Switching from Plastic Surgery?

[georgiaokeeffe]

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What are your thoughts regarding switching out of an integrated plastic surgery residency? My boyfriend, an intern, is unhappy with the hours and lifestyle -- I've been encouraging him to stick it out, but is my advice misguided? If such a switch required one or two years of research (to make connections, increase match chances, etc.), would you think twice about the lag time involved? I believe that he has worked very hard to achieve this competitive residency; I would hate for him to prematurely limit his skill set and future career opportunities. Thoughts?

 

[mercaptovizadeh]

What are your thoughts regarding switching out of an integrated plastic surgery residency? My boyfriend, an intern, is unhappy with the hours and lifestyle -- I've been encouraging him to stick it out, but is my advice misguided? If such a switch required one or two years of research (to make connections, increase match chances, etc.), would you think twice about the lag time involved? I believe that he has worked very hard to achieve this competitive residency; I would hate for him to prematurely limit his skill set and future career opportunities. Thoughts?

Switch into what?

 

[ThoracicGuy]

What are your thoughts regarding switching out of an integrated plastic surgery residency? My boyfriend, an intern, is unhappy with the hours and lifestyle -- I've been encouraging him to stick it out, but is my advice misguided? If such a switch required one or two years of research (to make connections, increase match chances, etc.), would you think twice about the lag time involved? I believe that he has worked very hard to achieve this competitive residency; I would hate for him to prematurely limit his skill set and future career opportunities. Thoughts?

He is in a specialty that can have extremely nice hours depending on what he wants to do as an attending. Residency is not what you should base the lifestyle decision on. Base it on the attending role.

If he does wish to switch, what does he think would make him happier?

 

[georgiaokeeffe]

He is thinking that the dermatology hours/lifestyle would make him happier -- in residency, but also in career.

 

[evilbooyaa]

Oh boy. Sounds like a case of someone chasing money and lifestyle without a passion for anything. If that's the case (and excuse my assumptions if it is not), then he's going to be miserable regardless of the residency that he does. But that's the sweet part, residency is only 5 years.

All this being said, if he could match into an integrated plastics spot, his scores are likely pretty good. However, matching Derm isn't no joke either, and he'll probably need a year of research and a strong reason as to why he's doing it (besides "The hours suck on plastics residency, and I heard the hours you guys do is pretty chill") otherwise residency programs may be concerned he'll drop out again unlike all of the US seniors he'd be competing against (I forget if Derm has an intern year. @DermViser help me out here)

 

[DermViser]

Oh boy. Sounds like a case of someone chasing money and lifestyle without a passion for anything. If that's the case (and excuse my assumptions if it is not), then he's going to be miserable regardless of the residency that he does. But that's the sweet part, residency is only 5 years.

All this being said, if he could match into an integrated plastics spot, his scores are likely pretty good. However, matching Derm isn't no joke either, and he'll probably need a year of research and a strong reason as to why he's doing it (besides "The hours suck on plastics residency, and I heard the hours you guys do is pretty chill") otherwise residency programs may be concerned he'll drop out again unlike all of the US seniors he'd be competing against (I forget if Derm has an intern year. @DermViser help me out here)

Yup, Derm requires an internship year completion whether that be a transitional or an IM/Surgery/Peds year.

 

[NotAProgDirector]

There's some chance that his plastics PGY-1 would count for the derm prelim year.

I agree with others that this may be an uphill battle. He clearly will have the scores/grades/performance for derm. But he will need multiple derm rotations of some sort to be comeptitive, and it will look like he's chasing the hours/money switching from plastics to derm and many programs don't want those types of people.

I think his best option is to complete the PGY-1. If he's truly miserable, he can drop out after the PGY-1, and will qualify for a medical license in many states. Once he has a license, he might be able to rotate with Derm departments while doing research. The real problem here is that he could do all of this and then not get a derm position, and of course his plastics position is gone forever.

 

[MedStud!]

I'm doing my plastics rotation now and after 5 months of general surgery.... Plastics is GLORIOUS!!! The guys come in at 7-9am, do 1-3 cases, then go home on their hospital days. Then they have cosmetic cases at their office on other days. They are almost always done by 3pm, there aren't very many times they have to deal with catastrophic complications, they don't take call from the ER, and they get paid WELL! No one is going to force him to be a ridiculously busy plastic surgeon making $1million plus. He could have a reasonable schedule and still be compensated very well once he gets out into practice. If I was going for a fellowship after a General Surgery residency I would choose plastics hands down.

Guess what? ALL interns are miserable with the hours and lifestyle... Derm residency might be a bit easier but its no joke, and has been pointed out, there is a very good chance he wouldn't ever match. So he'd better think long and hard before ditching an integrated plastics gig (the MOST competitive residency to get) as he won't ever get it back. That program director will have NO PROBLEM filling his open spot.

