Backup options OTHER than General surgery

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TrapperJohnMD

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Pretty sure I am set on making a career out of PRS. I know the foundation is ~3 years of GS prior to starting the plastics portion of residency. Honestly though I have little interest in general surgery.

Additionally, I compared the rotations that a categorical GS resident does in years 1-3 and what a PRS resident does in the same time frame and, my god, what world of difference, at least at my home program --seemed more like a 1+5 than a 3+3 for PRS.

If people are unlucky and dont match what other things can you do if you are still committed to doing PRS? The 2 things most talked about seem to be:

Research? --yeah, but where...and will it be a paid position? You need to have some sort of income even if you hold off on starting to repay loans.

GS residency as back up? suffer through an additional 2 years of a traditional general surgery program before even considering applying to prs?? Nauseating.

Any other ideas/thoughts out there?

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.....suffer through an additional 2 years of a traditional general surgery program before even considering applying to prs?? Nauseating.

This attitude going into the process pretty much flags you as someone with an attitude that's not likely to enjoy (or do well in) any kind of surgical training.
 
plus his post seems to imply that he hasn't done his research in knowing that all independent PRS program require you to complete your gen surg residency (5+years).
 
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Well, not technically. You can apply as an independent candidate out of ENT, OMFS, urology, orthopedics or neurosurgery, with ENT being the runaway favorite for the non-gen surg folks.

The logistics of applying to any of these very competitive specialties as a "backup" make it practically impossible, as all will require multiple sub-is, strong LORs, specialty-specific research, etc.

And although I'm still a med student, I quite agree with Dr. Oliver.
 
Seriously? This is the response i get to a legitimate post?

I guess I shouldnt have expected much from this site but dang...cut the crap people.

Wanting to go directly into the field instead of going into a back up program flags me as someone who will not enjoy or succeed in surgery? Please. You must be one of the few people that enjoy jumping through more hoops rather than attaining your goal directly. I realize that the specialties are connected on some cerebral level and any skills you learn in those two extra years can only make you a better plastic surgeon -that is obvious. Is it a path to plastics? Yes. Is it necessary? No. Therefore why would I want to spend another 2 years in training (8 years vs 6) when it is not essential to my career. What is so wrong with being nauseated about having to do 2 more years to complete a 5 year residency in general surgery that trains you to be A GENERAL SURGEON? If it were that essential then combined/integrated programs wouldnt exist. Dr. oliver i know this is the route you took (GS+PRS) so i understand why you would take offense to me saying i want to take the shorter, integrated route, but you are premature at judging my motivations and attitudes.

I havent done my research about independent programs? Come on man. My post was partially about doing GS as a back up, getting through 2 extra years to complete the residency and then apply for PRS (ie the independent route). While i didnt come out and say "apply to an independent program" I thought it was implied. Lots of plastics applicants apply to both with GS being a BACK UP.

I understand that indie programs require complete training in GS, ENT, ortho, uro..and others. Couple problems there: OMFS requires you to be a dentist (i'm not), URO is an early match in January so thats out, and ortho/neuro/ ENT...well why would you apply to any of those if your ultimate goal is PRS?? I'm NOT saying any of those are good ideas for back up...that would be dumb, way to competitive and specialized --youre just as likely not to match in them either. But GS on the other hand, if you are interested, have decent stats, a pulse, and are from an allo school you will match, period...like it or not it is the least competitive of all surgical residencies --But thats not my point. If your ultimate goal is PRS from the start then why bother with another specialty? Cut out the middle man and shoot for an integrated/combined spot right out of the gate!

What i am saying is I know these integrated/combined programs are rare, few, coveted positions --the most competitive specialty we have in surgery. SOOOO...just like way back when you were applying for medical school: surely you had a back up plan...ie reapply, work, research, another career path, DO school, whatever. And the thought of having to deal with that rejection after so much hard work is nauseating --at least to me.

I'm missing the part where I'm flagged for gloom and doom in surgery or that I havent done my research, or that its practically impossible to apply to GS as a back up to PRS....what gives folks?

Even though it seems I've disgusted the good people of this board with admitting I've got a back up plan, and that I would prefer my goal over my back-up -- I'll ask the original question again:

What other realistic options are you considering if you dont match straight plastics out of med school?
 
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Hello,
I think what Dr. Oliver was getting at with his comment is that potential PRS students who disdain GS so much generally will not like the mundane aspects of any residency program. Believe me, there are a lot of unpleasant aspects of PRS residency as well. Somehow that sacral decub that has been sitting on the floor for 8 months becomes an emergency consult at 8pm on Friday night for urgent transfer to your service. You may or may not have that attitude but Oliver and others on this board went through the residency gauntlet and have seen a lot of students come and go.

