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xylemera

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Oct 23, 2003
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Hello,

I am interested in pursuing plastics, and I was wondering in what direction plastics (cosmetics and reconstructive) will be heading in the future. Will there be more business or less business? Is this field growing, in decline, or will remain mostly stagnant because it's already saturated? How do you think health insurance and malpractice will factor into plastics compensation-wise ten to twenty years from now?

I hear there is a big difference between the "haves and the have nots" in cosmetics. How big is a big difference? Basically what I am asking is even though I am interested in plastics, is this field a safe field to go into instead of one that's more stable considering that in the next twenty years, many of the baby boomers will be seeking medical help in other more "conventional" fields instead of plastics. Just thinking more practical. Thanks.
 

droliver

Moderator Emeritus
15+ Year Member
May 1, 2001
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Attending Physician
Plastic Surgery is really made up of what I see as ~ 7 disciplines

1) Hand
2) Reconstruction & Microsurgery
3) Pediatric
4) Burns
5) Skin & head/neck Cancer
6) Wound Care
7) Aesthetic

With the exception of Aesthetic Surgery (which is for the most part fee for service), Plastic Surgery has been savaged by reimbursement cuts. Compared to ~ 1990 payments on many procedures have been cut up to 70% (eg. TRAM flap for breast reconstruction in 1990=$8-10K, TRAM in 2003 =$1500-2000) Demand for cosmetic procedures has been spiking annually for several years & this trend shows no end in the near future.

There is just as much work in the first 6 areas as there ever was, but Plastic Surgeons for the most part are en mass gravitating towards Aesthetics for obvious reasons. Along with this is the trend of other fields (ENT, OMFS, Opthamology, Dermatology, and a scattering of Gerneral Surgeons, OBGYN's, & Internists) trying to redefine themselves Cosmetic Surgeons as their incomes have been hurt by insured reimbursement cuts.

It's led to a very competative market for cosmetic surgery in most places. Inevitably you see a lot of people who want to do more cosmetics, but struggle against the well-oiled machines of some of the busier Aesthetic Plastic Surgeons' practices. There are a lot of primarily reconstructive and Hand Plastic Surgeons who are frustrated and bitter with the changes the field has undergone. There's even been some talk of the professional society splitting off into various Aesthetic, Reconstructive, and Hand societies.

The good times (1950's-1990), financially speaking, have been over for a decade for the field at large. If you do a large-volume cosmetic practice, things are still pretty good, but competition is fierce. All the other areas are in the same creaking boat as the rest of American Medicine and will continue to face shrinking reimbursements. Long-term it looks like (to me) that the US will fall in line with the rest of the world with Universal Health Care to control costs, and Physician Salaries will be greatly depressed from current levels and recent historical levels. Cosmetic Surgery however should continue to thrive outside of that as it does in other countries in a fee for service arrangement.
 

droliver

Moderator Emeritus
15+ Year Member
May 1, 2001
1,580
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Attending Physician
Originally posted by NikkiDeee
Does anyone know a good estimate for the salary of plastic surgeons in an academic setting?
Depending on the relative "wealth" of the division/department & location I think $120-180K guarentees are pretty normal to start if some of my friends offers were normal. After you're off guarentee its usually a smaller base salary + some % of your collections. I think on average academic salaries are about 30% less then private practice for similar practices
 
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