Can someone tell me why plastic surgery is so competitive?

[Winged Scapula]

How do I get in on that

First step: leave your conscious at the door,

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[tdram]

How do I get in on that

You just need to find willing customers

 

[Winged Scapula]

You just need to find willing customers

Or victims...

 

[PL198]

Or victims...

I want to be a surgeon just so I could manically laugh before I'm about to get to work(even if it's for no reason).

(I don't actually want to be a surgeon)

 

[Slack3r]

I guess it's time to study harder and aim for a 260+ in step1 ...

Good luck. Charting outcomes 2011 said the match rate for 260+ was still about 50%.

 

[username456789]

First step: leave your conscious at the door,

I assume you meant conscience, but your word is also good in this context.

 

[BestDoctorEver]

Good luck. Charting outcomes 2011 said the match rate for 260+ was still about 50%.

I will shoot for 280+ then...

 

[PL198]

I will shoot for 280+ then...

why aim so low? 300 or bust

 

[Winged Scapula]

I assume you meant conscience, but your word is also good in this context.

LOL...damn Siri. Yes that's what I meant.

 

[Wordead]

I will shoot for 280+ then...

Your chances of matching decrease above 260 or so.

Failing to grasp why people match and dont match in these ultra competitive fields aint good....do some research

 

[Serous Demilune]

Your chances of matching decrease above 260 or so.

How can this be true? It's not like they'll screen them out pre-interview. Unless you have some really petty attendings or residents who are jealous of that score and blacklist you after the interview...

 

[member1000765]

Simple breast augmentation isn't a terribly difficult technical operation, especially if it's the only operation you know how to do. Make an incision, stuff an implant inside, close the incision. No vital or important structures to worry about, and it really doesn't require a high degree of surgical acuity. Same with a panniculectomy - just hacking off fat, subcutaneous tissue, and skin and sewing it back together. It doesn't require a huge amount of technical skill, but it does require good judgment, and without judgment and experience you can completely F- up someone's body, which would be my argument for not allowing a mid-level to perform the operation. There are so many terrible breast augmentations and tummy tucks out there, it is unbelievable.

More than anything, I don't think it's ethical to let a mid-level do the surgery if a patient is paying full price for the plastic surgeon to perform that surgery. I know of several plastics clinics where the patient can pay half price if he/she agrees to let the resident or fellow do the case as the primary surgeon (with the attending present but not primary surgeon). If I'm going to pay $10,000 cash for implants, the attending plastic surgeon better be the one doing the procedure.

 

[username456789]

How can this be true? It's not like they'll screen them out pre-interview. Unless you have some really petty attendings or residents who are jealous of that score and blacklist you after the interview...

You're assuming that it operates in a vacuum.

He's stating that, statistically, the chance of matching for applicants >260 is lower. He's not necessarily suggesting causation. It's correlation. There are other possible confounding variables (maybe >260 scorers are more likely to have poor social skills? probably not, but just one of several possible associations at work here).

 

[DermViser]

You're assuming that it operates in a vacuum.

He's stating that, statistically, the chance of matching for applicants >260 is lower. He's not necessarily suggesting causation. It's correlation. There are other possible confounding variables (maybe >260 scorers are more likely to have poor social skills? probably not, but just one of several possible associations at work here).

 

[Dral]

I sort of understand that rationale, but if that's your philosophy, where's your self respect? The schizophrenic seriously needs advanced medical expertise and will get better with treatment. The soccer mom honestly needs a reality check, but instead you just end up nurturing her insecurities.

Not hating on PRS as a whole, just the 100% cosmetic PRS. I know some awesome PRS surgeons who would love to go full recon but have to keep the lights on with some cosmetics.



Inpatient psych at a large county hospital. A memorable rotation to say the least...

I can understand where you are coming from, but cosmetics can really be fulfillng. I remember a year ago I scheduled a 20 something for LHR on her chin...not doing it, just scheduled her...she literally went skipping out the door with an ear to ear smile.

You speak to the importance of helping psych pts. I'm not saying helping someone with schizophrenia is necessarily on the same level as giving someone an emotional boost, but cosmetic procedures really can make you feel good. Not that I know first hand *cough* got fraxel, Botox, and filler last week *cough*

 

[RJGOP]

You're assuming that it operates in a vacuum.

