Acgme Directive To Eliminate Prs Fellowships

[Moola]

Hey y'all,
I hear that that the ACGME has sent some sort of directive to eliminate all plastic surgery fellowships in place of integrated plastic surgery residency right out of medical school. Tell me this isnt true because this will be one hell of a kick in the nuts for ppl already in surgical residencies aiming for PRS fellowships. How long will it take for this to become a reality? Also, what is the trend...are more fellowships going towards integrated residency or vice versa? If this horrible DIRECTIVE becomes a reality, I would almost be tempted to do a whole PRS residency after my existing residency. Crazy s$#t man.


Moola

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[maxheadroom]

Yes, the ACGME has directed the ABPS and RRC of plastic surgery to transition all plastics training to a 2+3 model. There is no timeline as of yet, but the AACPS (Asssociation of Academic Chairman in Plastic Surgery) is taking up the matter in something of an accelerated form. The RRC had already allowed certain programs to start piloting a shortened preliminary component to their programs (most were looking at 2 years, but one program was shooting for one year). While the Traditional (AKA Fellowship) route is not foreseen to disappear in the next couple of years, it is doubtful to be around in another 10 years. The ACGME is being proactive because of pressure from CMS about the cost of training someone in general surgery and then plastics -- it just isn't a good financial option.

 

[Moola]

Do u think the ppl ALREADY in residency, incl PGY1s, can expect to have a good number of fellowship spots to apply to when it comes time to apply? Is it possible to do a full plastics residency after 5 years of GS/ORTHO/ENT residency for those who are crazy enough? Man, this is really scaring me. I would just piss my pants if I found out that when it comes time for me to apply...I am a PGY1...during my PGY-4/5 year, that the PRS door will be permanently shut to me. What do u think, ANYBODY, that the possibility of this is?

P.S. WHEN WAS THIS DAMN DIRECTIVE ISSUED?!!!!

 

[dilated]

Yes, the ACGME has directed the ABPS and RRC of plastic surgery to transition all plastics training to a 2+3 model.

Aren't the vast majority of integrated plastics residencies now 6 total? Are they all going to have to go to 5?

 

[maxheadroom]

True, most integrated programs are currently six years (3+3). My PD is working on the plan to change our program to 2+3, but he's unsure of how the RRC will want changes implemented. As I stated in my earlier post, no one knows for sure how quickly this mandate from the ACGME will be integrated by programs. The ACGME only issued this directive a few months ago. My PD says that at the most recent AACPS meeting that the majority of Traditional programs were starting to explore what/how/when they would make the transition.

Will there be traditional spots available in four years? Probably, although there may be fewer than there are currently.

If plastics is what you really want to do, start now. Get to know the faculty at your program, especially any nationally known ones whose letters/phone calls will be helpful. Start working on some sort of project that you can submit to PLASTIC SURGERY MEETINGS. The medstudents and residents that present at Plastic Surgery Research Council, ASRM, AAHS, ASSH, and the regional plastics meetings have a HUGE leg up on the competition, especially if they're smart and they make an effort to meet other faculty.

 

[JaggerPlate]

This sounds like bad news for people who wanted to do general surgery or something like ENT then a fellowship. This had been my plan for a really long time, and now I'm worried about how competitive these integrated residencies would become ... Any light at the end of the tunnel for someone in my situation (still a pre med).

 

[Faebinder]

I personally think it's a positive thing. You are truly wasting slots by training for general surgery in year #4 and #5 and then going for plastic surgery. Those slots could have been given to someone who truly was interested in general surgery.

Integrated plastic surgery is already the most competitive specialty out there, I can't see it getting "more" competitive. Probably will be a little less competitive once more programs switch over to this system and the supply of applicants increase because less applicants will have finished general surgery when applying and with time, those applicants will become a small minority.

 

[driedcaribou]

Will there be traditional spots available in four years? Probably, although there may be fewer than there are currently.

Oh great...

So much for doing gen surg first in order to get into plastics.

 

[Moravian]

These transition things take time, and they don't always go the way they are planned. Despite the ACGME directive, my opinion is that there will be fellowships after general surgery around for a long time. What, you may ask, am I basing this on?

1. There has been discussion at program directors meetings, at national meetings, and within the academic plastic community about training models. No one can really agree on what and for how long. It's going to time to sort itself out.

2. There are still people in power positions who feel that general surgery trained plastic surgeons are better.

I could be completely wrong about this (it's happened before), but I don't think general surgery as a path to plastics is going anywhere fast.

--M

 

[maxheadroom]

I agree that the Traditional route will probably be around for a while longer, but I think its days are numbered. With CMS looking to cut wasted training dollars, programs are going to have to fund themselves for any training past PGY-5. I'll have to look for the report, but CMS is pretty set on streamlining training because of the excessive cost of teaching a physician. They don't want to pay for 7-8 years of training when they could pay for 5 and get someone with the same qualifications.

I predict that in the next couple of years a large number of Traditional programs will initiate a transition to the Integrated format. Some places will hold-out, but when they have to find their own money to pay salary, benefits, malpractice, and administrative overhead, they'll see the light and change their format.

Short message: if Plastics is what you want, do everything that you can as a medical student to match Integrated or Combined. Traditional positions are only going to follow the current trend of being more and more difficult to obtain, especially if their numbers shrink.

 

[Moravian]

Max has some good points about the funding issue. Money does seem to have a way in dictating the chosen path. That being said, there are many places that could afford to fund the fellowship slots if it comes to that, and of course, there will be some that won't even if they could. However, I'm still on the side of a very slow transition.

I am also in strong agreement one should do everything that they can to maximize their chances of getting an integrated/combined spot the first time around. I see plastics as only getting more competitive (if that's actually possible) and even if the fellowship route is going to be around, those spots are going to be progressively harder to get.

Not to trivialize the issue, but I'll challenge Max to a bet that over the next five years, the loss of fellowship spots is actually going to be quite minimal. Winner gets dinner at their restaurant of choice.

--M

 

[medhacker]

I should be around in 5. I can be sort of the guarantor and bring back the thread at the right time. Yeah, I love bets...

 

[maxheadroom]

Moravian,

I'm not sure where ASPS is in 2012, but I think we can arrange for a pretty sweet meal regardless.