Gen Surg to Plastics/CT

[tbhdying]

Good morning everyone, I hope you all are doing well amidst these unprecedented times. I just had a question and I haven't made many M3/M4 friends to consult with them, so I really had to come on here and ask. I am currently a third year and just can't seem to figure out whether I want to pursue cardiothoracic surgery or plastic surgery. I know I can do electives and better find out which one I like more than the other. But, one of the main reasons I was drawn to gen surg was because it seems that it gives me exposure to many surgical specialties and allows me the time to make an informed decision on which subspecialty i like. So I wanted to ask on here that how likely is it that I can get into a CT or plastics fellowship after Gen surg vs going directly into these. Do many that apply to fellowship end up getting it?

I don't know a lot about the gen surg to fellowship pathways so any insight is greatly appreciated.

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[dienekes88]

Plastics and cardiac surgery are very different. I recommend you try to shadow a bit. There's a completely different risk profile... and the operations are very different.

They're both very challenging to get into in terms of integrated programs.

 

[TraumaLlamaMD]

I have heard plastics is getting harder to match for general surgery residents every year, as more traditional fellowships convert over to the integrated (plastics from year one) residencies. I imagine CT is going through similar issues but I didn’t have any co-residents who applied CT in recent years. You’d have to do some digging online to find the exact match rates for each, but if you do end up targeting general surgery, I would do so with the knowledge and acceptance that these particular fellowships may be extremely competitive by the time you finish, and you may end up practicing general surgery or one of the other fellowships it offers.

 

[WinslowPringle]

Plastics match data: Residency and Fellowship Match 78% match rate
CT match data: Thoracic Surgery - The Match, National Resident Matching Program (under "2020 Thoracic surgery match results statistics report"). 77% US MD match rate for thoracic.

You can match to either program from general surgery. How easy it is depends on you as an applicant and where you are applying from. The other hard part is going through a general surgery residency and dealing with general surgery as a field if you know you are not genuinely interested in it at some level or if you would not be happy being a general surgeon if you didn't get a fellowship.

The integrated match tends to attract very high scoring applicants. If you have a poor step I/II etc. probably easier to match a fellowship than integrated residency.

As noted, they are vastly different fields despite some superficial similarities. Just because they are both 'competitive' and surgical, doesn't make them similar. Superficial similarities - filled with 'driven' personalities, can be high stress, can be thought of as 'creative', can require lots of technical skill.
Big differences - 1) Patient populations. CT has usually middle-age to elderly patients (outside of congenital) and you'll be spending lots of time in the ICU in fellowship and a variable amount of time in ICU depending on your attending practice (academic/private, thoracic only v. cardiac or combined...). Plastics definitely has a broad range of patient ages and presentations although non-academic practices skew towards a younger population than CT.
2) Patient concerns. Again, it depends on your ultimate practice type choice. However, CT will majority of the time be dealing with 'life or death' lesions/surgeries - cabg/valve/cancer, etc. Plastics can deal with life or death lesions - skin cancers - but it's a very different context. Non-surgical practice concerns probably play a bigger role in plastics than CT (ie, office decor and patient satisfaction and word of mouth referrals, etc.)
3) Complications - In CT, the patients tend to either get better or die. (In general surgery, they linger forever with drains and fistulas.....). In plastics, death isn't as common, but a really angry elective cosmetic surgery patient with a bad wound/implant infection can be unpleasant to deal with, too.
Would really recommend lots of exposure to both fields.

 

[tbhdying]

thank you so much everyone for such helpful advice and guidance. I do feel like I have some sense of direction now, after hearing you guys. I never thought i'd consider plastics until now, so I was lost as to how to proceed to make a better informed decision. I am not sure if I would be competitive for the integrated paths but @WinslowPringle since you mentioned it, I just took step 1 this summer and got a 251 and just started M3. I have 4 publications and one pending. They are in ortho and neuro though. So I hope if I figure it out by shadowing and getting involved with CT/Plastics faculty and research so that if I choose integrated, I could have a good chance.

EDIT: i saw the PD survey from 2016, but didn't get this piece of info from it, so i wanted to ask anyone who may have an idea: how big of a factor do step 1/2 truly play in these two fellowships?

 

[BovieToMe]

Step 1 and 2 do not play a large role for fellowship. That said, you will take the ABSITE every year and those numbers will be looked at and scrutinized. I cannot speak on plastics, but CT surgery programs want to make sure you are going to pass your boards and have organized study habits to pass standardized tests. The quantity and quality of formal didactics is very variable from program to program. As always, the top fellowship programs are going to be super competitive no matter what field you are talking about. That said, most people who apply in CT match, but it's getting more and more competitive. I don't know anything about the plastics match.

The more important thing to you is to figure out what you want to do because the actual work involved in both fields is very different and attracts very different personalities. I would probably kill myself if I were in plastic surgery. I have the sneaking suspicion that most of my colleagues in plastic surgery would have similar sentiments about being in CT surgery. Both fields sound very sexy on a surface level. But trust me, that is the last thing you are thinking about when you are trying to rewarm an aortic dissection at 3am and they won't stop bleeding or when your free flap goes down for the nth time. In times like that, you better actually like what you're doing.

 

[MediCane2006]

thank you so much everyone for such helpful advice and guidance. I do feel like I have some sense of direction now, after hearing you guys. I never thought i'd consider plastics until now, so I was lost as to how to proceed to make a better informed decision. I am not sure if I would be competitive for the integrated paths but @WinslowPringle since you mentioned it, I just took step 1 this summer and got a 251 and just started M3. I have 4 publications and one pending. They are in ortho and neuro though. So I hope if I figure it out by shadowing and getting involved with CT/Plastics faculty and research so that if I choose integrated, I could have a good chance.

EDIT: i saw the PD survey from 2016, but didn't get this piece of info from it, so i wanted to ask anyone who may have an idea: how big of a factor do step 1/2 truly play in these two fellowships?

As @BoToMe said, your Step scores do not really play a role in matching for fellowship. Like CT surgery, your inservice exams will be scrutinized for plastics fellowship. Other important components of a successful application for plastics are research (especially research that demonstrates at least some relevance to plastics), and your letters of recommendation. Academic plastic surgery is a small community (I’m sure CT is the same way) and PDs tend to favor applicants who are “vouched for” by someone they know.

I know CT and plastics both have that “glam” factor but I think you need to explore both fields a little bit more to figure out which one you fit into. Plastic surgery has a HUGE scope of practice; you can be a hand surgeon with a private outpatient practice, a cosmetic surgeon, an academic microsurgeon doing the big flaps, or a pediatric plastic surgeon at a children’s hospital. Each one of these has a completely different patient population, workload, and practice profile. If you are the academic microsurgeon you may be rounding every day in the ICU, whereas the cosmetic surgeon may not ever set foot inside a hospital.

 

[Banco]

With a 251 step 1 you are competitive for integrated programs, so try to explore them before application time and get some research in. If you're not sure still, you can always also dual apply with GS + integrated.