He's stating that, statistically, the chance of matching for applicants >260 is lower. He's not necessarily suggesting causation. It's correlation. There are other possible confounding variables (maybe >260 scorers are more likely to have poor social skills? probably not, but just one of several possible associations at work here).

Oh, but they do. Maybe not all, but when you have guys scoring in the 270s those people tend to be the photographic memory, socially inept savants. Also, 270 step 1 doesn't always equate to a great surgeon, in fact many times the opposite is true.

 

[username456789]

Oh, but they do. Maybe not all, but when you have guys scoring in the 270s those people tend to be the photographic memory, socially inept savants. Also, 270 step 1 doesn't always equate to a great surgeon, in fact many times the opposite is true.

You know, that's a common dogma that people (especially people on SDN) like to parade about, but it doesn't jive with my own personal interactions with such individuals. I'm not convinced that people who score above 260 or 270 (or whatever) are statistically more likely to be "socially inept savants." I mean, it sounds like it could be true, but it just doesn't seem to play out in the real world. Perhaps you have a completely different set of experiences with these people.

 

[PL198]

You know, that's a common dogma that people (especially people on SDN) like to parade about, but it doesn't jive with my own personal interactions with such individuals. I'm not convinced that people who score above 260 or 270 (or whatever) are statistically more likely to be "socially inept savants." I mean, it sounds like it could be true, but it just doesn't seem to play out in the real world. Perhaps you have a completely different set of experiences with these people.

Eh I think it does. That's not to say there can't be people that score 275 that are really good socially, but by nature standardized testing thrives on the socially inept for the high score ranges. The more difficult and wide in subject matter a standardized exam is, the more likely you are to isolate those people I think. It takes a sort of irrational pursuit of studying and obsessing over a 3 digit number to score that high unless the person is like rainman. soo either they're obsessed(I'll probably end up this way TBH) or they're mentally ill ( I'm probably this too).

 

[Southplains]

You know, that's a common dogma that people (especially people on SDN) like to parade about, but it doesn't jive with my own personal interactions with such individuals. I'm not convinced that people who score above 260 or 270 (or whatever) are statistically more likely to be "socially inept savants." I mean, it sounds like it could be true, but it just doesn't seem to play out in the real world. Perhaps you have a completely different set of experiences with these people.

My anecdotes fall in line with this too, though I'm thinking back on the mcat. Premeds and ms1s want to believe the "42+" mcat person is some socially inadequate walking textbook and not much else, and while some of them may be, a lot of them are just "37ers" with some luck on test day, and they're just as down to earth and fun to be around as the next person.

Some people are just downright impressive AND have the stars align on test day.

 

[PL198]

My anecdotes fall in line with this too, though I'm thinking back on the mcat. Premeds and ms1s want to believe the "42+" mcat person is some socially inadequate walking textbook and not much else, and while some of them may be, a lot of them are just "37ers" with some luck on test day, and they're just as down to earth and fun to be around as the next person.

Some people are just downright impressive AND have the stars align on test day.

just because there are people that can get 42 on the MCAT and be really social doesn't mean on the whole, the average person that does isn't really bad socially.

 

[Southplains]

just because there are people that can get 42 on the MCAT and be really social doesn't mean on the whole, the average person that does isn't really bad socially.

Right but now we'd have to look at a well executed study to see who's correct. We're both trying to say the ratio of socially inept to socially typical falls in the favor of our argument, which we just don't know.

 

[Wordead]

Right but now we'd have to look at a well executed study to see who's correct. We're both trying to say the ratio of socially inept to socially typical falls in the favor of our argument, which we just don't know.

There aren't a whole lot of other reasons why a lower % of 260+ scorers match than 250-260 applicants. Overconfidence in their application perhaps?

 

[dadaddadaBATMAN]

There aren't a whole lot of other reasons why a lower % of 260+ scorers match than 250-260 applicants. Overconfidence in their application perhaps?

I could see this happening... get a "borderline" score of 250, continue busting ass. Get a 280, think you have it made. Don't put in the effort needed in a surgery rotation...only get P/HP instead of honors.

Or perhaps less publications/connections. If you were doing hardcore research first two years it might be harder to get that high a score.

I also wonder how many people test that high period, and how many of those apply to plastics (probably somewhat biased, as many lower scorers won't bother)...I kind of doubt it's a large, representative sample. It's pretty easy for small populations to have "patterns," especially when we have preconceptions to bias our views.

