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Gen Surgery to Plastic?

Discussion in 'Plastic Surgery' started by NRAI2001, Apr 15, 2004.

  1. NRAI2001

    NRAI2001 3K Member
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    Hi I was wondering if someone was to do a general surgery residency, after the completion of the general surgery residency could they apply to plastics residency? If so would they be required to do the general surgery portion of the plastics residency over?
     
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  3. maxheadroom

    maxheadroom Rhinestone Cowboy
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    Two routes to plastics

    1. Integrated/combined -- you do 3-4 years of general, then 2-3 years of plastics. Becoming more and more popular. Many think these programs will eventually take over.

    2. Traditional route -- you do 3-5 years of General surgery residency (most require 5) or a complete ENT, Ortho, NeuroSurg, or Uro residency and then do 2-3 years of PRS. You don't have to go back and do more General.

    Currently the ABPS requires at least three years of general surgery training (hence the three years for the integrated programs). Some prominent Plastics chairmen want to reduce this to two years (more probable) or one year (probably not) while extending plastics training to 3-4 years.

    The traditional vs integrated format has been debated extensively on this site. Search for the old plastics posts and you'll find me and Ollie squaring off (in the most friendly manner).
     
  4. NRAI2001

    NRAI2001 3K Member
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    o cool. One question you said that the traditional route will probably be taken over by the integrated route. So will someone who had done the general surgery residency be required to do 3 more years of general surgery if they decided to do plastics?
     
  5. maxheadroom

    maxheadroom Rhinestone Cowboy
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    Half of the programs right now are the integrated/combined; the other half are traditional. There are still plenty of programs available in the traditional route, but no one knows how long those will persist. Each year, several programs move towards the integrated curriculum. Ollie will probably have some good insights on this, also.
     
  6. droliver

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    The number of spots offered for integrated & traditional programs have been relatively stable for a few years now & I don't think that there will be a whole lot of movement on that front for a awhile. As surgery (as a field) is moving towards four years of core training with the subspecialties (trauma/CC, peds,transplant, cardiac, +/- vascular) prior to starting those fellowships, I think there will be less momentum for programs to switch to integrated & more of the traditional programs (that haven't already) go from 2 to 3 years of plastic surgery training to remain @ ~7 yrs of residency for PRS training.

    There are a great many people in academics who remain skeptical about the whole integrated program concept & are not inclined to retool their programs. You've got to remember that @ many institutions Plastic Surgery cannot just unilaterally seccede from the Department of Surgery & write their own curriculum. In fact, many Plastic Surgery divisions are as weak politically as they have ever been in academics as whole generations of Plastic Surgerons abandoned academics to do cosmetic surgery. I believe that you're also likely to see several training programs collapse & dissolve (like Case Western recently) when the finances and personel stability of some programs become unsustainable. These factors work against large scale changes in the near future the way I see it.
     
  7. NRAI2001

    NRAI2001 3K Member
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    O wow, good points.
     
  8. LSuzy

    LSuzy Junior Member

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    Coming from a medical school with a very prominent integrated plastics program, I would tend to disagree with Oliver's comments. Most of our eleven faculty, although many of them trained via the traditional route, agree a combined and especially integrated curriculum where all 5-7 years of training are geared towards plastics, really is superior considering what a challenging and specific field plastics has become. Although basic training in surgery is obviously necessary, spending five years in general surgery and then only two for plastics is unbalanced and counterintuitive. Whether many more plastics departments have the resources to change their curriculum and apply for integrated status, the best programs are definitely moving in that direction, and integrated programs are seen as the "gold standard," especially by the most academic programs. More years of training in plastics=more desirable. Therefore I think that with time there will end up being quite a few more integrated programs. Plastics is quite a different field than CT, pedi surg, etc. In fact, the plastics program at my med school is currently trying to secede from the surgery dept. Just my two cents, and obviously from the viewpoint of a very academic program. :cool:
     
  9. droliver

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    Lsuzy,

    Let me stipulate a few points of agreement I have with you before reiterating a few things:

    - There is too much to learn in 2-3 years in plastics to master. There always has been and things are fragmenting into superspecialties within Plastic Surgery itself.

    - There is redundency in doing a full general surgery, ENT, Orthopedic, GU, or OMFS residency in respect to Plastic Surgery training

    - A well-desighned integrated program can be the best model

    - most Plastic Surgery divisions would LOVE to become free-standing departments

    - More years of didactics in Plastics is a good thing

    Now in response to those same points:

    1. An 11 member full-time Plastic Surgery division in 2004 exists in a number of programs I can count on one hand. That is not the norm. Most programs are paring down to the bone both by choice & by attrition of faculty into private practice

    2. There is inherent tension b/w the goals of training of training a plastic surgery resident alongside a general surgery training program. Asking for set-asides among the plum rotations in surgery training while avoiding the more labor-intensive ones penalizes the remaining resident pool & is viewed that way by most surgery department chairmen. This tension is negotiated well @ some programs, but at many its a point of contention. There are a lot of medicre integrated programs despite excellent faculty because of issues with this.

