Is plastic surgery struggling?

[Stare Decisis]

I had the opportunity to attend a lecture at an independent program and during the break some of the fellows were getting together and discussing job prospects. It was quite an eye opener! They were saying how it was almost impossible to find a good job and they were getting offers in the ballpark of a someone coming of an ER residency. I was standing there drinking my Pepsi and one of the fellows turned to me and asked if I was a medical student. They told me how much fun plastic surgery was but the amount of work was starting to outweigh the returns. These were reconstruction guys, which I thought were somewhat protected from the "Great Recession." They were saying if they had it to over they would they would have chosen another specialty. A friend of mine at another program said he hears the same things from the fellows that are job hunting.

Is it really this bad? The cosmetic field is a saturated shark tank and reconstruction is pretty much done for free? I am not concerned with being wealthy, but it seems depressing to think that after 7+ years of training I will be sweating just to keep the lights on in the office.

---

Members don't see this ad.

 

[maxheadroom]

Yes, the job market in Plastics sucks right now. The commonly quoted figure is that the cosmetic market is down ~40%. This has led to some of the mid-range guys trying to get back into more of the recon market, making in hard for the newbies (like me) to get much traction. Recon doesn't pay as well as cosmetic, but it is more stable (although we're seeing a slowdown in some of that work, too).

 

[rongeur]

Yes, the job market in Plastics sucks right now. The commonly quoted figure is that the cosmetic market is down ~40%. This has led to some of the mid-range guys trying to get back into more of the recon market, making in hard for the newbies (like me) to get much traction. Recon doesn't pay as well as cosmetic, but it is more stable (although we're seeing a slowdown in some of that work, too).

Why do you think that is? Are there too many plastic surgery training spots relative to the amount of recon available and that's just been hidden by increases in cosmetic volume? It's true the economy sucks but the ENT and Uro guys I know seem to be faring substantially better.

 

[maxheadroom]

No, there is more than enough recon work out there. There are tons of places where there is a huge need for plastics -- they're just geographically undesirable.

 

[Winged Scapula]

I can tell you as the economy tanked I started getting PRS guys who weren't interested in recons when money was flush, were now knocking on my door. Unfortunately, the reimbursement for breast recon sucks especially when you factor in all the after care. Some guys put very little work into and it shows.

You can't walk down the street here without tripping over a plastic or "cosmetic" surgeon, but times they are tough. People who can afford aesthetic procedures will still get them but a large portion of the clientele is Joe Average Citizen...these are the people who won't see a dentist or a physician because of the co-pay when times are tough. They are likely to put off that abdominoplasty until they feel more financially comfortable.

 

[maxheadroom]

I'm planning on paying the bills for the next few years with Hand surgery while I wait for the economy to perk up. While some of the indicators seem to show that things really are starting to improve, it's going to be several years before the aesthetic surgery market takes off again. I won't get rich doing Hand, but I'll pay my loans and still be able to drive a nice car and save a bit of money.

 

[Taurus]

Another very important to consider is that more and more people are getting Botox instead of going under the knife because it's cheaper and reversible if the end result isn't so desirable. This will continue to hurt plastics even after the economy improves.

 

[maxheadroom]

Another very important to consider is that more and more people are getting Botox instead of going under the knife because it's cheaper and reversible if the end result isn't so desirable. This will continue to hurt plastics even after the economy improves.

Not really. It might keep them away from a facelift for a few years, but Botox doesn't stop jowling and malar descent. Actually, it's a great way to get people into the cosmetic pipeline. They get Botox in their 30s and by their late 40s they're ready for surgery.

 

[Spiker]

No, there is more than enough recon work out there. There are tons of places where there is a huge need for plastics -- they're just geographically undesirable.

Hey I am just curious where are geographically undesirable area? And what usually makes an area undesirable?

 

[Slack3r]

Hey I am just curious where are geographically undesirable area? And what usually makes an area undesirable?

aka "the Midwest"

 

[Stare Decisis]

No, there is more than enough recon work out there. There are tons of places where there is a huge need for plastics -- they're just geographically undesirable.

I was told that reimbursement for reconstruction had become quite low because plastic surgeons were not very politically active and allowed general surgeons or non-surgeons to negotiate reimbursement rates. Also, it was unlikely for reimbursement to increase for plastic surgeons, just because rates have just not been trending in that direction. I am not sure if this is true or not.

I do wonder what the psychological effect of this recession will be on the american consumer. Certainly after the great depression american consumers were a little wary of large purchases. If history repeats itself then plastic surgery may rebound but remain significantly depressed as compared to the "golden years".

On another note, some mentioned that Botox was the "gateway drug" of plastic surgery and slowly prepares patients for more invasive provedures. I was wondering if surgical procedures are being revamped to reflect the need for greater patient turnover. I heard someone mention that the new thing was a "liquid facelift", not sure exactly what that means but it is supposed to more cost effective.

