Questions about becoming a burn specialist

[866983]

Hi all,
I have recently become interested in the possibility of becoming a burn specialist and working someday in a burn unit. So far I have been able to figure out that most are general surgeons that do a burn fellowship and some do a critical care fellowship. My questions are these:

1. Can you become a burn specialist by doing the fellowship after PGY 3 without going back to finish the general surgery residency? I haven't been able to get a straight answer about this so far.

2. Many burn fellowships say that they combine it with critical care surgery so you can get that accreditation. If I were accepted into such a program would an additional critical care fellowship be necessary?

3. Would a burn fellowship as a general surgeon provide enough knowledge of plastics to do a significant amount of reconstruction?

4. Would doing plastics give you a better skill set as a burn specialist?

Answers to any of these questions would be very much appreciated. Thanks!

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[TypeADissection]

I'll start, but there has to be someone else out there that can add more.

1. Can you become a burn specialist by doing the fellowship after PGY 3 without going back to finish the general surgery residency?
- I think the answer is yes, depending on how your program is structured, you probably CAN leave after PGY-3 to do a specialized burn year. It makes zero sense though to not come back and finish because nobody is going to hire a half-trained general surgeon who did an un-accredited burn fellowship.

2. Many burn fellowships say that they combine it with critical care surgery so you can get that accreditation. If I were accepted into such a program would an additional critical care fellowship be necessary?
- I think you're going to have to read the fine print on this one. Full disclosure: I don't know a whole lot about this because this has never interested me, but these fellowships that people do in between residency years are not accredited. People do them for various reasons: preliminary surgery limbo and trying to stay clinical, dismissed from another program, some genuinely interested, etc. Patients with bad burns can be really sick. Lots of fluid shifts and it's going to be important to know how to manage fluids, vents and a lot of the other critical care stuff.

3. Would a burn fellowship as a general surgeon provide enough knowledge of plastics to do a significant amount of reconstruction?
- Depends on the reconstruction. We do a lot of skin grafts of various sorts here, but once it starts involving the face, hand or joints - it's really nice to have a plastic surgeon who knows what they're doing.

4. Would doing plastics give you a better skill set as a burn specialist?
- It gives you a different skill set. Our plastic surgeon does the full gamut of recon and both adult and peds burn stuff.

My former chief resident is currently in his second year of trauma/critical care/burn fellowship. If the idea of operating in super hot rooms, getting in and out of yellow gowns for each patient you see, and the smell of burnt hot dogs turns you on; I think going through a formal general surgery residency then doing trauma/crit care/ACS/burn is the better way to go. Then you'll be boarded and marketable to do the full gamut. Just my 2 Abe Lincolns for what it's worth.

"Don't believe everything you read on the internet." - Abraham Lincoln.

 

[ACSurgeon]

I'll start, but there has to be someone else out there that can add more.

1. Can you become a burn specialist by doing the fellowship after PGY 3 without going back to finish the general surgery residency?
- I think the answer is yes, depending on how your program is structured, you probably CAN leave after PGY-3 to do a specialized burn year. It makes zero sense though to not come back and finish because nobody is going to hire a half-trained general surgeon who did an un-accredited burn fellowship.

2. Many burn fellowships say that they combine it with critical care surgery so you can get that accreditation. If I were accepted into such a program would an additional critical care fellowship be necessary?
- I think you're going to have to read the fine print on this one. Full disclosure: I don't know a whole lot about this because this has never interested me, but these fellowships that people do in between residency years are not accredited. People do them for various reasons: preliminary surgery limbo and trying to stay clinical, dismissed from another program, some genuinely interested, etc. Patients with bad burns can be really sick. Lots of fluid shifts and it's going to be important to know how to manage fluids, vents and a lot of the other critical care stuff.

3. Would a burn fellowship as a general surgeon provide enough knowledge of plastics to do a significant amount of reconstruction?
- Depends on the reconstruction. We do a lot of skin grafts of various sorts here, but once it starts involving the face, hand or joints - it's really nice to have a plastic surgeon who knows what they're doing.

4. Would doing plastics give you a better skill set as a burn specialist?
- It gives you a different skill set. Our plastic surgeon does the full gamut of recon and both adult and peds burn stuff.

My former chief resident is currently in his second year of trauma/critical care/burn fellowship. If the idea of operating in super hot rooms, getting in and out of yellow gowns for each patient you see, and the smell of burnt hot dogs turns you on; I think going through a formal general surgery residency then doing trauma/crit care/ACS/burn is the better way to go. Then you'll be boarded and marketable to do the full gamut. Just my 2 Abe Lincolns for what it's worth.

"Don't believe everything you read on the internet." - Abraham Lincoln.

I don't know much about burn fellowships, but critical care fellowships done between pgy-3 and 4 leads to the same board certification as critical care fellowships done after five years of general surgery. Most people doing critical care between years stay at their home institution, so this can be viewed as an academic limitation for some.

 

[ACSurgeon]

Hi all,
I have recently become interested in the possibility of becoming a burn specialist and working someday in a burn unit. So far I have been able to figure out that most are general surgeons that do a burn fellowship and some do a critical care fellowship. My questions are these:

1. Can you become a burn specialist by doing the fellowship after PGY 3 without going back to finish the general surgery residency? I haven't been able to get a straight answer about this so far.

2. Many burn fellowships say that they combine it with critical care surgery so you can get that accreditation. If I were accepted into such a program would an additional critical care fellowship be necessary?

3. Would a burn fellowship as a general surgeon provide enough knowledge of plastics to do a significant amount of reconstruction?

4. Would doing plastics give you a better skill set as a burn specialist?

Answers to any of these questions would be very much appreciated. Thanks!

Once you have a medical license you're legally allowed to do whatever you want.

However, without completing a general surgery residency, you won't be board certified in anything. Therefore getting any desirable job will be impossible.

Burn fellowship vs. plastics. This depends on what you're really interested in and the burn fellowship you do. Burn surgeons learn some basic reconstruction techniques beyond skin grafts. However, you'll be no where near as capable as a plastic surgeon with complex flap options. I'd also bet no plastic surgeon in their right mind would want to the a full time burn surgeon (i.e. Receiving burn patients and acutely managing them).

Finally: burn vs. critical care. I don't know about burn certification but I know critical care is certified. This makes you marketable. It might help with insurance billing too. If you could do a one year burn fellowship that gives you enough critical care to sit for the boards, why not? Also, you could probably become a surgeon without ever doing a burn fellowship. Not anywhere prestigious but managing burn patients and doing basic debridement and skin grafts is within the scope of general surgery. Burn fellowships would make you marketable at academic center, to be burn director, and give you advanced skills so you don't need help with burns to sensitive areas and complex recons.

Ultimately, you should plan on doing five years of general surgery and 1-2 years of fellowship (plus/minus research years depending on your academic ambitions and the type of residency program you're interested in training at).

 

[Winged Scapula]

RE: marketability

Also bear in mind that not every hospital/community has a burn center, therefore, its not like these jobs are a dime a dozen. There's also not a lot of competition (since for reasons detailed above, not everyone wants to do it) but doing just a few years of surgery and then a 1 year burn fellowship isn't very marketable in an already tight market (due to lack of jobs).