 

[Southplains]

There aren't a whole lot of other reasons why a lower % of 260+ scorers match than 250-260 applicants. Overconfidence in their application perhaps?

Yeah, I wouldn't be surprised if that was a reason the 260+ crowd aren't matched, but I wouldn't imply you can only score in that range if you've sacrificed (intentionally or not) social skills for academic prowess.

 

[Southplains]

I also wonder how many people test that high period, and how many of those apply to plastics (probably somewhat biased, as many lower scorers won't bother)...I kind of doubt it's a large, representative sample. It's pretty easy for small populations to have "patterns," especially when we have preconceptions to bias our views.

Yeah that's what I'm wondering

 

[Winged Scapula]

Amused that a bunch of med students and residents (and at least one attending) are arguing on SDN about who's socially inept, ON A SATURDAY NIGHT.

 

[Serous Demilune]

Amused that a bunch of med students and residents (and at least one attending) are arguing on SDN about who's socially inept, ON A SATURDAY NIGHT.

+10000

 

[Southplains]

Amused that a bunch of med students and residents (and at least one attending) are arguing on SDN about who's socially inept, ON A SATURDAY NIGHT.

Haha hey my parents are in town. Otherwise I'd be.. Well not a whole lot else I suppose

 

[Winged Scapula]

Haha hey my parents are in town. Otherwise I'd be.. Well not a whole lot else I suppose

LOL...My point exactly.

 

[DermViser]

Amused that a bunch of med students and residents (and at least one attending) are arguing on SDN about who's socially inept, ON A SATURDAY NIGHT.

 

[Silent Cool]

It's so competitive because there are so few residencies and the potential pay is good. That's why any specialty is competitive. Once the pay/outlook starts to slip or the number of residencies starts to increase the competition dissipates (see radiology).

Agreed.

Also see Orthodontics.

 

[Silent Cool]

Slack,

Thanx for posting that. It's an interesting pie chart that I actually wouldn't have expected.

In other words, ~48% of the PRS patients are seeking only cosmetic care. I would have guessed that it would be higher.

 

[DermViser]

Agreed.

Also see Orthodontics.

Most people in Dentistry don't specialize. A residency is not required to practice. Whole different game.

 

[dermaway]

You know, that's a common dogma that people (especially people on SDN) like to parade about, but it doesn't jive with my own personal interactions with such individuals. I'm not convinced that people who score above 260 or 270 (or whatever) are statistically more likely to be "socially inept savants." I mean, it sounds like it could be true, but it just doesn't seem to play out in the real world. Perhaps you have a completely different set of experiences with these people.

i agree. maybe >270 is much different and might be more likely to be socially inept, but i definitely wouldn't put that stigma at >260

like 8 people in my class scored above 260 and only 1 has issues interacting with people, and even that its not in a socially inept quiet shy guy type of way its more of an arrogant gunner

 

[DermViser]

i agree. maybe >270 is much different and might be more likely to be socially inept, but i definitely wouldn't put that stigma at >260

like 8 people in my class scored above 260 and only 1 has issues interacting with people, and even that its not in a socially inept quiet shy guy type of way its more of an arrogant gunner

Well if 260 is 2 standard deviations above the mean, I think people in this thread are referring to the ones who are 270+. And arrogant gunner can usually be masked on interview day.

 

[RJGOP]

You know, that's a common dogma that people (especially people on SDN) like to parade about, but it doesn't jive with my own personal interactions with such individuals. I'm not convinced that people who score above 260 or 270 (or whatever) are statistically more likely to be "socially inept savants." I mean, it sounds like it could be true, but it just doesn't seem to play out in the real world. Perhaps you have a completely different set of experiences with these people.

I realize not everyone is like that, frankly many are not. I've only met one person who scored in the 270s before and he was impossible to have a conversation with. But then there are people who can score >260 with ease and they will be the chillest most personable human being you'll ever meet.

 

[RJGOP]

Amused that a bunch of med students and residents (and at least one attending) are arguing on SDN about who's socially inept, ON A SATURDAY NIGHT.

Hey! My gf is not in town yet. What else am I supposed to do?

 

[Winged Scapula]

fellowship trained general surgeons can do boobs and tummies...

I'm confused… What are you talking about here? A fellowship in plastic surgery after general surgery is the traditional training route.

 

[Silent Cool]

Most people in Dentistry don't specialize. A residency is not required to practice. Whole different game.

