Newly matched plastic surgery resident AMA

[PlasticsAMA]

Hi all,

With all this home-dwelling, I've been returning back the these forums that I used to visit so frequently as a pre-med and throughout the first few years of medical school.

I matched into an integrated plastic surgery program which is an accomplishment I had much anxiety about. Heck, I had plenty of anxiety throughout this whole process, from college grades, to applying to med school, and beyond.

I am very happy to answer any questions you might have about plastic surgery or my process.

Be safe and best of luck to you all.

PlasticsAMA

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[Office Visit]

Thanks for doing this! I have two questions:

1. Did you do away rotations and if so what are your recommendations for excelling on aways?
2. I have heard mixed reviews on residency and attending lifestyle. What have you seen in your experience??

 

[meronebib]

wAt WaS uR sTeP

 

[vrazzles]

What were your main motivations in pursuing specifically plastics (e.g. lifestyle, pay, creativity, patient population etc.)?

 

[CheeseCurd]

First off, congratulations! It's refreshing to hear some great success stories on here

Did you know you were interested in plastic surgery when you were first starting medical school? What experiences/research/rotations did you do that helped you prepare for matching into this program?

 

[PlasticsAMA]

So I actually created two AMAs, one in the premed forum and one in the MD forum.
Perhaps foolish but i'll continue to answer questions on both.
Just for reference here is the link to the other thread:

MD & DO - AMA Plastic Surgery Matched

Hi all, With all this home-dwelling, I've been returning back the these forums that I used to visit so frequently as a pre-med and throughout the first few years of medical school. To be concise, I matched into an integrated plastic surgery program which is an accomplishment I had much...

forums.studentdoctor.net

With all that out of the way, ill get to answering your questions:

1. Did you do away rotations and if so what are your recommendations for excelling on aways?

Yes, I did three away rotations. Virtually every applicant does them. Most will do three aways plus home rotation. Some will do two aways some will do four. Key fact: more than 50 percent of matches in integrated PRS are applicants at their home programs are places they rotated. These rotations are excellent opportunities to (1) make an impression on residents and faculty at a new program. (2) learn about how PRS is practiced outside your home institution (3) assess your fit at a program you are interested in (4) get a new letter of rec from a well known faculty member.

Tips for Excelling on Sub-I's (non-exhaustive)

Generally, realize that you are being evaluated 100% of the time. On your first week, step back and try to get a sense of what is expected of you. Its different at different places (sounds obvious but its not) at some places you are expected to get supplies, at some you make the list, etc. You might feel that you are not being productive when really you are doing a good job. It can't hurt to ask either - just try not to come off super insecure or like you are doing a terrible job - be an adult about it.

other classic things that are true:
- first one is ALWAYS, last one to leave unless they say go (if they do, go).
- know how to suture COLD. Nothing leaves a better impression than a med student who knows how to sew well and fast. Simple interrupted, subcuticular, deep dermals, etc.
- There are some canonical things you must know about content wise. Off the top of my head - three stages of skin graft incorporation, definition of a flap versus a graft, know the anatomy of a micro breast reconstruction cold, know the names of common instruments, etc.
- You can't prep this but the thing people will remember most is the stuff that gets said in normal conversation.. talking about a classic rock band, a great skiing spot, sports, broadway shows, etc. - stuff people enjoy talking about.

2. I have heard mixed reviews on residency and attending lifestyle. What have you seen in your experience??

In general, PRS is a hard surgical residency. Cosmetics, while it is a very well-known subfield of plastics, is probably less or in certain places only equally heavy in the resident experience as autologous breast reconstruction after cancer, head and neck reconstruction, extremity reconstruction, complex wound management and reconstruction, craniofacial surgery etc. For the most part, flap surgery is rather intense, long cases, has the ability to fail at night requiring flap takedowns etc. = tough hours. PRS residents also take hand trauma call and craniofacial trauma which can be very busy. So in sum the residency is tough.

As far as attendings, you can have a mix of whatever you like from what i've seen. Their are crackerjack surgeons (love that term) who do +10hr flap surgeries all week and into the night. There are those that like the predictability of breast recon. There are craniofacial surgeons who take on complex syndromic patients, there are cosmetic people who operate on weekends or not at all - its a flexible lifestyle in every sense which is one of the greatest draws of the field.

