Plastics?

[GAdoc]

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Hi...I'm an MS1 at one of Georgia's allopathic schools. I plan to keep my mind open to all of the medical specialties, but there are a few things I know:

First, from multiple experiences I just don't think primary care will ever be my field. It's not the patients, it's the monotony of dealing with the same four illnesses day in and day out.

Second, I enjoy the human aspect of medicine and would like to interact with (awake) patients.

Third, I have always wanted to be a surgeon.

For these reasons, I have given serious thought to plastics. I know most of you guys have hard time remembering what being a first year med student was like. Also, many of you probably changed your minds a dozen times before ending up where you are. But, I'd like to know early on what to expect if I pursue plastics.

1. Why did you go into the field?
2. What do you enjoy/not enjoy?
3. If I do decide to pursue plastics, which part of the next few years will be most important - Step 1, clinical rotations, residency program, research, etc? When answering this questions, assume I don't attempt a combined program

Thanks!

 

[Mariah246]

Step 1 and clinical grades are the most important things to land a solid general surgery residency (if you aren't attempting a combined program, you typically enter a plastics fellowship after a general surgery residency. Although technically, you could opt to do another surgical residency like ENT, ortho, neurosurg, uro, etc.....)

Research during your medical school years never hurts either in terms of landing a solid residency spot

Once in the residency program, some research in plastics (if time permits) and receiving solid recommendations from faculty during your residency should set you up nicely for a spot in plastics

 

[GAdoc]

Step 1 and clinical grades are the most important things to land a solid general surgery residency (if you aren't attempting a combined program, you typically enter a plastics fellowship after a general surgery residency. Although technically, you could opt to do another surgical residency like ENT, ortho, neurosurg, uro, etc.....)

Research during your medical school years never hurts either in terms of landing a solid residency spot

Once in the residency program, some research in plastics (if time permits) and receiving solid recommendations from faculty during your residency should set you up nicely for a spot in plastics

Thanks...

Generally, how competitive are plastics "fellowships"? I mean, I'm sure it depends on many factors, but in general?

 

[dr.evil]

Plastics is extremely competitive. Usually the top people in the class go into the integrated programs and those who trudge through 5 years of general surgery and land a plastics spot tend to have some research and excellent in-service training scores. As a student, Step I scores are HUGE as well as your grades. AOA is a major plus.

I'm currently in general surgical practice and pondering entering plastics. So I'll tell you what is going through my mind and why plastics may be the field for me. Those who are out there in plastics residency or a plastics fellowship feel free to correct me anywhere you like.

Why to go into the field?

There is a huge variety in plastics. craniofacial, hand, cosmetics, burn, reconstructive, you can do pediatrics or adult, trauma of all kinds.

You can also focus your practice when you get out. You can do just craniofacial if you want (albeit after an extra year of fellowship), or you can do 50%cosmetics and 50%hand, or reconstructive or whatever. It's just an easier field to narrow your scope of practice to what you really enjoy doing.

It's lifestyle friendly overall. Now residency and/or fellowship may not be but once your out, call is tolerable at most places if you decide to take it. Pay is good.

Patients are generally healthy although if you do reconstructive, burn and trauma this can change but you are not likely taking care of all the minutia.

Technically it's an enjoyable challenge and makes you use several areas of your brain you've forgotten you had.

Patients generally appreciate what you have done for them.

Most plastic surgeons are happy

Now, for the bad. My theory is that you can only enjoy a specialty forever if you can tolerate the worst part of the field while enjoying the rest.

Cosmetic patients can be a pain in you butt sometimes. Their perfect body may not always be achievable no matter the results (although overall, the patients are generally elated).

You tend to get the rep of a cosmetic surgeon only without the recognition of the wonderful things you can do such as clefts, hand, reconstructive, trauma, etc.

It will be 8 years for you if you do general surgery followed by plastics residency so ideally you should look into the 6 year integrated/combined program to ease the pain. Alternatively, you could do general surgery and change your mind during that time and do general surgery or vascular, CT, pediatrics, colorectal, breast, surg onc, burn, hand, laparoscopy, etc.

Hands and facial lacerations can get old in the E.R.

When you get out, there are less opportunities overall to be guaranteed a salary for awhile so the first 6 months of practice Ramen noodles are still good things to eat.


I'm currently a general surgeon and very happy with my lifestyle financially. I just don't think I can do it for the rest of my life. I'm getting away from the vascular, I quit enjoying the colorectal stuff, and the bowel obstructions and chronic abdominal pain wear on me. I do enjoy endocrine, thoracoscopy and advanced laparoscopy but enjoying a few cases while suffering through the others is not going to be good for the next 30 years.

Hang in there. No matter what you end up doing, you won't regret smashing Step I and getting really good grades. It opens a lot of doors for you. 3rd year will really guide you into your decision most of the time. Otherwise, sub-I's in 4th year will help.

I remember 1st year very well. Medical school was by far the best years of my life.

 

[GAdoc]

Plastics is extremely competitive. Usually the top people in the class go into the integrated programs and those who trudge through 5 years of general surgery and land a plastics spot tend to have some research and excellent in-service training scores. As a student, Step I scores are HUGE as well as your grades. AOA is a major plus.

I'm currently in general surgical practice and pondering entering plastics. So I'll tell you what is going through my mind and why plastics may be the field for me. Those who are out there in plastics residency or a plastics fellowship feel free to correct me anywhere you like.

Why to go into the field?

There is a huge variety in plastics. craniofacial, hand, cosmetics, burn, reconstructive, you can do pediatrics or adult, trauma of all kinds.

You can also focus your practice when you get out. You can do just craniofacial if you want (albeit after an extra year of fellowship), or you can do 50%cosmetics and 50%hand, or reconstructive or whatever. It's just an easier field to narrow your scope of practice to what you really enjoy doing.

