Reconstructive Only?

[sykosomatik]

This post is just a bunch of questions I'm hoping someone can answer. I know little about plastic surgery...the little that I do know has made me choose against this field because of the cosmetic side

1. Is it possible as a plastic surgeon to focus only on reconstructive
surgeries (for me, mostly cranio-facial procedures)? Do most surgeons find
it a financial necessity to also do cosmetic procedures, or do they do that
more so to just make money? What can a surgeon focusing solely on the
reconstructive side make on average?

2. Do most insurance companies cover all reconstructive surgeries that a
patient may need, or do they limit it to a few surgeries? I don't want to
just abandon a patient requiring extensive surgery; I'd like to carry the job
through

3. For those doing reconstructive surgery only, what's the workload like? Is it
possible to make a career solely on these type of surgeries, or would I
have to look into doing cosmetics just to have enough work. Even at big
centers, do the doctors have to also do cosmetics on the side?

4. As a plastic surgeon, can you do both reconstructive surgeries and also
work with burn victims? Or is burn surgery so specialized that you have to
focus on that solely?

Thanks to anyone that takes the time to answer these questions

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[alexroet]

I'll let someone more experienced in the field most of the questions, but I wouldn't rule out a specialty just b/c you don't like one aspect of it. And I think most people tailor their practice to a mix of cosmetic/recon that suits them. Cosmetic pays more in general, but if you don't want to do it, you certainly don't HAVE to. I've worked with groups of 5 attendings or so, and one will be the recon/flap guy, one is the breast guy, one is the face guy, etc etc.

But my experience with (initial) burn surgery, at least in burn units, is that it is very NOT specialized, and done by the general surgeons. It's just skin grafting. Subsequent surgeries and re-dos may be a different story- but I've never heard of a whole burn specialty. But I very well may be wrong.

This post is just a bunch of questions I'm hoping someone can answer. I know little about plastic surgery...the little that I do know has made me choose against this field because of the cosmetic side

1. Is it possible as a plastic surgeon to focus only on reconstructive
surgeries (for me, mostly cranio-facial procedures)? Do most surgeons find
it a financial necessity to also do cosmetic procedures, or do they do that
more so to just make money? What can a surgeon focusing solely on the
reconstructive side make on average?

2. Do most insurance companies cover all reconstructive surgeries that a
patient may need, or do they limit it to a few surgeries? I don't want to
just abandon a patient requiring extensive surgery; I'd like to carry the job
through

3. For those doing reconstructive surgery only, what's the workload like? Is it
possible to make a career solely on these type of surgeries, or would I
have to look into doing cosmetics just to have enough work. Even at big
centers, do the doctors have to also do cosmetics on the side?

4. As a plastic surgeon, can you do both reconstructive surgeries and also
work with burn victims? Or is burn surgery so specialized that you have to
focus on that solely?

Thanks to anyone that takes the time to answer these questions

 

[maxheadroom]

It is possible to have a purely reconstructive practice. There are lots of academic jobs for reconstructive microsurgeons. I can't speak to craniofacial -- my experience with major academic craniofacial surgeons is limited. If you're interested in Burn reconstruction, you'll definitely be in high demand. Don't abandon Plastics because you don't want to do Cosmetics. There is plenty of work in reconstructive surgery.

 

[scalpel2008]

This post is just a bunch of questions I'm hoping someone can answer. I know little about plastic surgery...the little that I do know has made me choose against this field because of the cosmetic side

1. Is it possible as a plastic surgeon to focus only on reconstructive
surgeries (for me, mostly cranio-facial procedures)? Do most surgeons find
it a financial necessity to also do cosmetic procedures, or do they do that
more so to just make money? What can a surgeon focusing solely on the
reconstructive side make on average?