 

[PlasticsAMA]

wAt WaS uR sTeP

Step 1 was in the 250's which is average for plastics
Didn't take step 2 until real late and didn't release my score to programs.

 

[PlasticsAMA]

What were your main motivations in pursuing specifically plastics (e.g. lifestyle, pay, creativity, patient population etc.)?

Not necessarily in order:

1) The ability to be involved in the part of someone's medical experience in which you are giving something back (I thought of it as net additive versus subtractive) - i.e. you have breast cancer > you get chemo > you get a mastectomy > you are in the dumps > plastic surgery offers you a hand in recrafting your identity in a positive direction. The same for complex wound management etc. We take people who have had traumatic experience and focus on holistically restoring them. In a presentation I once heard a mentor of mine say "here is a lady who is falling apart at the seams" - complex facial wound from H and N cancer.. I thought about that for a while, what does that mean, exactly? He showed a two year post-op, she looked like a person again if you know what I mean, reflecting inner contentment.. its soft but it moved me.

2) Flexibility in terms of reimbursement - there are options for cash based reimbursement if I want it.

3) Flexibility in terms of the types of problems I take care of - I see something surreal in both cancer recon and cosmetic rhinoplasty - they are very different though - I can choose to do more of one or the other based on what I want.

4) Diversity in terms of patient population - again severity of disease but also age.

5) Diversity in anatomy and techniques - hand surgery, breast recon, simple craniofacial procedures, simple cosmetic procedure - all fall within the purview of a general plastic surgeon and cases as diverse as these can be on the "menu" for a community plastic surgeon on any given day.

 

[PlasticsAMA]

Did you know you were interested in plastic surgery when you were first starting medical school? What experiences/research/rotations did you do that helped you prepare for matching into this program?

I had an idea that I was interested in plastics and got involved in research early as many people do. It was good that I did as that opened up many opportunities for me. I didn't rule out other fields completely until later in med school though. Those other fields were neurosurgery and orthopedics.

Plenty, plenty of research. I genuinely love technology in plastic surgery including flap monitoring techniques, innovative surgical techniques, artificial intelligence, and even some 3D technology. These things helped me make relationships for PRS attendings through research and gave me stuff to talk about on aways and interviews.

 

[gulli_97]

I had an idea that I was interested in plastics and got involved in research early as many people do. It was good that I did as that opened up many opportunities for me. I didn't rule out other fields completely until later in med school though. Those other fields were neurosurgery and orthopedics.

Plenty, plenty of research. I genuinely love technology in plastic surgery including flap monitoring techniques, innovative surgical techniques, artificial intelligence, and even some 3D technology. These things helped me make relationships for PRS attendings through research and gave me stuff to talk about on aways and interviews.

Mind discussing why you ruled out those other fields?

 

[PlasticsAMA]

Mind discussing why you ruled out those other fields?

Great question:

One of the defining aspects of plastic surgery is that it is a principle rather than procedure based field. Throughout its history, plastic surgeons have invented new techniques when faced with challenging problems that didn't fall into the scope of other surgical fields and through this, entire subfields of plastic surgery were born. For example, the first allogeneic transplant (a kidney) was performed by a plastic surgeon. Entire fields of microvascular reconstruction have been invented through the concept of free flaps, craniofacial surgery, of the most interesting fields to me, was invented largely through the efforts of paul tessier and others who spent time refining techniques in bony surgery... the idea that I will build an arsenal of tools and principles in training that will enable me to help people with new and unseen problems is a tantalizing idea.

To add to this - the breadth of complex wound reconstruction - cancer resection, trauma, inflammatory processes, etc. - coupled with the functional and cosmetic goals of each patient does require an individualized approach. This is so much different than what I saw in other fields. Few other surgical fields enjoy a true open field in the way plastic surgeons do. A cholecystectomy is a cholecystectomy. A total knee is a total knee. Sure, there are plastic surgeons who do only routine stuff in private practice - I would acknowledge that fully - but that's not me and I think that a lot of people who are drawn to plastics are drawn for this reason.

Finally just want to say I enjoyed almost all other aspects of surgery. Truly I did. I felt like plastics actually gave me a little bit of everything I liked with a lot of the stuff I loved.