My point was that the field has become much less desirable due to a radically changed supply/demand ratio compared to 10-15 years ago, as well as the add-on of ridiculous tuition at most programs.

 

[bc65]

I'm confused… What are you talking about here? A fellowship in plastic surgery after general surgery is the traditional training route.

Indeed. Until relatively recently, doing a full general surgery residency, followed by a plastic surgery residency, was the preferred and more respected route to plastic surgery. Only in recent years has the integrated model, in which residents match while still in medical school, become popular.

Not only was doing a combined program the traditional route, it still comprises almost half of the available positions.

And, for the record ( I'm not trying to be picky or obnoxious here ) plastic surgery training done after a residency in general surgery ( or in ortho, ENT, neurosurgery, or urology), now known as an "independent" residency, is not called a "fellowship". It is still called a plastic surgery "residency". Only plastic surgery subspecialy training done after competion of a plastic surgery residency , whether integrated or independent, is called a fellowship, eg a craniofacial fellowship, or hand, microsurgery, pediatric, cosmetic, etc.

So, Slack3r, a heads up: if you are applying for a plastic surgery residency, you should use the correct terminology or you will appear to be uninformed. Other than that, I agree with most of your post.

However, the precentage of dissatisfied plastic surgeons didn't differ much from the satisfaction rates of other surgical specialties. I think that the dissatisfaction comes when, as an attending, you realize that there is no light at the end of the tunnel. You will always have to work hard. This is true regardless of specialty.

But to go back to the original question as to why plastic surgery is more competitive, the real answer is that it really isn't that much more competitive than ortho or ENT. The differences in Step 1 scores are small, and probably not statistically significant. Also, as already noted above, there are very few spots for integrated plastic surgery residencies ( just over 100 at last count) so competition is greater than it should be. And of course, there is a lot of misperception about what plastic surgeons actually do. Then there is the lay prestige factor, that entices students into the field.

As far as compensation goes, in every salary survey I've ever seen, ortho earns more than plastic surgery.

As for the poster above who talked about PA's doing plastic surgery: When I was a 4th year surgery resident rotating through cardiac surgery, we were not allowed to harvest veins from the patient's legs. Only the PA's were allowed to do that, because the cardiac surgeon knew that they knew how to do it without ruining the veins, whereas the residents would likely not do as good a job. The PA's had many years of experience and knew how to do it better than we could. Similarly, if a plastic surgeon has a PA doing a lot of the sewing on a breast reduction, I assure you that the PA is trained and can do that part of the procedure. The surgeon's reputation is on the line, so she will make sure that the surgery is done properly. As any surgeon will tell you, it's patient selection and surgery planning that are the crucial steps in a procedure. The technical parts are easiest to learn and perform. The surgeon did the surgical markings, and probably made the initial incisions. Sewing skin is the easy part. Most likely the PA was doing a simple closure of the incisions. And I can assure you that, as a patient, I would much prefer having a PA or RN first assistant do parts of my surgery than most residents and any medical student.

 

[Winged Scapula]

And, for the record ( I'm not trying to be picky or obnoxious here ) plastic surgery training done after a residency in general surgery ( or in ortho, ENT, neurosurgery, or urology), now known as an "independent" residency, is not called a "fellowship". It is still called a plastic surgery "residency". Only plastic surgery subspecialy training done after competion of a plastic surgery residency , whether integrated or independent, is called a fellowship, eg a craniofacial fellowship, or hand, microsurgery, pediatric, cosmetic, etc.

That is correct. I misspoke in my hastily composed response above.

 

[alpinism]

I'm applying to plastics this cycle and here's my (humble) understanding behind its competitiveness. This isn't an exhaustive list by any means:
- After you get out of training, you have the ability to make your practice what you what. Like breast reconstruction? You can do flaps all day and make a great living. Like hand surgery? You'll be in high demand in many places and make good money (although the call can be tough). Like pediatric craniofacial? There's opportunity there too and is actually fantastic for those surgeons who enjoy continuity of care as many patients will require multistage reconstruction over the course of their childhood/adolescence. Want a hybrid academic/private practice? Want 9-5 hours? Want to teach residents? Want to operate under a microscope? Yada yada yada. You get the point...there are a lot of options and the operative variety was a draw for the majority of all of the plastic surgeons I've worked with.
- Truly amazing surgeries that require high technical skill. Personally, plastic surgery was the only thing that ever blew my hair back in medical school (although delivering babies was cool to0). I've gathered that most plastic surgeons in practice aren't bored with the surgeries they perform (although some may get tired of a certain patient population, namely cosmetic patients) and continue to enjoy their work even after years of operating
- Vast array of patient ages and whole-body anatomy--they get to operate on every age and from head to toe
- Novelty of cases, intellectually challenging, opportunity to go abroad for mission work, etc

