Independent Plastic Surgery Programs. Fading away?

[OnePunchBiopsy]

So I recently matched categorical GS at a residency where independent plastics is a possibility (lots of graduates pursue it). I love GS and have always loved it, but I also have come to appreciate plastic surgery, especially reconstruction. Overall I'm keeping my options open.

Today a plastics attending told me that independent programs are slowly disappearing in favor of the integrated model. I heard this before, but he also told me that the ASPS (or some other plastics governing body) has a deadline in coming years that requires all programs to switch to the integrated model. I've searched online for this info to no avail. Is this true?

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[caffeinemia]

About 40 left in the country... A few disappear every year. There will be holdouts, but in general, yeah, there will be more competition for fewer spots.

The reality is that there's so much plastics to master that 6 years is barely enough. The 5+3 route can be satisfactory in some places, but in other instances, eh. I am not sure whether the first 5 years of general surgery training are truly all that helpful for plastics. My 1.5 years of general surgery were honestly just a bore and aside from learning a good base of ICU care, I didn't get much from going to laparoscopic whateverectomies and advancing diets till patients either shat or threw up.

 

[Salamechton]

Is there an official date after which all programs will convert to integrated (ie, independent track will completely disappear)?
I'm in the same boat as OP, matched GS but have an interest in PRS. Wondering if PRS independent will still be a reasonable option in 7 years. If not, it may not be wise to do 2 years of dedicated research in plastics.

Thanks!

 

[Neonseva]

Is there an official date after which all programs will convert to integrated (ie, independent track will completely disappear)?
I'm in the same boat as OP, matched GS but have an interest in PRS. Wondering if PRS independent will still be a reasonable option in 7 years. If not, it may not be wise to do 2 years of dedicated research in plastics.

Thanks!

I am currently on the independent PRS trail- a chairman at one of the elite programs (he is also on the board of directors) mentioned that as long as they continue receiving strong applications and as long as the final end product of their training (independents vs. integrated) were similar, they would continue their independent track. There is no question though that the number of programs are decreasing as are the spots. If I had to guess, the number will be significantly smaller in 5 years, if still in existence.

 

[ram006]

Residency and Fellowship Match

Click on statistics. Both number of positions and programs are decreasing. Additionally, there may be 41 programs or whatever but not everyone has a realistic shot at all 41. Of the remaining spots, not all of them are places I would have wanted to live for three years.

Really the only thing you can control is how good of an applicant you are.

If you decide to not do research or have a habit of underperforming on tests just remember you get out what you put in. Plenty of people from prestigious programs on the trail last year had 1-3 years of research with killer in service exams.

Though statistically favorable, the independent match is still deceptively competitive. You'll find most good candidates like the same programs and the competition for those coveted spots can get up there.

 

[ram006]

About 40 left in the country... A few disappear every year. There will be holdouts, but in general, yeah, there will be more competition for fewer spots.

The reality is that there's so much plastics to master that 6 years is barely enough. The 5+3 route can be satisfactory in some places, but in other instances, eh. I am not sure whether the first 5 years of general surgery training are truly all that helpful for plastics. My 1.5 years of general surgery were honestly just a bore and aside from learning a good base of ICU care, I didn't get much from going to laparoscopic whateverectomies and advancing diets till patients either shat or threw up.

The benefit from gen surg is certainly not in the junior years.

The traditional argument is that it produces more well rounded experienced surgeons with broader clinical foundation.

The counter argument is, of course, how relevant that foundation is. Sure, I'm taking care of sick liver patients this year as a chief resident on transplant but, really, does that make any difference? Probably not. I certainly have no desire to do so once I'm done nor do I want to be pulling up a colostomy at 2 AM for perforated diverticulitis in the morbidly obese, poorly controlled diabetic. I doubt that experience is going to help me much as a plastic surgeon and I'm already behind in terms of fund of knowledge with my integrated counterpart who, as expected, is a boy genius 3 years my junior with a better head of hair and less wrinkles.