 

[gulli_97]

I find that plastic surgeons often say there is a lot of breadth and diversity in the field but then again most I see are in PP and are doing routine cosmetic procedures. Do PP plastic surgeons ever delve into the other subfields of plastics that are mostly done in academic settings? I have a feeling that there just isn't enough patient volume to sustain a PP without doing cosmetics.

 

[PlasticsAMA]

I find that plastic surgeons often say there is a lot of breadth and diversity in the field but then again most I see are in PP and are doing routine cosmetic procedures. Do PP plastic surgeons ever delve into the other subfields of plastics that are mostly done in academic settings? I have a feeling that there just isn't enough patient volume to sustain a PP without doing cosmetics.

Like most fields, where you practice in PP will affect the diversity of cases you get. Hyper specialized markets like New York will have PP people specializing in particular niche areas in plastics including micro breast, ab wall and hernia repair, hand of course, wounds etc. for cash or they figure out how to make it work with insurance, but perhaps less of other things as this is the way the market shakes out. PP seems to me to be much more than just strictly cosmetic. You will also have people who do bread and butter cosmetic stuff. And then people who do a mix of everything. I am based in one of these Uber competitive markets and have seen this routinely. It’s just about building referral patterns and a clinical practice. Btw, many people who market themselves aesthetically do reconstructive work in their pp too including traumatic and secondary rhino, complex facial lacs, giant Nevus recon etc.

not sure who you’ve seen in PP also but would just add that when a pp person has the opportunity to do cosmetic surgeries like rhino, facelift, breast aug etc. they will typically take them as they reimburse handsomely. So maybe you shadowed a skewed set of really established pp cosmetic guys and that is what you saw? versus other new pp people who are taking on less well reimbursed but varied cases. Just a thought.

 

[Engrailed]

Did you ever consider a non-surgical specialty? and if so, what would that have been?

 

[bredtobe]

Was all your research strictly in plastics? I’m more interested in orthopedics which I know likes research in ortho specifically, but the idea of reconstructive surgeries sounds interesting too. I’m planning on pursuing ortho research in med school from the get-go but will that not help if I pursue something like plastics?

 

[PlasticsAMA]

Did you ever consider a non-surgical specialty? and if so, what would that have been?

This is a great question: though its a virtue to be open-minded, and I advise my younger peers to be open-minded about choosing a specialty, I knew in my heart of hearts that I was going to be a surgeon and never truly considered going into a non-surgical field. Though I have to say I immensely enjoyed my psychiatry rotation and very much enjoyed my peds rotation.

 

[PlasticsAMA]

Was all your research strictly in plastics? I’m more interested in orthopedics which I know likes research in ortho specifically, but the idea of reconstructive surgeries sounds interesting too. I’m planning on pursuing ortho research in med school from the get-go but will that not help if I pursue something like plastics?

It will definitely help and you should pursue ortho research if thats what you are interested in. If you decide to go into plastics later, you will figure out how to craft a compelling narrative to describe your journey when you are on interviews. For what its worth, there are a lot of great collaborations that I personally enjoy between ortho and plastics. Look at Scott Levin's work and his publications about orthoplastic surgery in limb salvage. Really interesting stuff. I looked at ortho for a while too and published a bit in their literature. I found it to be too routine/algorithmic for me but that's just my individual preference and some of the pods I worked with were my fav people in med school. Do what your heart desires and then when your heart desires something else, do that.

 

[bredtobe]

It will definitely help and you should pursue ortho research if thats what you are interested in. If you decide to go into plastics later, you will figure out how to craft a compelling narrative to describe your journey when you are on interviews. For what its worth, there are a lot of great collaborations that I personally enjoy between ortho and plastics. Look at Scott Levin's work and his publications about orthoplastic surgery in limb salvage. Really interesting stuff. I looked at ortho for a while too and published a bit in their literature. I found it to be too routine/algorithmic for me but that's just my individual preference and some of the pods I worked with were my fav people in med school. Do what your heart desires and then when your heart desires something else, do that.

I appreciate the advice! And I’ll definitely look into his work, thanks!

 

[deleted861279]

Thanks for starting this AMA, and congrats on this matching into plastics! Just curious, what was your MCAT score and undergraduate GPA? Also, what tier med school did you attend?

 

[PlasticsAMA]

Thanks for starting this AMA, and congrats on this matching into plastics! Just curious, what was your MCAT score and undergraduate GPA? Also, what tier med school did you attend?

