Plastics fellowship following GS

[usctrojans24]

Hey everyone,

I was wondering if someone could shine light on the independent model for plastics here. (Is it 5 GS + 2 yrs of research + 3 yrs of Plastics). If anyone has gone down this route and explain the difference between this and the integrated model possibly some benefits and drawbacks. I'm just generally curious why is the extra 2 years needed is it just so the person is a more competitive applicant? For some of you guys who did GS before plastics how did it prepare you for Plastics?

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[MediCane2006]

I think you will find that most people advocate for the model under which they trained.

I did the traditional pathway (6 years GS + 3 years plastics) plus a subspecialty fellowship. The big downside of this is obviously time. However, I think it really made me a more complete surgeon and certainly facilitated learning the technical skills in plastics (laparoscopic and vascular skills, for example, translate somewhat to microsurgery). Proponents of the integrated pathway would argue that you learn a lot of “bad habits” in general surgery which are hard to break - personally I found that most of these involved tissue handling and were fairly easy to get over.

Faculty at my institution generally agreed that the integrated residents were more “book smart” while the traditional pathway residents were more comfortable in the OR all the way through to graduation. I’d say my experience thus far has borne that out. There were some studies a few years back that showed integrated residents were more likely to do a subspecialty fellowship but I’m not sure if that’s still the case.

Ultimately either pathway will get you to being a competent plastic surgeon. I think for me the extra training time was beneficial as I probably wouldn’t have been mature enough as a surgeon to jump into practice after an integrated residency. But there is no denying that being a PGY-10 is a rough path to take and not for everyone. On the flip side, while plenty of people have the stats to get into a general surgery program, integrated plastics is so ridiculously competitive that it’s not an option for many applicants.

 

[usctrojans24]

I think you will find that most people advocate for the model under which they trained.

I did the traditional pathway (6 years GS + 3 years plastics) plus a subspecialty fellowship. The big downside of this is obviously time. However, I think it really made me a more complete surgeon and certainly facilitated learning the technical skills in plastics (laparoscopic and vascular skills, for example, translate somewhat to microsurgery). Proponents of the integrated pathway would argue that you learn a lot of “bad habits” in general surgery which are hard to break - personally I found that most of these involved tissue handling and were fairly easy to get over.

Faculty at my institution generally agreed that the integrated residents were more “book smart” while the traditional pathway residents were more comfortable in the OR all the way through to graduation. I’d say my experience thus far has borne that out. There were some studies a few years back that showed integrated residents were more likely to do a subspecialty fellowship but I’m not sure if that’s still the case.

Ultimately either pathway will get you to being a competent plastic surgeon. I think for me the extra training time was beneficial as I probably wouldn’t have been mature enough as a surgeon to jump into practice after an integrated residency. But there is no denying that being a PGY-10 is a rough path to take and not for everyone. On the flip side, while plenty of people have the stats to get into a general surgery program, integrated plastics is so ridiculously competitive that it’s not an option for many applicants.

Thank you so much for taking the time to reply to my post. So is a research component not required for someone who completed GS and wanted to do a Plastics fellowship.

I have a few more questions if you don't mind answering:
1) How competitive is Plastics Fellowship if you completed GS?
2) Do you know if Integrated Plastics programs have the residents do (3 yrs of GS and 3 yrs of Plastics)?
3) What subspecialty do you go for?
4) I've read that the traditional pathway spots are diminishing? Thoughts on this?
5) What drew you towards plastics?
6) How is the plastic lifestyle as an attending?
7) Isn't GS (5 year residency)?

 

[MediCane2006]

Thank you so much for taking the time to reply to my post. So is a research component not required for someone who completed GS and wanted to do a Plastics fellowship.

I have a few more questions if you don't mind answering:
1) How competitive is Plastics Fellowship if you completed GS?
2) Do you know if Integrated Plastics programs have the residents do (3 yrs of GS and 3 yrs of Plastics)?
3) What subspecialty do you go for?
4) I've read that the traditional pathway spots are diminishing? Thoughts on this?
5) What drew you towards plastics?
6) How is the plastic lifestyle as an attending?
7) Isn't GS (5 year residency)?

1. Plastics fellowship used to be one of the most competitive fellowships, but once it went from two years to three it dropped off a bit. However, it's still reasonably competitive - I think between 10 and 20% of applicants don't match most years. Matching usually requires some good letters of recommendation (so it really helps if you can work with a plastic surgeon during your general surgery residency), decent inservice scores, and research. It doesn't necessarily mean you need to take a year off to do bench research, but you do need to have at least some clinical stuff on your CV. Matching into the upper tier of programs obviously requires a greater degree of all of these, plus it helps to have some connections through a mentor or faculty member.

2. Most integrated plastics programs have a 1+5 or 3+3 model, with the 3+3 having a decreasing amount of time on non-plastics rotations as you progress. This varies from program to program.

3. There are several subspecialty fellowships you can pursue, including microvascular, Craniofacial, cosmetic, and hand.

4. Overall I think the trend is toward an integrated model but there are still plenty of traditional pathway programs and I don't think it will be going away anytime soon.

5. I find the overall mindset of plastic surgery to fit my personality better than any specialty. Particularly with reconstruction, plastics is largely a "problem-solving" field - you learn a bunch of techniques, and then you have to customize each surgery to fit the problem and the patient. There often isn't a right or wrong answer, and if you ask three different surgeons how to do a case you will get three completely different answers. I also love that we operate all over the body - in a typical week, I may do a cleft lip, an open cranial vault reconstruction, a breast case, a hand case, and a leg reconstruction. The variety is different from almost any other field and it keeps me challenged and interested every single week. But if you want a practice where you super-specialized and only do breast reconstruction, for example, you can have that too.

