Scope of General Surgery with Plastics

[DocHawk]

Hello every one,

Happy new year to you and your families, may you have a blessed and prosperous 2011.

I have few questions. I am a plastic surgery enthusiast and in SF match. I have to admit that I like being a general surgeon and enjoy hernias, colons, gallbladders, carotids etc. I don't mind working 80-90 hours a week or being on call. I just don't want to waste my 6 years of hard work in General surgery by just quitting it.

1. What are the chances to continue practicing general surgery with plastic surgery in future (after PRS fellowship) ?

2. Is that possible to take general surgery call as an attending during PRS fellowship ?

3. Can you build a good plastics practice based on hand, recon, clefts, micro vascular alone ?

4. If i am not interested in aesthetic surgery how would that effect salary or annual income ? any percentage in mind ?

5. Can you actually get to do pediatric / micro vascular cases without a fellowship ? I am assuming we will be able to scrub more of these cases during an extra 3rd year Plastics fellowship.


Please remember that I am not insulting people who likes the aesthetic part of Plastics. I feel that i am not equiped with the personality required to do it.


Peace

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[igap]

Hello every one,

Happy new year to you and your families, may you have a blessed and prosperous 2011.

I have few questions. I am a plastic surgery enthusiast and in SF match. I have to admit that I like being a general surgeon and enjoy hernias, colons, gallbladders, carotids etc. I don't mind working 80-90 hours a week or being on call. I just don't want to waste my 6 years of hard work in General surgery by just quitting it.

1. What are the chances to continue practicing general surgery with plastic surgery in future (after PRS fellowship) ?

2. Is that possible to take general surgery call as an attending during PRS fellowship ?

3. Can you build a good plastics practice based on hand, recon, clefts, micro vascular alone ?

4. If i am not interested in aesthetic surgery how would that effect salary or annual income ? any percentage in mind ?

5. Can you actually get to do pediatric / micro vascular cases without a fellowship ? I am assuming we will be able to scrub more of these cases during an extra 3rd year Plastics fellowship.


Please remember that I am not insulting people who likes the aesthetic part of Plastics. I feel that i am not equiped with the personality required to do it.


Peace

Answers:

1. It's being done by a minority of plastic surgeons. Generally you will be too busy as a plastic surgeon to have a general surgery practice as well. This is also dependent on referral patterns, and the needs of a community. If you are dead set on practicing both general and plastic surgery, it can be done.

2. Although it is possible to take call as a general surgeon, you really do not want to do this. First, you will be too busy as a plastics resident. Two, plastics is a residency and is bound by the 80 hour work week and so you will probably need to keep your moonlighting activities to yourself and hope that your program director does not find out. This is a high stakes gamble for a minimal return on investment. Is it worth risking getting fired from residency just to take some weekend call?

3. Yes, you can build a good plastics practice doing almost any of the things that you learn in residency. The exception is probably craniofacial. In general craniofacial care is best delivered at a center with a craniofacial team consisting of several different disciplines. These patients need to be followed for years by many different doctors and so you will probably not be doing these cases unless you do a CF fellowship and build or work in a craniofacial center. There are some overseas opportunities for clefts or microtia, but most plastics folks would frown on a non-cf trained person doing these surgeries.

Hand, micro, "recon", and aesthetics are all fields that you can do after residency as your comfort level allows, and referral patterns allow. Many residents get enough micro training that fellowships are unnecessary unless you just want another piece of paper. Hand surgery fellowships are probably only necessary if you want a pure hand practice, or are addicted to being a trainee.

4. You can do 0% cosmetic surgery and still do very well. 100% cosmetic surgeons are hurting right now. I recommend witholding judgement on cosmetic surgery until you actually learn how to do it, and see experienced cosmetic surgeons at work. It is pretty cool, and it represents a fun and lucrative part of a practice. Just keep that overhead low, and stay diversified.

5. See my comments above for CF. You definitely will not need a micro fellowship after a 3 year plastics residency. Pick a residency that does a high volume of free flaps and you will be sick of them by the time you are a chief. That said, if you are going to be an academic surgeon, you may want that extra piece of paper.

 

[DocHawk]

Thanks a ton for taking out time and replying.

 

[maxheadroom]

You almost certainly won't be allowed to moonlight during Plastics residency. Work hour restrictions have pretty much killed that. Plus, if you do and your in-service scores/clinical performance are not top notch, you'll lose that privilege almost instantly.

Out in practice it's pretty unusual to see someone doing both GenSurg and Plastics for a couple of reasons. First, you'll piss off the General Surgeons who would otherwise refer to you -- they don't want you doing both mastectomy and recon or other GenSurg work. They want you to refer that to them -- in return, they'll send you work. Second, you won't be taken seriously by the Plastics community where you set up shop. Third, if you join a practice, they won't want anything to do with covering your GenSurg patients.

I think you'll also find that once you're a couple of years into Plastics, your interest in taking care of patients with GenSurg problems will plummet.

 

[igap]

You almost certainly won't be allowed to moonlight during Plastics residency. Work hour restrictions have pretty much killed that. Plus, if you do and your in-service scores/clinical performance are not top notch, you'll lose that privilege almost instantly.