I would agree with him that the disdain you show for general surgery in your post would be a red flag to me if I were interviewing you. I have seen students match into integrated programs with that attitude and unfortunately be miserable as hell in plastic surgery as well. Again, you may not fit that mold but I am going by what I read in your original post.

The most realistic backup plan is general surgery unless you have outstanding stats, outstanding recs, outstanding research etc. Sometimes even the best candidates get unlucky and maybe a couple years of research would make you more competitive. I can't answer whether that would be paid or not but just make sure it is at a high powered institution with tons of publications per year and a good track record of having students go out of the lab and into plastics. Whoever is running that lab will expect you to have a great attitude about doing the research and fully commit to doing your best work with a smile on your face. Not everything in life works out like we want it to. Most of the PRS applicants have suffered little failure in their lives and not matching is the first. It can be devastating. How the person gets back up and keeps going determines the course of the rest of life. Good luck.
 
TrapperJohnMD I know some aspects of your post has been discussed before. But I do think its still unique and I love how you just got to the point lol. I typically here people go into ENT, or Ortho, Uro prior to PRS, and I know you know that already. But what i want to add to that is does the plastics being your first choice hurt your chances in the other specialies since they know you would rather be a plastic surgeon. 😱 And if so would that theoretically make doing a year in a high powered research position the lesser of two evils in terms of hoops to jump through if you don't match right away?
 
does the plastics being your first choice hurt your chances in the other specialies since they know you would rather be a plastic surgeon.

It can assuming you tell them. If you don't match into plastics it doesn't automatically mean that ENT or Ortho will want you.

And if so would that theoretically make doing a year in a high powered research position the lesser of two evils in terms of hoops to jump through if you don't match right away?

Doing research for a year has its own drawbacks. You might have to start paying your student loans back during that year. If you went to a private med-school that can easily eat up your entire salary as a researcher. You might be able to get an economic hardship deferment but I guess it would depend on your particular situation. It might also mean that you get hosed at some point in residency with payments. I would make sure that you have a lot of monetary support from various sources if you were to pursue that route.

Another drawback about a research year is that you still might not match and they might just use you for cheap/free labor. Believe me I know that general surgery is an extremely difficult residency but if you don't match, at least you have a spot that will advance you towards a career in plastic surgery. If you do 2 years of research and don't match then you truly are hosed. You will forever have that stink on you and I hope you like working as an FP in BFE because that is where you are going. Obscurity is in your future. If you do general surgery and are motivated and work hard the chances are you will match into a plastics fellowship. If not you can do a year of hand and reapply. During the last 2 years, all of the fellows who were doing hand at Jewish Hand Care Center matched. 2+6 or 7 still = 8 to 9 (research track). 5+3 = 8. 5+1+3 = 9. The General surgery route is probably safest.

Here is the hard truth - plastic surgery is a damn hard residency to get. Even if you match straight out of medical school you will still have to make enormous personal sacrifices to make it through.
 
Not everything in life works out like we want it to. Most of the PRS applicants have suffered little failure in their lives and not matching is the first. It can be devastating. How the person gets back up and keeps going determines the course of the rest of life. Good luck.

👍

Very well said.
 
Hello,
I think what Dr. Oliver was getting at with his comment is that potential PRS students who disdain GS so much generally will not like the mundane aspects of any residency program.

I just dont buy it. Why do I have to be gung-ho about GS to be able to love plastics or any other specialty? And who actually DOES like the mundane aspects of their residency? You cant get your jollies off of every single facet of your chosen career path --just not realistic.

Believe me, there are a lot of unpleasant aspects of PRS residency as well. Somehow that sacral decub that has been sitting on the floor for 8 months becomes an emergency consult at 8pm on Friday night for urgent transfer to your service.

Still, I would rather deal with the ulcer than seeing: an appy, gall-bladder, splenectomy, hernia, SBO, etc at 8pm on friday. In fact, I would be up for dealing with the decub at 8PM, then following in the same OR with a replant, facial trauma, hand case, or burn, etc. PRS is awesome...pain in the ***** cases/schedules arent near as a painful when you like the pathology and are fulfilled in the work you do.

You may or may not have that attitude but Oliver and others on this board went through the residency gauntlet and have seen a lot of students come and go.