6. My lifestyle is pretty great, although that's kind of by design as (again), there isn't a one-size-fits-all model of practice. I am in an academic-affiliated practice doing pediatric reconstructive surgery and Craniofacial, and so my practice is almost 100% elective with a smattering of ER call. Most of my days are 8-4, and I don't work weekends. I am fairly active with research and administration so I do have some extra responsibilities on top of my clinical duties. I don't make as much money as I would if I were hustling in private practice, but to me the tradeoff is worth it as I absolutely love both my job and my life outside of work.

7. Most general surgery residencies are 5 years but some (like mine) have a built in research year (or two) making them 6 or 7 years.

Hope that helps!!

 

[Frogger27]

1. Plastics fellowship used to be one of the most competitive fellowships, but once it went from two years to three it dropped off a bit. However, it's still reasonably competitive - I think between 10 and 20% of applicants don't match most years. Matching usually requires some good letters of recommendation (so it really helps if you can work with a plastic surgeon during your general surgery residency), decent inservice scores, and research. It doesn't necessarily mean you need to take a year off to do bench research, but you do need to have at least some clinical stuff on your CV. Matching into the upper tier of programs obviously requires a greater degree of all of these, plus it helps to have some connections through a mentor or faculty member.

2. Most integrated plastics programs have a 1+5 or 3+3 model, with the 3+3 having a decreasing amount of time on non-plastics rotations as you progress. This varies from program to program.

3. There are several subspecialty fellowships you can pursue, including microvascular, Craniofacial, cosmetic, and hand.

4. Overall I think the trend is toward an integrated model but there are still plenty of traditional pathway programs and I don't think it will be going away anytime soon.

5. I find the overall mindset of plastic surgery to fit my personality better than any specialty. Particularly with reconstruction, plastics is largely a "problem-solving" field - you learn a bunch of techniques, and then you have to customize each surgery to fit the problem and the patient. There often isn't a right or wrong answer, and if you ask three different surgeons how to do a case you will get three completely different answers. I also love that we operate all over the body - in a typical week, I may do a cleft lip, an open cranial vault reconstruction, a breast case, a hand case, and a leg reconstruction. The variety is different from almost any other field and it keeps me challenged and interested every single week. But if you want a practice where you super-specialized and only do breast reconstruction, for example, you can have that too.

6. My lifestyle is pretty great, although that's kind of by design as (again), there isn't a one-size-fits-all model of practice. I am in an academic-affiliated practice doing pediatric reconstructive surgery and Craniofacial, and so my practice is almost 100% elective with a smattering of ER call. Most of my days are 8-4, and I don't work weekends. I am fairly active with research and administration so I do have some extra responsibilities on top of my clinical duties. I don't make as much money as I would if I were hustling in private practice, but to me the tradeoff is worth it as I absolutely love both my job and my life outside of work.

7. Most general surgery residencies are 5 years but some (like mine) have a built in research year (or two) making them 6 or 7 years.

Hope that helps!!

This was really informative. I'm curious as to how the lifestyle during Plastics Fellowship compares to lifestyle of GS and Integrated PS.

 

[MediCane2006]

This was really informative. I'm curious as to how the lifestyle during Plastics Fellowship compares to lifestyle of GS and Integrated PS.

As with any fellowship, it depends. If your fellowship has a lot of hand and face call, as mine did, you are going to get worked harder than a lot of general surgery residents. Remember, too, you are going from being a chief resident to being a junior fellow, and going back to working intern hours can be a tough pill to swallow for some people. You’re also going from knowing everything about your specialty to having to learn a whole new vocabulary, learn what you can do in the ER vs what needs to go to the OR, what’s an emergency vs what needs outpatient follow up, etc. It can be overwhelming, and very humbling.

 

[nimbus]

Where I was an anesthesia resident, every single burn fellow was there to buff their CV in order to get a plastics fellowship. Nobody actually wanted to be a burn specialist. That was a while ago so maybe things are less competitive now.

 

[deleted903608]

I'm only an MS1 so take this with a grain of salt, but I recently spoke with the PD for the plastics program at my school about this and her opinion is that GS -> plastics is going to become much harder in the coming years because there are fewer spots and most programs are moving towards the integrated program. Essentially her advice was if you know you want to do plastics before residency don't do general surgery first, go straight to integrated plastics.

 

[CyrusHabs7695]

I'm only an MS1 so take this with a grain of salt, but I recently spoke with the PD for the plastics program at my school about this and her opinion is that GS -> plastics is going to become much harder in the coming years because there are fewer spots and most programs are moving towards the integrated program. Essentially her advice was if you know you want to do plastics before residency don't do general surgery first, go straight to integrated plastics.

It seems pretty unlikely that people would WANT to do a GS residency prior to a plastics fellowship. Id imagine most people do it bc they don't have the scores to get into an integrated plastics. Someone correct me if Im wrong

 

[Blunt Dissection]

It seems pretty unlikely that people would WANT to do a GS residency prior to a plastics fellowship. Id imagine most people do it bc they don't have the scores to get into an integrated plastics. Someone correct me if Im wrong

NRMP data and program director panels at conferences suggest scores while they play a role, are not as all determining as they are made out to be for integrated. Academic plastic surgery is an incredibly small field where almost all of the program directors have at one point or another have met in person so it makes sense that being able to obtain strong letters of recs from an academic mentor is game changing to one's application. This is achieved through dedicated time doing research with them or occasionally on an away rotation where the individual is just stellar. It isn't so much that people that go the GS route don't have the numbers, it's more that the lack of networking makes those that do have a network more appealing.