2003 PRS match

[droliver]

PRS match was today. The success rate for applicants has tumbled to only 32%(!) I was told by the secretary here. That is now far and away the most competative fellowship going, beyond the last few years where this was ~ 50-60%.

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[maxheadroom]

Part of the fall may be due to the increasing number of non-integrated combined positions that are open to M4s over the last few years. It seems as though there are lots of programs now that offer a combined format that no one knew was offering the pseudo-integrated position. Think about UCLA, USC, UCSF, NYU, Penn, all combined, but not integrated.

Glad I matched integrated. Makes life happy. Now if only they'd make that 1+4 jump soon . . .

droliver, are you staying at Louisville? Do you get much Kleinert experience there as a resident?

 

[droliver]

Yes I'm staying here. I rotated on the Hand service as a resident & enjoyed it. It's a very strange situation for Plastics & Orthopedics here. The norm @ most places is alternating hand call b/w those service. Here KK&A have ~ 24 hand fellows a year & do all the hand call in the downtown medical complex (5 hospitals). I spend 3-4 months as a hand fellow of my 2 years & don't do any hand the rest of the time unless I choose to do some of my elective time on that service. Ironically, this is prob. NOT a good place to get good hand training during your PRS training because you do it so infrequently. However, if you don't want to do a lot of hand in your practice (an increasing sentiment among plastic surgeons in practice) it works out incredible. I will have NO hand call for the majority of my fellowship which is the traditional bane of plastic surgery call nights & only be taking face call 2-3 nights a month. It works out beautiful & lets the fellows here do obscence #'s of aesthetic cases with our clinical faculty (aesthetic training is by far and away the weakest part of training at almost program)


As far as the match.... the # of positions has been pretty static for the traditional fellowships for the last several years. The match rate falling has to do with a steady surge of application #'s.
There should actually be more spots via this route as I believe Duke, NYU, Emory,& UCLA are abandoning the combined programs they've experimented with. It's become clear to a number of people that the 3/3 model will not work at some places for a variety of reasons.I personally think 4 years of surgery prior would be the best compromise prior to starting plastics, and this may be the future "integrated" model to fall in line with the other specialties with the coming changes in the general surgery specialties. It would suprise me if some of the current combined & integrated programs didn't evolve that way.


When you say "1+4" jump I'm not sure what you mean. I haven't heard any movement for that model discussed in the Plastics forums. Like I pointed out, there have been a lot of hiccups with the attempts by some programs to go integrated. A model like urology (1+4) would be a disaster I think & marginalize the field from its core disciplines.


BTW, congrats on your match. Where are you going?

 

[maxheadroom]

During my interview at UTSW (Dallas), Rohrich said that one of his goals during his time with ABPS is to move training towards a 1+4 or 2+3 or 4. He said that most chairmen at integrated programs felt as though the third year was for sure a waste and that the second year probably didn't add anything besides the rotations with ENT, Ortho, and maybe Derm. He also said that given the federal mandate to reduce redundant training, it made financial sense to get people through more quickly (eventually killing the traditional model). Several other chairs said that they spent the first year of plastics re-training their traditional residents. They liked having 2-3 months per year with their integrated residents to move them in the "right" direction from the beginning.

In contrast, Paletta at SLU is probably going to move his combined program to 4+2 or 3.5+2.5. No one could get a good explanation from him for his reasoning.

I'd say that 2+3 is probably the right setup for plastics. But I haven't been there yet. Looking forward to starting, though.

 

[droliver]

Dr. Rohrich is certainly one of the movers & shakers in academic Plastic Surgery. I get the impression though that his feelings on that model are not shared by a lot of people. The integrated program @ UTSW is prob. the consensus best program in the country, but a lot of the things that make it so do not exist @ most programs. PRS has tremendous power there that does not & will not ever exist at many programs. A main criticism from some of the PD's is that there is a lack of technical skills and maturity with people who start PRS specialization without a pretty complete background prior. It certainly would make the attendings job harder as you'd require a great deal more supervision. I imagine things even out down the road but you can't expect to abbridge training that much and not lose a lot of the skills and perspective that have driven much of the innovation in PRS over the last 75 years