My pleasure and thanks
My mcat score was a 38, not sure what that translates to these days. GPA was a 3.8.
Prob on the upper end of mid-tier I would think.
Don't let anything get in the way of doing this if this is what you want to do.
The road may be long, may not always be a clear path, might take extra work, but if you want it bad enough you will get it.
Simple, but best advice i've gotten, best advice I could give.
Wish I could've given this advice to myself as a pre-med.

 

[deleted861279]

Thanks @PlasticsAMA!

Another question I have is, what are your thoughts on the differences between MCAT and STEP 1? Do you think its possible to do well on STEP even though one struggled on the MCAT?

I really appreciate it!

 

[TLR123]

For research how much did you have and how did you know if it was enough? I am interested in another surgical sub specialty and have been productive but it always seems like others are more productive.

 

[PlasticsAMA]

Thanks @PlasticsAMA!

Another question I have is, what are your thoughts on the differences between MCAT and STEP 1? Do you think its possible to do well on STEP even though one struggled on the MCAT?

I really appreciate it!

Edit: I forgot to mention that by the time you are taking step 1 if you are pre med it will be likely be pass fail. Big questions in the air as a result of that. Everything else becomes more important.

this is a good question - our school actually had internal data about these kinds of associations that they showed to us during our pre step one presentation. There is a statistically significant correlation between MCAT and step scores but the correlation value wasn’t tremendously high. The highest correlation were found to be with course grades in first two years of medical school and the number of practice questions done during the study period.
In general the MCAT is probably 50 perfect memory and 50 percent logic. Step one Is probably two thirds memory one third Logic but the amount of content Is very large. So yes, emphasizes different skill sets

 

[PlasticsAMA]

For research how much did you have and how did you know if it was enough? I am interested in another surgical sub specialty and have been productive but it always seems like others are more productive.

I had a good amount of research. Maybe around ten publications, a bunch of presentations at national meetings etc. you don’t need to crush the research game if everything else in your app is solid but it definitely helps. Don’t worry about what other people are doing - do you to the best of your ability. You dont know where other people are failing.

 

[freyamal]

hey, congrats and thanks for this thread! I wanted to ask what do you expect from this job in the future? I mean, plastic surgery is something that is very popular nowadays and I guess it will keep its popularity for some time on. Moreover, it has a lot of branches like the one that I have recently used is microneedling that revives your skin and makes you look younger. If anyone wanna read about it, check out this site Microneedling at Seattle Plastic Surgery | Top Plastic & Cosmetic Surgery

 

[Justapremedguy]

Not necessarily in order:

1) The ability to be involved in the part of someone's medical experience in which you are giving something back (I thought of it as net additive versus subtractive) - i.e. you have breast cancer > you get chemo > you get a mastectomy > you are in the dumps > plastic surgery offers you a hand in recrafting your identity in a positive direction. The same for complex wound management etc. We take people who have had traumatic experience and focus on holistically restoring them. In a presentation I once heard a mentor of mine say "here is a lady who is falling apart at the seams" - complex facial wound from H and N cancer.. I thought about that for a while, what does that mean, exactly? He showed a two year post-op, she looked like a person again if you know what I mean, reflecting inner contentment.. its soft but it moved me.

2) Flexibility in terms of reimbursement - there are options for cash based reimbursement if I want it.

3) Flexibility in terms of the types of problems I take care of - I see something surreal in both cancer recon and cosmetic rhinoplasty - they are very different though - I can choose to do more of one or the other based on what I want.

4) Diversity in terms of patient population - again severity of disease but also age.

5) Diversity in anatomy and techniques - hand surgery, breast recon, simple craniofacial procedures, simple cosmetic procedure - all fall within the purview of a general plastic surgeon and cases as diverse as these can be on the "menu" for a community plastic surgeon on any given day.

So why not general surgery?

 

[drtribbiani]

Hi, thank you for doing this! I sometimes (maybe 20% of the time) have a small, resting hand tremor. I haven't really found out why this is, but it's there. However in my experience, the tremor doesn't come up when I'm working with tools or anything. I've only noticed it when I'm sitting down with my elbow rested on the table. I wanted to ask if such a tremor will be a problem for a specialty like plastics. Or any surgery in general for that matter.