2. Do most insurance companies cover all reconstructive surgeries that a
patient may need, or do they limit it to a few surgeries? I don't want to
just abandon a patient requiring extensive surgery; I'd like to carry the job
through

3. For those doing reconstructive surgery only, what's the workload like? Is it
possible to make a career solely on these type of surgeries, or would I
have to look into doing cosmetics just to have enough work. Even at big
centers, do the doctors have to also do cosmetics on the side?

4. As a plastic surgeon, can you do both reconstructive surgeries and also
work with burn victims? Or is burn surgery so specialized that you have to
focus on that solely?

Thanks to anyone that takes the time to answer these questions

I'm an OMS resident but we work with a Craniomaxillofacial PRS who pretty much only does craniofacial surgery. He has established himself as one of the only guys in the city that does cranial vault surgeries, frontal-orbital advancements and distractions, cleft lip and palate, etc. He is able to remain booked out for several months with these procedures so he doesn't have to do stuff he doesn't want to (hand, microvascular, cosmetic, burn, trauma etc). If you want to focus on a single aspect of any specialty, especially craniomaxillofacial surgery, you have to be "the guy in town" for it. That's the only way you can keep your OR schedule full with these cases. Thats what he does ever year (60-70 cleft lips repairs, 60-70 cleft palate repairs, 50 or so speech surgeries, 40-50 cranial vault cases, 20 or so FOAs, 20-30 distractions). He has a pretty sweet setup with a PA and a nurse practitioner who do ALL of his paperwork, H+Ps, discharges, etc.

 

[Debridement]

But my experience with (initial) burn surgery, at least in burn units, is that it is very NOT specialized, and done by the general surgeons. It's just skin grafting. Subsequent surgeries and re-dos may be a different story- but I've never heard of a whole burn specialty. But I very well may be wrong.

Have you ever been in a Burn Unit? It may not be 'specialized surgery' but it is certainly specialized care. Granted, the surgeries are as you say, 'just skin grafting' but the care is different from the SICU, TICU etc.

FYI: There is a Burn Specialty of GS--complete with fellowships, meetings etc.

I don't know what GS program you are part of, but I am very suprised that as a PGY-4 you didn't know that Burns is it's own specialty. Usually, Burn Surgeons do two fellowships (in series), Burns and Trauma/CC.

 

[alexroet]

haha, yes I've been in a burn unit. My program is very trauma-heavy and has the only burn center around, and for 3 rotations as PGY-3s we cover the Burn unit (alone). I agree it is specialized care- maybe specialized nursing even more so. I knew there was a burn society and burn journals etc- but didn't know there was a whole fellowship. My bad. The attendings I work with in burn are GS with Tr/CC fellowships.
Maybe it's b/c it's practically every day we have another 'big burn' to take to the OR for excision and grafting, that it's kind of routine and I take it for granted.
My apologies- not trying to belittle burn care. Just that those initial cases, while critical, are a big bloody mess, just trying to get some coverage- not exactly fine, delicate work.

Have you ever been in a Burn Unit? It may not be 'specialized surgery' but it is certainly specialized care. Granted, the surgeries are as you say, 'just skin grafting' but the care is different from the SICU, TICU etc.

FYI: There is a Burn Specialty of GS--complete with fellowships, meetings etc.

I don't know what GS program you are part of, but I am very suprised that as a PGY-4 you didn't know that Burns is it's own specialty. Usually, Burn Surgeons do two fellowships (in series), Burns and Trauma/CC.

 

[Debridement]

Where I went to school there was a big burn unit and a fellowship. Some people did a MSIII rotation, a MSIV AI rotation and if you did GS there, a month or two as an intern and more blocks throughout residency. The Chair of GS was a well-known burn surgeon as well.

For those of us who did surgery, we had burn surgery/care coming out our ears by the time we finished our surgery clerskips and AIs whether we like it or not...

 

[lilnoelle]

I'm also one who is interested in "Reconstructive only" plastic surgery. Is this something that residency directors like or does it matter? Also, how important is the first two years in establishing oneself as competitive for plastics. I'm performing well in my class, but am not exactly in the top 5%.