It's lifestyle friendly overall. Now residency and/or fellowship may not be but once your out, call is tolerable at most places if you decide to take it. Pay is good.

Patients are generally healthy although if you do reconstructive, burn and trauma this can change but you are not likely taking care of all the minutia.

Technically it's an enjoyable challenge and makes you use several areas of your brain you've forgotten you had.

Patients generally appreciate what you have done for them.

Most plastic surgeons are happy

Now, for the bad. My theory is that you can only enjoy a specialty forever if you can tolerate the worst part of the field while enjoying the rest.

Cosmetic patients can be a pain in you butt sometimes. Their perfect body may not always be achievable no matter the results (although overall, the patients are generally elated).

You tend to get the rep of a cosmetic surgeon only without the recognition of the wonderful things you can do such as clefts, hand, reconstructive, trauma, etc.

It will be 8 years for you if you do general surgery followed by plastics residency so ideally you should look into the 6 year integrated/combined program to ease the pain. Alternatively, you could do general surgery and change your mind during that time and do general surgery or vascular, CT, pediatrics, colorectal, breast, surg onc, burn, hand, laparoscopy, etc.

Hands and facial lacerations can get old in the E.R.

When you get out, there are less opportunities overall to be guaranteed a salary for awhile so the first 6 months of practice Ramen noodles are still good things to eat.


I'm currently a general surgeon and very happy with my lifestyle financially. I just don't think I can do it for the rest of my life. I'm getting away from the vascular, I quit enjoying the colorectal stuff, and the bowel obstructions and chronic abdominal pain wear on me. I do enjoy endocrine, thoracoscopy and advanced laparoscopy but enjoying a few cases while suffering through the others is not going to be good for the next 30 years.

Hang in there. No matter what you end up doing, you won't regret smashing Step I and getting really good grades. It opens a lot of doors for you. 3rd year will really guide you into your decision most of the time. Otherwise, sub-I's in 4th year will help.

I remember 1st year very well. Medical school was by far the best years of my life.

Thank you for the thoroughness of your response. I'm doing my best to see to it that I "smash Step 1". In the meantime, my grades are pretty good (though from what I hear basic science grades probably don't count other than their contribution to AOA, and a good dean's letter).

That's good advice, and I don't plan on making up my mind now on what I'm going to do...but it is good to start thinking things through.

 

[98782972]

Hi Dr. Evil, I enjoyed reading your reply to this thread. I'm a resident in Canada. Now that more and more residents are entering a Plastics Surgery residency directly, I'm wondering if there are many more programs out there (in the Canada or the states) that accept General Surgeons into a Plastic Surgery fellowships. How long are these fellowships afterwards, and would you have to do more (yikes) training after that for specialized areas like hand, etc.?

From your perspective, what would you say to someone who is still in their residency training expecting a similar situation as you. I like medicine, and fresh out of med school I enjoy being thoroughly trained to handle most medical issues ("ie. feel like a complete doctor"). General surgery probably offers the closest match to that while letting one operate. But I know that I will get tired of the bread and butter of GS eventually (I don't particular fancy the lap choles, the appeys of GS, it's just the complete medicine that I like), and would like to move on to a cleaner, less-strings attached office practice when that happens. I find it similar to anticipating your situation. Is it unwise to stick to Gen Surg just because I appreciate the medicine now even though I already recognize that I might get tired of it in the future? Thanks for your perspective.

Canada Res

 

[dr.evil]

How long are these fellowships afterwards, and would you have to do more (yikes) training after that for specialized areas like hand, etc.?

From your perspective, what would you say to someone who is still in their residency training expecting a similar situation as you. I like medicine, and fresh out of med school I enjoy being thoroughly trained to handle most medical issues ("ie. feel like a complete doctor"). General surgery probably offers the closest match to that while letting one operate. But I know that I will get tired of the bread and butter of GS eventually (I don't particular fancy the lap choles, the appeys of GS, it's just the complete medicine that I like), and would like to move on to a cleaner, less-strings attached office practice when that happens. I find it similar to anticipating your situation. Is it unwise to stick to Gen Surg just because I appreciate the medicine now even though I already recognize that I might get tired of it in the future? Thanks for your perspective.

Canada Res

Tough but good questions.

I can't speak for Canada so I'll stick with what goes on here in the ol' US of A.

There are still quite a few residencies in plastic and reconstructive surgery following the 5 years of training. They are definitely becoming fewer in number and many have gone to 3 years lenght.

This is the last year, I believe, that you can enter a plastics residency after 3years of general surgery. Therefore, if you are in general surgery and want to do plastics, you must do the 5 years of GS then Plastics. Beginning for the incoming class of 2010, plastics residents will all be doing 3 years of residency. So that's a total of 8 years when you take the long route like us.

Then there is the consideration of a plastics fellowship if you desire to do so. These are universally an extra year of hand, craniofacial, aesthetics, etc.

Now I definitely don't want to discourage people away from General Surgery. I'm a general surgeon and there are a ton of aspects to it that are great. It does have the "complete doctor" aspect and you will definitely lose that as a plastic surgeon as you age. All specialties have their "bread and butter" and you may or may not get tired of that no matter the field. That's definitely different for different people. If you really enjoy the medicine/surgery combination, critical care or burn are great fields for a general surgeon to pursue. Breast surgery can also be more "office-based" surgery with less hospital politics to worry about (although that definitely varies by location).

I still struggle everyday with my current situation. I really don't want to go back and do 2 or 3 more years of residency but I also want to do something I enjoy each day.

The best approach for me is to either pick out the surgeon who I most want to emulate their practice and write down the aspects of their day to day life I want and enjoy. Plastic surgeons tend to fit that bill for me.