I would agree with him that the disdain you show for general surgery in your post would be a red flag to me if I were interviewing you. I have seen students match into integrated programs with that attitude and unfortunately be miserable as hell in plastic surgery as well. Again, you may not fit that mold but I am going by what I read in your original post.

I have to disagree. URO and ENT resdients have to deal with a year of general surgery before really starting their specialty. I dont think you'd find many that would say they were pumped to be on the general service and I seriously doubt any would sign up for another year, given the option. In fact many URO residencies nationally are actually SHORTENING the GS requirement from 2 to 1. Plenty of uro and ent residents that dont much care for general surgery go on to throughly enjoy uro/ent after intern year, and dare I say, some may even enjoy a "bad" day in uro/ent over a "good" day in general surgery --why is it so wrong to feel the same way in plastics? I just dont get where the red flags come in --I am interested in plastic surgery: the variety, pathology, techniques, outcomes, advances and research all give me a mental erection. General surgery, while it has its moments, does not even come close to driving me like that. And I honestly dont understand why that is an issue or a red flag.

I know that many plastic surgeons got their foot in the door through the GS route. Say you were into plastics and had to slog through GS --or even if you werent originally, say GS was your baby --but somehow somewhere you became interested in PRS during GS residency and then had to apply to the competitive independent programs. I can see where you would be a bit offended that someone who wants to attain your endpoint (PRS) using a different, shorter, more direct route (ie integrated spot). But that doesnt give you the perspective to say that my attitude isn't fit for PRS, or surgery in general.

Not everything in life works out like we want it to. Most of the PRS applicants have suffered little failure in their lives and not matching is the first. It can be devastating. How the person gets back up and keeps going determines the course of the rest of life. Good luck.

I understand this. Personally, I've fallen off the hoarse a few times in my life and as a non-trad student, so if (god forbid) I dont match, I will recover. My original post though was trying to stimulate discussion amongst the potentials/vets that got in unconventionally about the diversity of backup options available.
 
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Why do I have to be gung-ho about GS to be able to love plastics or any other specialty? And who actually DOES like the mundane aspects of their residency? You cant get your jollies off of every single facet of your chosen career path --just not realistic.

You don't have to be gung-ho about GS. I wasn't either. You do have to have a positive attitude when you are on the service and leave the 'I'm a plastic surgery resident' entitlement attitude at the door. I don't know you, I don't know what your attitude is. I'm not attacking you. You simply won't be able to hide your disdain for GS when you are on those services and you will suffer greatly for that attitude.

till, I would rather deal with the ulcer than seeing: an appy, gall-bladder, splenectomy, hernia, SBO, etc at 8pm on friday. In fact, I would be up for dealing with the decub at 8PM, then following in the same OR with a replant, facial trauma, hand case, or burn, etc. PRS is awesome...pain in the ***** cases/schedules arent near as a painful when you like the pathology and are fulfilled in the work you do.

Me too but guess what, there are dues to pay before you get to make choices like that and you haven't paid yet.

General surgery, while it has its moments, does not even come close to driving me like that. And I honestly dont understand why that is an issue or a red flag.

Because you will be on those services for at least 3 years my friend, and by the end of your 3rd year you will be expected to be able to lead other residents. If you truly disdain general surgery you won't be a good resident during those 3 years. I didn't like general surgery either, especially the butt cases, but you absolutely have to keep a positive attitude. When I was in college I hated the fact that I had to take stupid humanities classes like survey of film and quest for human destiny but you know what? I learned a lot from those classes and over the years they have become my favorites. You will learn a lot from general surgery if you keep an open mind. You will have a great time with your co-residents but you can't approach it with disdain or you will suffer.

I've fallen off the hoarse a few times in my life and as a non-trad student, so if (god forbid) I dont match, I will recover.

That is probably your single biggest strength. If you are even in a position to be competitive for PS residency then you have an enormous amount of intestinal fortitude. The best thing that anyone in the world can do with their life is become a plastic surgeon. I'm sorry but it is true. Because it is so awesome, the road is awesomely hard. Best of luck. Remember I'm not trying to bust your balls. I'm trying to point out some things that will come out as red flags if mentioned in an interview or during your GS years. While you are in your GS years, be the best GS resident.
 
Disdain would be poor form. You dont have to like it, but to be openly negative most of the time is bad. There are a lot of good things to be learned in gsurg, not 3 years worth, not in this era of lack of GME funding, and not necessarily the mix/match method of those years either.