He seriously needs to consider if being unemployed is better than being a plastic surgeon. Maybe it is? Maybe he hates surgery so much he just can't see himself doing it the rest of his life. Despite all the idealistic crap medical professionals spew... at the end of the day it is a JOB. And once he's done he can have what many consider to be a pretty good one. If he just can't handle it then maybe he should switch, but likely won't waltz right into a Derm position (and may never!), and very realistically might have to settle for something less competitive. If he's not okay with that... he'd better keep that spot.

 

[member1000765]

I'm doing my plastics rotation now and after 5 months of general surgery.... Plastics is GLORIOUS!!! The guys come in at 7-9am, do 1-3 cases, then go home on their hospital days. Then they have cosmetic cases at their office on other days. They are almost always done by 3pm, there aren't very many times they have to deal with catastrophic complications, they don't take call from the ER, and they get paid WELL! No one is going to force him to be a ridiculously busy plastic surgeon making $1million plus. He could have a reasonable schedule and still be compensated very well once he gets out into practice. If I was going for a fellowship after a General Surgery residency I would choose plastics hands down.

Guess what? ALL interns are miserable with the hours and lifestyle... Derm residency might be a bit easier but its no joke, and has been pointed out, there is a very good chance he wouldn't ever match. So he'd better think long and hard before ditching an integrated plastics gig (the MOST competitive residency to get) as he won't ever get it back. That program director will have NO PROBLEM filling his open spot.

He seriously needs to consider if being unemployed is better than being a plastic surgeon. Maybe it is? Maybe he hates surgery so much he just can't see himself doing it the rest of his life. Despite all the idealistic crap medical professionals spew... at the end of the day it is a JOB. And once he's done he can have what many consider to be a pretty good one. If he just can't handle it then maybe he should switch, but likely won't waltz right into a Derm position (and may never!), and very realistically might have to settle for something less competitive. If he's not okay with that... he'd better keep that spot.

Are you referring to "the guys" as attendings or residents? I would understand if that was the lifestyle of the attendings, but if that's the lifestyle of the residents/fellows, it's a very different program than the one at my institution. Where I am, there are only 6 plastics residents, and they take both face call (split with ENT and OMFS) as well as hand call (split 50/50 with ortho). The fellows also don't have work hour restrictions that the residents do, so they get worked, hard. And if they are at a program that does a lot of flaps...In essence, it's more pleasurable than General surgery, but the hours aren't any better as a resident.

 

[ThoracicGuy]

Are you referring to "the guys" as attendings or residents? I would understand if that was the lifestyle of the attendings, but if that's the lifestyle of the residents/fellows, it's a very different program than the one at my institution. Where I am, there are only 6 plastics residents, and they take both face call (split with ENT and OMFS) as well as hand call (split 50/50 with ortho). The fellows also don't have work hour restrictions that the residents do, so they get worked, hard. And if they are at a program that does a lot of flaps...In essence, it's more pleasurable than General surgery, but the hours aren't any better as a resident.

If its an ACGME plastics program, which unless its some superfellowship, they are held to the same work hour restrictions as general surgery residents...

 

[member1000765]

If its an ACGME plastics program, which unless its some superfellowship, they are held to the same work hour restrictions as general surgery residents...

It's not an integrated program, so they're all technically fellows rather than residents (we just call them residents). I don't know all the semantics of the issue, but I think they are regulated by the American Board of Plastic Surgery rather than the ACGME.Regardless, they work every bit as hard as the general surgery residents.

 

[Winged Scapula]

It's not an integrated program, so they're all technically fellows rather than residents (we just call them residents). I don't know all the semantics of the issue, but I think they are regulated by the American Board of Plastic Surgery rather than the ACGME.Regardless, they work every bit as hard as the general surgery residents.

Actually you have more than the semantics wrong.

ACPS (American College of PS) sponsors the specialty match but the programs are accredited by ACGME. ABPS ("the board") is not involved in residency match or accreditation.

Plastic surgery trainees are referred to as residents even if the training is completed after a GS residency or directly after medical school. PS fellowships are for super specialties: craniofacial, facial plastics etc.

But as you note, they work hard regardless.

 

[RJGOP]

Yup, Derm requires an internship year completion whether that be a transitional or an IM/Surgery/Peds year.

I didn't know Derm could do surgery for intern year.

 

[RJGOP]

I'm doing my plastics rotation now and after 5 months of general surgery.... Plastics is GLORIOUS!!! The guys come in at 7-9am, do 1-3 cases, then go home on their hospital days. Then they have cosmetic cases at their office on other days. They are almost always done by 3pm, there aren't very many times they have to deal with catastrophic complications, they don't take call from the ER, and they get paid WELL! No one is going to force him to be a ridiculously busy plastic surgeon making $1million plus. He could have a reasonable schedule and still be compensated very well once he gets out into practice. If I was going for a fellowship after a General Surgery residency I would choose plastics hands down.