 

[maxheadroom]

I was told that reimbursement for reconstruction had become quite low because plastic surgeons were not very politically active and allowed general surgeons or non-surgeons to negotiate reimbursement rates. Also, it was unlikely for reimbursement to increase for plastic surgeons, just because rates have just not been trending in that direction. I am not sure if this is true or not.

I do wonder what the psychological effect of this recession will be on the american consumer. Certainly after the great depression american consumers were a little wary of large purchases. If history repeats itself then plastic surgery may rebound but remain significantly depressed as compared to the "golden years".

On another note, some mentioned that Botox was the "gateway drug" of plastic surgery and slowly prepares patients for more invasive provedures. I was wondering if surgical procedures are being revamped to reflect the need for greater patient turnover. I heard someone mention that the new thing was a "liquid facelift", not sure exactly what that means but it is supposed to more cost effective.

Reimbursement is bad, but the problem that the aesthetics guys have is high overhead. If you're paying an aesthetician, a dedicated scheduler, and a couple of nurses, plus high rent on a ritzy spa-like office, and have fresh flowers everyday, you're not going to be able to make it on recon work. If you keep the overhead low, you'll be fine.

Sorry, I don't know much about consumer psychology post-Depression. I've never read a paper about it. The discussions that I've heard amongst Plastic Surgeons and the practice consultants is that the cosmetic market will rebound slowly. Some people say that the rebound has started, others say that they expect to see the up-tick next summer. I don't know. When credit becomes more accessible again and people feel secure in their jobs, they'll be back.

Liquid facelifts? I assume they're speaking of use of fillers in the face to reestablish facial contour. That's good for smaller problems, but it doesn't change the fact that gravity pulls the facial structures down. Filling is important, but it is of limited benefit.

 

[rongeur]

I was told that reimbursement for reconstruction had become quite low because plastic surgeons were not very politically active and allowed general surgeons or non-surgeons to negotiate reimbursement rates. Also, it was unlikely for reimbursement to increase for plastic surgeons, just because rates have just not been trending in that direction. I am not sure if this is true or not.

I think recon rates are terrible because they ARE like general surgery. Look at what's happened to the fee for an appy over the past 20 years. The way our billing system seems to work is that if you invent new codes (e.g., coming out with a new type of radiotherapy every two years) you make a ton of money then they slowly drop the value of each code over time. If you're billing the local flap code that's been around for 30 years or the chole code, you're SOL.

 

[medfriend]

I was under the impression that a lot of hand surgeons make over 500k. Is this way off base? And what about those on staff at hospitals who do 100% recon work? Do they average about the same as gen surgeons?

 

[maxheadroom]

I was under the impression that a lot of hand surgeons make over 500k. Is this way off base? And what about those on staff at hospitals who do 100% recon work? Do they average about the same as gen surgeons?

Not sure where you're getting those numbers on Hand, but that's waaaaay inflated. I think the most recent MGMA data that I've seen had a median salary for Hand at a touch about 300K and the upper limits as a bit over 400K.

People who do 100% recon can make it a bit above 300K with the right payor mix and a very efficient system. That's not the usual case, though.

 

[medfriend]

I got the over 500k figure from a book by Atul Gawande. He listed several fields where it is not uncommon, at least according to him, to make over 500. In a typical (i.e. not Beverly Hills) private plastics practice, with roughly a 50/50 split between cosmetic and recon, do you know what the usual range of incomes is?

 

[droliver]

Unless you work an "assembly line" type of practice, it is just hard to produce the revenue to generate net $500K salaries doing anything in medicine anymore. It will only get harder as rates as reimbursement is going nowhere but down while overhead will steadily creep up (don't even get me started on the whole pending mandatory EMR quagmire which is going to be a sinkhole of $)

The only guys I know that can do $500K in the forseeable future are people who are out of network doing complex Neuro or orthopedics in fee-for-service setups. For example, my mother went for a consult with a well-known spine surgeon in Atlanta who would charge you $25K for surgery (cash) for him to do your complex case and have you file your insurance for which you might get reimbursed back $2-4K. If you do a couple high dollar cases like that a week, it adds up quick.

OTOH, it would take ~ 30 carpal tunnels surgeries, 10-12 replants, or 125+ trigger releases to match that revenue with Medicare rates. For plastic surgery, it just takes up too much time for most reconstructive cases (2-4 hours for a breast reduction by yourself for example) to generate a really lucrative income. We don't have a lot of things (like endoscopy for instance) that you can do 10-20 of per day to churn the wheel. To expect there to be much of a market for high dollar out of pocket reconstruction patients is wishful thinking.

 

[maxheadroom]

To expect there to be much of a market for high dollar out of pocket reconstruction patients is wishful thinking.