I find the hard part in the last amount of time to be not what you are learning/doing, but what you arent doing and could be learning. It starts to feel like you are just hanging out checking off a timeline, for no other reason than to do so. Plastics is a huge and ever expanding field, while becoming less and less compatible with general surgery training. I would love to have another year or two of studying/operating/seeing prs stuff and patients, than doing what seems to be a trauma/cc fellowship (thankfully its my second favorite field). Just a cost/benefit thing. One doesnt become a world class cyclist by spending half their time playing basketball.

Another side to that coin is that the diversity in the field is what makes it great and innovation and new ideas so plentiful and well accepted. Yet it also points out the obvious. If ENT, Uro, Ortho, OMFS guys can do PRS residencies, and are equivalent and of course some are great, what is the real rationale for gsurg? I think the problem is most ppl and programs try to rationalize and give an argument of why you are doing gsurg, and there isnt one, it just is what it is.

With that said, it just comes down to attitude, this is how it is, and its up to you to get the best out of what is currently required. One day you may even be thankful for having done neurosurgery/vascular/etc.. because it will somehow impact a case you do.
 
The moral of the story: get ready to bend over and say thank you sir may I have another because "I had to go threw it so will you" mentallity.

Hey you could always do ob or FP and then call yourself a cosmetic surgeon like some of those guys on 90210 and still drive a bentley.
 
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If ENT, Uro, Ortho, OMFS guys can do PRS residencies, and are equivalent and of course some are great, what is the real rationale for gsurg? I think the problem is most ppl and programs try to rationalize and give an argument of why you are doing gsurg, and there isnt one, it just is what it is.

You will find that plastic surgery is much more broad than operating on the head and neck (ENT), the genitourinary system (Uro), the mouth (OMFS) and the bones (Ortho). I have worked with an ENT resident who was an outstanding ENT resident. When it came to operating on anything but head and neck he was a bit freaked out at first.

One doesnt become a world class cyclist by spending half their time playing basketball.
Why go to medical school and learn about the Krebs cycle and all that other BS? Why bother learning histology or pathology or microbiology or anything else but how to operate? By your logic, the best plastic surgeon in the world would not even need to read or graduate highschool. The plastic surgeon should just get out of diapers and go straight into the operating room.

You must face a fact. Because being a plastic surgeon is the best possible thing you can be, the path to get there is difficult. Not everyone can be a plastic surgeon. Smarter people than the 2 of us have looked at how to train plastic surgeons and have decided through decades of experience that general surgery training is a good way to make a plastic surgeon. For one thing, all of those other services you mentioned consult the real difficult patient management issues (ICU etc.) out to general surgery. At least you will have an understanding of how to manage a sick patient when you finish your GS years.
 
Are the first 3 years of an integrated program pure general surgery?

I was under the impression there is a strong core of general surgery but plenty of rotations in other fields such as ENT, ortho, neurosurg, etc... etc... across the first 3 years?
 
You must face a fact. Because being a plastic surgeon is the best possible thing you can be, the path to get there is difficult. Not everyone can be a plastic surgeon. Smarter people than the 2 of us have looked at how to train plastic surgeons and have decided through decades of experience that general surgery training is a good way to make a plastic surgeon.

The problem is I don't think this is true. It's just a legacy of plastics evolving from general surgery to a separate division of general surgery to (?) its own subspecialty. There are now integrated programs with 24 months (or less!) of true general surgery. Five years ago that wasn't the case. It's entirely possible that in five or ten more years there will be integrated programs with 18 or 12 months of GS.
 
The problem is I don't think this is true. It's just a legacy of plastics evolving from general surgery to a separate division of general surgery to (?) its own subspecialty. There are now integrated programs with 24 months (or less!) of true general surgery. Five years ago that wasn't the case. It's entirely possible that in five or ten more years there will be integrated programs with 18 or 12 months of GS.

I was under the impression that the bulk of the plastics component didn't occur until the final 3 years.

Perhaps they're replacing the general surgery time with more electives in other surgical subspecialties? I've read some programs have critical care rotations, anesthesia rotations, dermatological surgery rotations as well.

I'm guessing those will be lighter than pure general surgery rotations? (Then again, if those subspecialties are in neurosurgery or ortho, that might not be the case)
 
I was under the impression that the bulk of the plastics component didn't occur until the final 3 years.

Perhaps they're replacing the general surgery time with more electives in other surgical subspecialties? I've read some programs have critical care rotations, anesthesia rotations, dermatological surgery rotations as well.

