Is fellowship required to practice micro or hand these days?

[ram006]

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Question directed towards those who are either finishing up their PRS training or in practice.

One of the things that draws me to PRS is the breadth of surgery-- cosmetic, recon, hand, face, etc. I have heard, however, that more and more hospitals/institutes are requiring micro fellowships to do things like breast recon and free flaps, which would seem to fall under the general scope of a PRS residency. Hand seems more obvious, but to the contrary, I've heard you actually don't need a fellowship to take hand call in some places including academic institutes...

Of course, all of this is second hand info from other residents considering doing an independent PRS residency so I wouldn't be surprised if it was an inaccurate picture. Anyone care to share their experiences job hunting or as a practicing plastic surgeon?

 

[maxheadroom]

Regarding Micro:
I don't think you'll have a hard time getting micro privileges after Plastics residency. Micro is considered to be a "core" of the specialty and everyone should have some level of competence. It's hard to find a place where you'll get high volume training in Head & Neck Micro, but you'll also have a hard time finding a practice where you'll do Head & Neck Micro out in real life. I know several guys who have done significant Head & Neck in training and couldn't get the referrals out in practice. As far as Breast Micro goes, if you want to do it and are appropriately trained, you should be fine.

Regarding Hand:
If you want to take Hand call, very few places will tell you "no." I know plenty of folks who are taking Hand call post-residency without a Hand fellowship. There are a few academic medical centers where CAQ-eligibility are necessary to take Hand call. That's definitely the exception rather than the rule as lots of places have a hard time getting adequate Hand coverage.

 

[ram006]

Regarding Micro:
I don't think you'll have a hard time getting micro privileges after Plastics residency. Micro is considered to be a "core" of the specialty and everyone should have some level of competence. It's hard to find a place where you'll get high volume training in Head & Neck Micro, but you'll also have a hard time finding a practice where you'll do Head & Neck Micro out in real life. I know several guys who have done significant Head & Neck in training and couldn't get the referrals out in practice. As far as Breast Micro goes, if you want to do it and are appropriately trained, you should be fine.

Regarding Hand:
If you want to take Hand call, very few places will tell you "no." I know plenty of folks who are taking Hand call post-residency without a Hand fellowship. There are a few academic medical centers where CAQ-eligibility are necessary to take Hand call. That's definitely the exception rather than the rule as lots of places have a hard time getting adequate Hand coverage.

Thanks for taking the time to respond. Greatly appreciated.

 

[ram006]

@maxheadroom

You may be able to tell the subtext of my post is essentially "how long will I be stuck in training if I pursue plastic surgery." It gets harder and harder not to think about length of training and income when co-residents are signing very lucrative contracts to either stay general or start after a one year fellowship in colorectal or trauma. Just wondering if you had any thoughts. From previous posts I think you also did GS, correct?

Frankly, every year I extend training after GS is a pretty substantial net loss of income, to train for an additional 3 to 4 years is going to add up to quite a bit of scratch and, also, quite a bit of accumulated interest on student debt. I would imagine this has had a large influence in fellowship selection and has played a significant role in the drop off in independent applicants. Most of the residents that pursue PRS from my program are FMGs with no debt who are still young because they didn't do 4 years of undergrad prior to med school. Not sure if it's a national trend, but definitely one I've noticed on my own.

I'll pose a straightforward question to you: If you were a GS resident now, having graduated medical school in the era of 7-8% interest rates on an average debt of 175k, would you still pursue a career that requires 9 to 10 years of training?

 

[maxheadroom]

I trained in the integrated pathway and did a Hand fellowship, so my opinions are colored by that experience. I knew going into the Plastics match that my interest in General Surgery as a career was nil and that I would be better off going into a lab to improve my application if I didn't match.

I think it's worth the training as I cannot imagine being a General Surgeon, but that's a very personal decision.