Out in practice it's pretty unusual to see someone doing both GenSurg and Plastics for a couple of reasons. First, you'll piss off the General Surgeons who would otherwise refer to you -- they don't want you doing both mastectomy and recon or other GenSurg work. They want you to refer that to them -- in return, they'll send you work. Second, you won't be taken seriously by the Plastics community where you set up shop. Third, if you join a practice, they won't want anything to do with covering your GenSurg patients.

I think you'll also find that once you're a couple of years into Plastics, your interest in taking care of patients with GenSurg problems will plummet.

I think that you are generalizing too much. There are situations where plastic surgeons who are boarded in gen surg have practices that cover both fields. I know one personally who does this. He is taken seriously by his colleagues, and if any general surgeons are pissed at him, it does not affect his bustling practice. Also, his interest in general surgeon is as high today as it ever has been, and he's been doing the combo thing for 10 years now.

As I previously stated though, it is not common to have this kind of dual practice. But if this is desired, it can be done.

 

[maxheadroom]

I think that you are generalizing too much. There are situations where plastic surgeons who are boarded in gen surg have practices that cover both fields. I know one personally who does this. He is taken seriously by his colleagues, and if any general surgeons are pissed at him, it does not affect his bustling practice. Also, his interest in general surgeon is as high today as it ever has been, and he's been doing the combo thing for 10 years now.

As I previously stated though, it is not common to have this kind of dual practice. But if this is desired, it can be done.

This could be the case, but that's definitely the exception and not the rule. I trained in the Integrated model, so I don't have much experience with this kind of thing beyond what I've seen in the three communities where I trained/practice.

droliver could shed more light on this as he's been in practice for a few years and came through the Independent model.

There are some areas of Plastics where your GenSurg training will certainly augment your Plastics practice. If you like hernias/abdominal wall reconstruction, you'll probably be inundated with patients. It seems as though the General Surgeons in a couple of locations where I've worked have been moving away from abdominal wall reconstruction and I'm not sure why. I would think that they would be more comfortable with component separations than I am, but they want nothing to do with them. Instead, we do them together with them peeling the bowel away and me releasing and closing the belly.

 

[DocHawk]

Thanks guys.

What i am assuming is that if you practice in two different hospitals, one where you do plastics exlusively and then general surgery at another then hypothetically you should not have problems getting consults.

I am amazed why a general surgery trained person would let go an abdominoplasty or ventral hernia repair ?

I am a resident in an academic center where 2 general surgeons have started doing abdominoplasties + ventral hernia repair on there Lap gastric bypasses and sleeve patients.

One more question is are there any reasonable locums offered in Plastic surgery ? If somebody is spending 6-8 month in a foriegn country and then still wants to practice 3-4 months in US then what are the options ?

I have alot of difficult questions for you

 

[surgeon4ever]

Thank you for bringing up this discussion. I had the same question about General Surgery, but didn't want to go forward from being a lurker on the forum

 

[DocHawk]

More input will be appreciated about questions in my last message, especially from seniors like Max head and Dr. Oliver.

Thanks

 

[maxheadroom]

Thanks guys.

What i am assuming is that if you practice in two different hospitals, one where you do plastics exlusively and then general surgery at another then hypothetically you should not have problems getting consults.

I am amazed why a general surgery trained person would let go an abdominoplasty or ventral hernia repair ?

I am a resident in an academic center where 2 general surgeons have started doing abdominoplasties + ventral hernia repair on there Lap gastric bypasses and sleeve patients.

One more question is are there any reasonable locums offered in Plastic surgery ? If somebody is spending 6-8 month in a foriegn country and then still wants to practice 3-4 months in US then what are the options ?

I have alot of difficult questions for you

Not sure I understand your question. I do abdominal wall recon and I'm not General Surgery trained.

As far as being a Plastic Surgeon at one place and a General Surgeon at another, that doesn't seem very workable. Some patients have to go to Hospital A and some have to go to Hospital B.

I appreciate your desire to not throw away your GenSurg training, but it is a RARE Plastic Surgeon who maintains any sort of General Surgery practice, mostly due to lifestyle, money, and ease of practice.

 

[DocHawk]

Thanks Max for the reply, I am already clear on every body's point of view on this subject.

The question I had was about availability of Plastic surgery Locums but anyway .. I guess enough of this discussion.

 

[maxheadroom]

Sorry, missed that one. I'm sure there are some Plastics locums jobs out there, but probably not a ton. I haven't seen any specific ads.

 

[Moravian]

Sorry, missed that one. I'm sure there are some Plastics locums jobs out there, but probably not a ton. I haven't seen any specific ads.

Try CompHealth as a starting place. They have a lot of the locums market. There is also locumtenens.com (I used both my fellowship. I took some vacation time so I could make a few extra bucks to help with bills. But if anyone finds out, you could be fired).

As a boarded general surgeon, I sometimes miss general surgery but not enough to do it anymore. I still do some general on mission trips, but not in my practice. I'm just too busy.

And, as an aside, you really shouldn't be taking care of cleft kids if you're not involved with a craniofacial team. And a couple of clefts a year is not enough to be good at it. I know this because I end up doing revisions from other surgeons.

Best,

--M

 

[maxheadroom]

And, as an aside, you really shouldn't be taking care of cleft kids if you're not involved with a craniofacial team. And a couple of clefts a year is not enough to be good at it. I know this because I end up doing revisions from other surgeons.

Agree, agree, agree