Question

[dark apprentice]

---

Members do not see this ad.

Plastic surgery seems like a rather intriguing career option. However, i know that i shall never do a cosmetic procedure upon completion of my residency in plastics. Just how much scope is there in private practise for the plastic and reconstructive surgeon who dosent touch cosmetics. Does this effect your annual income significantly? Is there such a thing as a renound reconstructive surgeon in the private sector?

 

[maxheadroom]

There are people who do primarily recon, but the financial rewards aren't as good. None of them are living beneath bridge or eating Ramen noodles everyday, but their income potential isn't as great. In private practice, this is best done as part of a multi-specialty group like Kaiser. There are lots of people in academics who are reconstructive only. If you're interesting in micro, then you'll be very desirable at any place with a cancer center -- micro breast recon is very sought after and there aren't many people who can/want to do it.

 

[GSresident]

I would agree with maxheadroom's post. I'll add that if you are willing to do recon cases and don't mind working then you will be busy as hell. Once people figure out that you're willing to accept the sacral decub dumps from nursing homes the floodgates will open and you will have a very large service of stinking, festering butt wounds. I haven't even opened my doors yet and I've already been asked if I will take decub referrals. My answer (now) is YES! Daddy needs a new pair of shoes!

 

[deleted144060]

I've been meaning to write about my job search experiences one of these days, but in the mean time:

When I was a PGY-4 in GS, I was wondering whether I still wanted to do plastics. I had been with a guy who did mainly cosmetics and I knew that it wasn't for me. I almost didn't apply until another plastics attending told me I could make a good living doing only reconstructive work. After my recent discoveries on the job interview circuit, I can tell you he's right.

I interviewed with a private practice group that did mostly recon and these guys were doing very well. I know that the general feeling is that you can't make any money (comparatively speaking), but this really isn't true. Besides the group in question, there are employed positions, multi-specialty group positions (as mentioned), and solo jobs in smaller communities where one can do quite well.

I just did a locums weekend in a "smaller town" for a guy who is in private practice. His waiting room was full of just about every bread and butter plastics case you could imagine. Coincidentally, I had looked at working at this place a few years before I decided to do peds plastics so I know how approximately how much he was making. He was doing VERY well.

I just signed a contract to do mostly kids with some adult hand/face and recon work that I'm very happy with.

 

[droliver]

I haven't even opened my doors yet and I've already been asked if I will take decub referrals. My answer (now) is YES! Daddy needs a new pair of shoes!

Kyle,

Don't go there.

Those patients are not reconstructive surgery candidates and are almost never appropriate candidates for the types of flaps that were done commonly in years prior. If you track outcomes on flap closure in medicare data, the results are horrible and very expensive. While you can get steady work with ulcers, I really don't think it's the "smart" or conscientious surgeon who continues to do surgery that doesn't work

At the end of the day you end up doing none of the flap codes (with relatively high RVU's) and lots of the debridement procedures (very low RVU's) as add-on cases at the end of the day. Almost all these cases are also medicare now, which is due to be cut an additional 10-13%. The only good candidates for fairly stable coverage are young high-functioning paraplegics or older patients who are ambulatory. For most others it's debridement and dressing changes or a wound VAC.

It is not a sustainable practice builder anymore and palliative debridements are easier to accommodate in a hospital based general surgeon's practice (who usually operate 3 days a week in block time) rather then a plastic surgeon's practice who operate somewhat sporadically.

 

[jdm51]

can you reference this medicare data? I've been searching for it but can only find single surgeon or single center reviews.