I will say that my plastics rotations have been some of my hardest rotations in medical school and the residents/attendings work harder than I ever knew possible. It's a tough 6-7 year residency and really stretches your limits if you go to a high-volume program. The longest surgeries, toughest hours, and most complex cases have all been on my plastics rotations but it's been the most amazing and mind-blowing experience I've ever had in medicine. Even if you aren't going into surgery, I recommend you try to do a rotation in the field as it's one of the most misunderstood specialities in my opinion and will give you an immense appreciation for the field of reconstructive surgery.

Agreed, but also note this is a survey of thise who attended the Annual Meeting for PRS, so it might skew more towards academic types.

I also think it's interesting that PRS really isn't all that cosmetic, which I think contributes to a lot of the dissatisfaction in the field. On the Careers in Medicine site, PRS has among the lowest satisfaction among physicians (40ish% would choose medicine again, 30ish% would choose the same specialty, IIRC).

I think PRS is so competitive because a lot of applicants have this colored view of the specialty and envision themselves driving their Ferraris around LA when they're not throwing implants in models and actresses. The people that want a 100% cosmetic practice (Make sick bank, bro!) end up disillusioned when they realize that doig solely cosmetics faces stiff competition from every Tom, Dick, and Harry with a medical degree (and often without too), especially if you want to practice in a major metro like LA or NYC, or really any large city. Vascular does veins, ENT/OMFS do rhinos, fellowship trained general surgeons can do boobs and tummies, optho does blephs, and everybody does fillers and Botox. And on top of making it difficult to find business, this competition drives down prices, cutting into your take home. Not to mention, the patients are typically difficult and requires a specific personality that a lot of med students may not have. That's a recipe for dissatisfaction if I've ever seen one.

On the other hand, those students who shudder at the thought of cosmetics quickly find out that it's extremely difficult to keep up the volume necessary to keep the lights on with a solely reconstructive practice. So to stay afloat, these guys will often have to supplement their incomes with the occasional cosmetic patient, and all the headaches these type of patients come with. Again = dissatisfaction.

There's also the fact that a lot of PRS is anything but glamorous. Flaps are long, grueling surgeries that don't always have good outcomes, and taking call for every lac that comes through the door can also become pretty wearing.

Now, this is only the opinion of one student formerly considering PRS, colored by conversations with practicing surgeons (most of whom are a bit disillusioned), so take it for what you will.

Agree with most of the above.

IMO the main things that make PRS so competitive are the very small number of spots, the ability to do a wide range of technically challenging procedures, the ability to operate on any part of the body, and a greater amount of creative freedom than most surgical specialties. The perception of having a more relaxed and glamorous lifestyle may also play a role for some people, but considering the fact that most applicants have extensive exposure to the field prior to applying (Research and SubIs) I'm sure most applicants know what they're getting into.

Having done a plastics rotation as an M3 I'd have to wholeheartedly disagree with anyone describing the field as lifestyle friendly (especially residency). I probably had the worst hours of any rotation on plastics and the residents get worked to the bone (at least at my hospital). A typical day ran from 530am till 8pm at night. The service covered about 20-40 patients at a time including consults from all over the hospital. We probably covered 2 miles every morning during rounds. The operations were some of the longest Ive seen and I think I only got lunch twice during the whole rotation. As an example, we had a penile amputation come in at 5pm one afternoon and the reattachment operation lasted till 4am the next morning. Just enough time to grab dinner (breakfast?) before starting morning rounds. To top it off, The residents took 48hr call over the weekends during which time it's common to only get 2-4hrs of sleep total for both days. Much of that was due to the fact that they saw almost every facial or extremity laceration that come into the ED as well as covered any problems with the 20+ patients on the floor.

Considering that most attendings don't do 100% cosmetics and need hospital privileges, you'll still be taking night and weekend call most if not all of your career.

 

[Dral]

Considering that most attendings don't do 100% cosmetics and need hospital privileges, you'll still be taking night and weekend call most if not all of your career.

Especially true with the way things are going: less private practice and more hospital related group practice.