Very, very true. And, as Winged Scapula has pointed out in other threads, Atul Gawande is not considered to be a great authority on practice management in the "real world". In general, the word that most surgeons use to describe him rhymes with "swoosh".

 

[igap]

From reading these forums, it appears that plastic surgeons cannot make 500K+ anymore. I'm curious then, what is a realistic income that trainees can expect to make once they are finished?

Specifically for the plastic surgeons in practice now, what is a relaistic income?

I am in the job hunting process right now, and I have been in close contact with my peers at other programs. We are generally getting offers ranging from the 200s (academic) up to the 500s for private practice. The locations vary, and the practice models vary as well.

The highest offer is very high (>500k/yr), and it is for a 2 year guarantee in a very cold, highly undesirable location. There is no payback, and partnership is optional at 2 yrs. How would something like that work? How could it be a money maker for the employer if the surgeon couldn't generate the income to justify such a high salary? Are they doing everything in a surgicenter where the owners are making their money off of facility fees? It just doesn't seem like things could work out financially to justify the kind of salary that is being offered. Any thoughts?

 

[bobby6]

Make sure you read the fine print on income guarantees for physicians. Often, the guarantees work like loans from hospitals. You are guaranteed 500k for the 2 years but what ever the difference between what income you actually generate and your income guarantee is the "loan amount" that has be be repaid over the next several years. If you leave early, you can be heavily penalized with owing tons of money.

From reading these forums, it appears that plastic surgeons cannot make 500K+ anymore. I'm curious then, what is a realistic income that trainees can expect to make once they are finished?

Specifically for the plastic surgeons in practice now, what is a relaistic income?

I am in the job hunting process right now, and I have been in close contact with my peers at other programs. We are generally getting offers ranging from the 200s (academic) up to the 500s for private practice. The locations vary, and the practice models vary as well.

The highest offer is very high (>500k/yr), and it is for a 2 year guarantee in a very cold, highly undesirable location. There is no payback, and partnership is optional at 2 yrs. How would something like that work? How could it be a money maker for the employer if the surgeon couldn't generate the income to justify such a high salary? Are they doing everything in a surgicenter where the owners are making their money off of facility fees? It just doesn't seem like things could work out financially to justify the kind of salary that is being offered. Any thoughts?

 

[droliver]

From reading these forums, it appears that plastic surgeons cannot make 500K+ anymore. I'm curious then, what is a realistic income that trainees can expect to make once they are finished?

You misunderstood. I'm referring to kind of a traditional plastic surgery practice with a lot of insurance work. There is just no way to maintain your income at historical levels doing reconstructive surgery anymore (and hasn't been for sometime). Like I mentioned, we just don't have anything that you can churn 8-10 cases/day out of

If you have a busy cosmetic practice you can do very well and certainly earn >$500K, but even then it can be hard. Competative pressures have brought prices down for the last 25 years. To net $500K with commonly cited 60-70% overhead numbers for aesthetic practices, you'll have to produce gross revenues of $1.1-1.2 million which would be the equivalent of doing (if you only did 1 operation) 400-450 breast augs or 150-170 facelift in a year. Few people have those kind of #'s.

 

[bronx43]

You misunderstood. I'm referring to kind of a traditional plastic surgery practice with a lot of insurance work. There is just no way to maintain your income at historical levels doing reconstructive surgery anymore (and hasn't been for sometime). Like I mentioned, we just don't have anything that you can churn 8-10 cases/day out of

If you have a busy cosmetic practice you can do very well and certainly earn >$500K, but even then it can be hard. Competative pressures have brought prices down for the last 25 years. To net $500K with commonly cited 60-70% overhead numbers for aesthetic practices, you'll have to produce gross revenues of $1.1-1.2 million which would be the equivalent of doing (if you only did 1 operation) 400-450 breast augs or 150-170 facelift in a year. Few people have those kind of #'s.

So, would you say those TV doctors (like Dr. Rey from Dr. 90210) can't pull 7 figures anymore?

 

[Llenroc]

That Atul Gawande guy is a complete nutsack. I'd trust Pee Wee Herman before I'd trust him.

 

[Renaissance Man]

I don't understand what is wrong with Gawande? I have read his three books, and no one can argue that he is extremely bright, why is he considered not in touch with real world medicine?

 

[rddoms]

That Atul Gawande guy is a complete nutsack. I'd trust Pee Wee Herman before I'd trust him.

Epic! Thanks for making me laugh during finals.

 

[makingmd]

Hi!

I have opportunities available for Plastic Surgeons, Cosmetic Surgeons or Dermatologists to work at an exsisting liposuction facility with the newest laser procedure. This opportunity offers a flexible schedule and your pts. are booked out for you for many months. Please call Kristin 310-867-2727 and email [email protected].

I look forward to hearing from you!

Kristin
310-867-2727