    3. The experience that the integrated model portends to mine out of the core surgery rotations becomes pretty superficial as they're all from the junior levels. The important part of you maturation as a surgeon is really not accomplished at that point & the background you get from this is VERY superficial, @ which point you're now expected to function as an independent Plastic Surgery resident. This is the critical flaw I think most people point to when they don't like the integrated plans. ie... You're just not a very good or accomplished doctor when you get thrown into a very technique-oriented specialty

    4. Like I mentioned previously. The political strength of many programs is at an all time low as distinguished faculty (and later many of the junior faculty) left to earn a living doing cosmetic surgery. This really puts up formidable roadblocks to widespread seccession of Plastic Surgery divisions over objections from Surgery Departments. They have little or no incentive to let often profitable specialties jump ship out of their control. There will be occasions where a division chief has the political clout to do this, but its not often.
     
  10. maxheadroom

    maxheadroom Rhinestone Cowboy
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    This is a topic that has been argued (primarily between me and Ollie) ad nauseum.

    Whenever the faculty get a more experienced surgeon as a learner, their life is easier. At some institutions (Duke most prominently), they won't take anyone who isn't BE in G-Surg/Ortho/ENT.

    When it is possible for a bright, motivated student to enter PRS training after only three years of G-Surg (especially when they get 2-3 months of PRS and a couple other good months per year), that student will gladly take it. Why? It focuses their training and reduces their time in (what most consider) low-yield training. I think G-Surg PDs need to take a healthy view on the plastics prelims. At healthy integrated programs, the G-Surg PDs look upon their plastics prelims as a huge bonus. We're interns/junior level residents who make their call pool easier without stealing chief level cases.

    General Surgery needs to make a huge change in their training programs. Soon they will be losing senior residents to not only PRS, but CTVS, Vascular, and Peds (all have integrated programs in the works). General Surgery needs to figure out how to deal with their serious man-power issues that will only get worse when they have PGY-4/5s gone to their "fellowships".

    General Surgery residency has become a residency in laparoscopy and trauma/critical care. When Medicare starts to say, "We're not paying for more than five years of training," it's time to reconsider ALL surgical training programs. This is why CTVS, Vascular, and Peds are all considering integrated programs -- it just makes more sense. The Halstedian model of surgical training is over 100 years old. It's time for something new.

    Of course, Ollie will still disagree with me, but today's applicants are voting with their rank lists -- they choose an integrated format.
     
  11. droliver

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    Max,

    I agree for the most part with all you comments. Surgery Chairmen & PD's however by and large do not look at things the same way. The best summary of widely held views I've seen was by Claude Organ, president elect of the American College of Surgeons, in a panel discussion a on the whole issue the future of surgery training that was published in the Amer. Journal of Surgery in 2002 or 2003 I think. The subject of the integrated PRS programs came up & several of the well-known Chairmen (including Hiram Polk, president elect of the American Surgical Association )@ the meeting started chiming in on the self-serving attitudes Plastic Surgery divisions/departments were taking with demands for resident set-asides on these things. There's a lot of hostility (and jealously quite honestly) involved with the relationships between General Surgery and the Specialties that's been aggrevated by the economics of medicine. Rather then being seen as extra bodies in the call pool, they're viewed as prima donna donnas avoiding many of the more labor-intensive duties that go along with running teaching hospital surgery programs.

    The move towards "integrated" specialties in CTVS,Peds,transplant, trauma/cc, vascular, etc... Has nothing to do with academics or the ACGME funding, it was simply seen as a way of trying to keep applicants interested in fields where the length of training & decreasing salary expectations were causing rapidly shrinking applicant pools to alarming levels. Nobody you poll really thinks you'll turn out better surgeons with any of these program desighns, they just hope you don't turn out ones that are much worse then historical standards.
     
  12. LSuzy

    LSuzy Junior Member

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    Well, thank you for your replies. All very good points. All the politics of the surgical specialties are still kind of new to me. (And very interesting). Thanks for the info.

    L
     
  13. Dr JPH

    Dr JPH Membership Revoked
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    Where can you find a listing of the integrated vs traditional programs?
     
  14. maxheadroom

    maxheadroom Rhinestone Cowboy
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    If Plastics2002.com is truly dead (and not just down for a while, as has frequently happened), then you guys are screwed. PSS of Jefferson Medical College had a site, but it seems to be gone. It was pretty inaccurate, but it provided a starting point. Next best thing is to go to FRIEDA and look up every program's website.
     
  15. Apollyon

    Apollyon Screw the GST
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    When I didn't know anything about this, I asked one of the PRS fellows at Duke about this, and he said that Duke actually WAS integrated, then stepped back into the fellowship model, which I thought was interesting.

    From Duke PRS website:

    "Duke University Medical Center no longer participates in the Integrated Plastic Surgery match. Although three years of training is a minimum for acceptance into the independent plastic surgery program, trainees who have completed residencies in General Surgery, Orthopaedic Surgery, Oral Surgery or Otolaryngology are preferred. The training program is a three year program."
     

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