Guess what? ALL interns are miserable with the hours and lifestyle... Derm residency might be a bit easier but its no joke, and has been pointed out, there is a very good chance he wouldn't ever match. So he'd better think long and hard before ditching an integrated plastics gig (the MOST competitive residency to get) as he won't ever get it back. That program director will have NO PROBLEM filling his open spot.

He seriously needs to consider if being unemployed is better than being a plastic surgeon. Maybe it is? Maybe he hates surgery so much he just can't see himself doing it the rest of his life. Despite all the idealistic crap medical professionals spew... at the end of the day it is a JOB. And once he's done he can have what many consider to be a pretty good one. If he just can't handle it then maybe he should switch, but likely won't waltz right into a Derm position (and may never!), and very realistically might have to settle for something less competitive. If he's not okay with that... he'd better keep that spot.

Excellent point. In the event he wouldn't find a Derm spot, he would never be able to retain his plastics residency. It's best he deeply considers his options before proceeding in the direction of such a drastic choice.

 

[Raryn]

I didn't know Derm could do surgery for intern year.

Except for neurology (which requires medicine), every "advanced" specialty doesn't care what you do your intern year in. Medicine, Surgery, TY, even a few people do peds prelim years.

Not entirely sure why a future PMR doc would want to do a surgery PGY1, but they theoretically could..

 

[ThoracicGuy]

It's not an integrated program, so they're all technically fellows rather than residents (we just call them residents). I don't know all the semantics of the issue, but I think they are regulated by the American Board of Plastic Surgery rather than the ACGME.Regardless, they work every bit as hard as the general surgery residents.

I did CT surgery after general surgery. Technically we were residents, though we called ourselves fellows. We were still under ACGME rules and had to abide by the 80 hours. It would be the same in an I-6 program. Now those that did transplant/VAD fellowships after CT surgery training, those are not ACGME programs and they are usually worked like dogs. Same for pretty much any solid organ transplant fellowships...

 

[DermViser]

I didn't know Derm could do surgery for intern year.

All "advanced" specialties (vs. categorical) -- do 1 year not in their specialty before moving on -- Derm, Radiology, Ophtho, Anesthesiology, Neurology, PM&R, Rad Onc. It can be a transitional year or a prelim year including Surgery (I wouldn't but some people like it, I guess).

 

[Law2Doc]

...
Not entirely sure why a future PMR doc would want to do a surgery PGY1, but they theoretically could..

PM&R is not uber competitive so sometimes those who match need to take whatever prelim is available in the region they want - they aren't usually competitive for the cushy stuff. It's also not such a bad fit because a lot of their patients are post-surgical rehab and so it's helpful to understand what's been done. Plus some PM&R people are people who had the mindset but not the numbers foe ortho, so for them a surgery year doesn't sound so bad...

 

[Law2Doc]

I'm not really understanding why the OP won't gut out residency and then just open a Botox clinic or something else cosmetic and light and work 30 hours a week for the rest of his life. It's just as cushy as derm at the end of the gauntlet. residency goes by quick, ESPECIALLY if you are working nonstop in a long houred residency. You go in at 5 am Monday and by the time you come up for air it's Sunday evening each week.

 

[rokshana]

All "advanced" specialties (vs. categorical) -- do 1 year not in their specialty before moving on -- Derm, Radiology, Ophtho, Anesthesiology, Neurology, PM&R, Rad Onc. It can be a transitional year or a prelim year including Surgery (I wouldn't but some people like it, I guess).

neurology does require \ 6 months of internal medicine for the intern year, so can't do surgery or transitional unless the transitional year is 6 months of medicine.

 

[Over9000]

Dude. Stick with plastics. Believe me. What I wouldn't give to be able to just put up a shingle anywhere in the free world and have patients kicking the door down. You've written your ticket. It seems like crap now, but it won't in a few years. Hang in there.

 

[DermatoFIGHT]

Dude. Stick with plastics. Believe me. What I wouldn't give to be able to just put up a shingle anywhere in the free world and have patients kicking the door down. You've written your ticket. It seems like crap now, but it won't in a few years. Hang in there.

It isn't all that easy. Dermatology isn't all that easy either. Congress laws, taxes on small business, healthcare regulations, and other factors have made that old school thought a disappearing practice reality. I would love to be able to handle a shingle and practice too but it doesn't work that way anymore.

 

[LocumOnly]

What are your thoughts regarding switching out of an integrated plastic surgery residency? My boyfriend, an intern, is unhappy with the hours and lifestyle -- I've been encouraging him to stick it out, but is my advice misguided? If such a switch required one or two years of research (to make connections, increase match chances, etc.), would you think twice about the lag time involved? I believe that he has worked very hard to achieve this competitive residency; I would hate for him to prematurely limit his skill set and future career opportunities. Thoughts?