I think integrated plastics programs are in a state of transition and there's a lot of variation. It's probably true that most of the GS is being replaced with more time in specialties like ENT and derm, but I know of at least one program that has like 10 months on plastics services in the first 3 years.
 
You will find that plastic surgery is much more broad than operating on the head and neck (ENT), the genitourinary system (Uro), the mouth (OMFS) and the bones (Ortho).

I agree that PRS is very broad and is not an anatomically defined specialty.

FYI: OMFS = Oral AND Maxillofacial (i.e. there is a lot more to OMFS than just the mouth). Just like ENT they do full scope facial surgery and head and neck. OMFS may even be a better choice if you want to do craniofacial surg because of the huge orthognathic and cleft cases that you do in OMFS residency. 👍 🙂

There are a few programs out there that will accept MD graduates for a combined DDS/Maxfac surgery residency cert program. If you are interested in this option.. PM me.
 
I think integrated plastics programs are in a state of transition and there's a lot of variation. It's probably true that most of the GS is being replaced with more time in specialties like ENT and derm, but I know of at least one program that has like 10 months on plastics services in the first 3 years.

Pitt is now accredited for 1.5 yrs general surgery and 4.5 yrs plastic, and the gen surg rotations are nearly all plastics relevant. I believe there are a few other programs in the process of making this transition as well.
 
Pitt is now accredited for 1.5 yrs general surgery and 4.5 yrs plastic, and the gen surg rotations are nearly all plastics relevant. I believe there are a few other programs in the process of making this transition as well.

Wow, that sounds almost tolerable
 
My program (currently 5 going to 6 like all are) has 6 months of prs 2 months of hand 2 months of burn 1 month of occuloplastics and 1 month head and neck all during the first 3 yrs. We also may be adding a couple more prs-related months soon.
 
So what's the absolute minimum time you have to spend in general surgery? The two fields don't seem to overlap too much in my mind and I would understand some hating gs but really enjoying prs
 
So what's the absolute minimum time you have to spend in general surgery? The two fields don't seem to overlap too much in my mind and I would understand some hating gs but really enjoying prs

I've heard that 1.5 years of gs, 4.5 years of plastics/plastics related is the least official gs allowed. I believe that is Pitt's model. Also, with the majority of programs being/becoming integrated, I believe this will be more or less true.
 
I think Pitt states on their website that their integrated residents are on service 2 months in each of their first two years, "the maximum allowable." So I take that to mean the minimum amount of general surgery would be 20 months.
 
If you read the RRC/ABPS guidelines, it's actually 14 months of General Surgery-related rotations. All of the other stuff (ENT/OMFS/Anesthesia/Derm/Ophtho) can fill in the non-PRS time.
 
I think Pitt states on their website that their integrated residents are on service 2 months in each of their first two years, "the maximum allowable." So I take that to mean the minimum amount of general surgery would be 20 months.

Their website, like most, is out of date. Pitt's first 2 years includes 2 months straight plastics, 4 months recon, 2 months burns, 1 breast & 1 ortho trauma. UTSW similarly has 10 months of plastics-related rotations over the first 2 years (including hand, burns, oculoplast, breast, OMFS etc). The general surgery rotations that most require are transplant, general, surg onc, vascular, peds, trauma, anesthesia, and critical care. This seems to be consistent with the RRC (thanks Max). I think that most programs haven't whittled down the number of gen surg months to that point, yet (Tradition!). I definitely get the sense that most integrated programs are moving in that direction.
 
Most of the Integrated programs are shaving off every non-essential non-Plastics month in the first three years. I would expect that all of them (somewhere around 20) will be at the minimum in the next couple of years. That's based on conversations with faculty and residents at the last couple of meetings that I've attended.
 
you have to be careful about using terms like "back-up" when looking at gen surg residency as a bridge to plastics.

General surgeons are proud folks and I remember vividly how the looked upon the 3+3 plastic residents in their gen surg years. Comments like not wanting to "waste" lap choles on the plastics resident, etc.. (like the plastics guy even WANTS to do another lap chole!)

In fact, the hard core general surgeons would even turn on the senior residents once they matched into colon, or vascular, etc...

The moral- if you want to do plastics and you are a general surgery resident: choose your friends wisely.
 
Is it easier to get into plastics after GS residency than from ortho, ent, uro?
 
Most of the Integrated programs are shaving off every non-essential non-Plastics month in the first three years. I would expect that all of them (somewhere around 20) will be at the minimum in the next couple of years. That's based on conversations with faculty and residents at the last couple of meetings that I've attended.

What's the minimum? 6 months of general surgery?
 
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