Who knows, I could be wrong. We all travel our own path, I guess. I would definitely prefer to have match integrated and be done this year rather than starting as a PGY4 in July. Developing a late interest really slowed things down.

 

[Blunt Dissection]

This concerns me a little as a D.O student interested in plastics. I follow Plastics Match Insider fairly closely and was considering that it would be much more plausible for me to match GS followed by the independent match later, but if I wouldn't be starting residency until 2020, it seems like by the time I get to the window of applying for an independent PRS program as a GS resident, they may no longer be around 🙁

 

[caffeinemia]

The benefit from gen surg is certainly not in the junior years.

The traditional argument is that it produces more well rounded experienced surgeons with broader clinical foundation.

The counter argument is, of course, how relevant that foundation is. Sure, I'm taking care of sick liver patients this year as a chief resident on transplant but, really, does that make any difference? Probably not. I certainly have no desire to do so once I'm done nor do I want to be pulling up a colostomy at 2 AM for perforated diverticulitis in the morbidly obese, poorly controlled diabetic. I doubt that experience is going to help me much as a plastic surgeon and I'm already behind in terms of fund of knowledge with my integrated counterpart who, as expected, is a boy genius 3 years my junior with a better head of hair and less wrinkles.

Who knows, I could be wrong. We all travel our own path, I guess. I would definitely prefer to have match integrated and be done this year rather than starting as a PGY4 in July. Developing a late interest really slowed things down.

That was weirdly introspective and a little cryptic. Just fyi, she could be a girl genius with better hair and less wrinkles. I often think that the female PRS residents are the really intimidating and clinically smart ones. The guys are just full of hot air and swagger. At any rate, I will agree that general surgeons manage very critically ill patients and can save a lot of lives, but ultimately, there's little overlap or need for me to in the day and age of team based care. Just as no general surgeon is going to be allowed to do a free flap or hand replant, no one will let me manage a transplant patient, etc etc.

 

[ctusfinest]

As long as the ACGME allows it there will be a few holdout programs that will not go away. That said, as those programs become fewer and fewer every year, they are going to get more and more competitive.

 

[Moose A Moose]

I've heard this from my school's GS program director, and our plastics director. Speaking to them about it, they made it sound like most independents are working to integrate over the next several years.

Is what it is.

 

[ram006]

That was weirdly introspective and a little cryptic. Just fyi, she could be a girl genius with better hair and less wrinkles. I often think that the female PRS residents are the really intimidating and clinically smart ones. The guys are just full of hot air and swagger. At any rate, I will agree that general surgeons manage very critically ill patients and can save a lot of lives, but ultimately, there's little overlap or need for me to in the day and age of team based care. Just as no general surgeon is going to be allowed to do a free flap or hand replant, no one will let me manage a transplant patient, etc etc.

I already matched, so it is a guy. His hair is gorgeous. The rest I agree with.

 

[OnePunchBiopsy]

I've heard this from my school's GS program director, and our plastics director. Speaking to them about it, they made it sound like most independents are working to integrate over the next several years.

Is what it is.

Over the long hall it really does make sense. Since rotating with PRS I've learned that it is such a broad field. Seems like it would be harder to cover everything in 3 years compared to a 6 year integrated curriculum.

 

[caffeinemia]

I already matched, so it is a guy. His hair is gorgeous. The rest I agree with.

Mancrushin'!

 

[KanyeWes]

I wish this wasn't the case. Otherwise I would go to GS and try to land a plastics fellowship.

 

[Coffee]

I think this fear has been around since early 2000s. Seems like the total number of independent programs spots have been roughly 40-50 for the last 5 years +, but the spots available have been 60-70s, holding steady over the past 5 years. The number of people applying have been decreasing up until last year (for unclear reasons). If the independent pathway is fading away, it wont be completely dissolved for the another 10 year or so. But like everyone has echo-ed, there will be a few remaining coveted spots as programs like to have their picks and some old school places think the integrated way produces more immature surgeons (verbatim from one of my interviews).

I included the SF match statistics since we're all so... numbers driven.