat harvesting/injections, ORIFs, skin grafts, and everything else if hospitals need him to. Bottom line is (imo of course), you can do whatever you wish to and the scope of what you do and what is available to you is intrinsic to what you feel most comfortable/have experience doing. If you're good at something, your services will be sought after and by running a PP, you just answer to no one but yourself and can choose to avoid the politics and regulations that working in academia would restrict you with.

I think igap's narrative may be a little too simplistic for most people's experience. I'm in private practice 2 man group that we own, and I wouldn't change our setup for a second.

However, running your own private practice is a pain in the ass, and going forward, the ability to practice plastic surgery outside of an institution, multi-speciality group, or ACO is going to be increasingly limited as practices and referrals are funneled to networks of providers rather then independent contractors. While it is not prevalent where I practice, talking to friends in other metro areas there are many places where all the plastic surgeons are employed by hospitals, with the ability to function outside that framework to be very VERY limited. If you're an all cosmetic practice (which is actually very hard to pull off in many areas due to competition), this may not be as applicable, but if you do breast reconstruction, hand surgery, and other types of insurance cases there is a lot of tricky terrain which is only going to get worse. The number of things you have to juggle payrole, rent, employees(groan!), contracts, EMR, credentialing, accounting, etc... is not something that everyone is cut out for. Many people are happier just showing up to work with someone else taking care of all administrative and management issues.

Originally Posted by igap

I think, looking back, that a lot of the academic culture is about getting you to drink the kool-aid about academics being superior to private practice. I think that we all know that's a fallacy, but it somehow gets promulgated in spite of all of the misery that is on display in academia every day.

I would agree that there is some of that attitude in academics, and some of it's justified in that we do the cases that no one else wants, either because of complexity or ability to pay. We (and I'm using the royal we) also know that the vast majority of plastic surgery happens outside academics. I'm in academics because I wouldn't be able to do what I do in a private setting. I also like to teach, and as Droliver pointed out, I don't want the headaches of private practice. I'll take the headaches of academia. It suits me but it's certainly not for everyone.

I hear a lot of people say that "I didn't get into this for the money", or something along those lines. That's the kool-aid talking too.

I will also take some issue with this statement. When I was in college deciding on a career choice (and yes, salary was a factor in my thinking along with being able to contribute back to society), I had several viable options. You might think that a bit stale, the "contribution" part, but it's nonetheless true. I was older when I went to school and had some definite ideas about helping to make the world a better place. I think most of us that go into medicine, whatever the field, have some of that drive. I ended up choosing medicine because of experiences that I had while working part time at other jobs and I won't go into the details here. As I mentioned before, it is nice to get paid for your work and for the time it took to become a practicing physician, but it's not the primary motivator. I would say that if the dollar is what drives you, then you have the wrong job.

I would also second Droliver's comments on the direction of medicine. As reimbursements decline, healthcare organizations get bigger, and pay for performance comes to the forefront, most of us are going to be working for some type of larger entity. It might be a hospital (more like a group of hospitals) or something like a Kaiser or Sutter. I'm not saying it's bad or good, it's just what is coming down the road. Personally, for someone who does pediatric, it's a good thing in that we might actually get paid what we're worth. For the private practice guy, probably not so much.