Why is PRS so competitive?

[TupacalipseT96]

Why do you think PRS is THE most competitive residency right now? (and most competitive fellowship)

I've spent quite some time lurking this board, as well as a few other specialties' boards, but I still don't really understand why PRS, as a whole, attracts the most competitive applicants.

I've heard that the field is just very broad and interesting and that one "falls in love with it at first sight". But I'd imagine lots of specialities (especially surgical) can say this; are people really more inclined to fall in love with PRS solely because you do varied/interesting cases?

Is it because your patients are generally healthier?
Is it because you know you can greatly affect quality of life? (...but ortho & pain say this too)
Is it because you have the security of knowing you can increase cash-paying cosmo cases if recon reimbursements plummets in this uncertain healthcare climate?

Is it because total available residency spots are deliberately limited (as in derm)?

Is there more room for lifestyle balance, as GSresident seems to have found, in PRS vs. other surgical subspecialties?

Obviously it's different for each individual, but the broad trends demand some bigger driving force -- I just can't quite figure out what that is from discussion on these forums.

From your experience, what do you think that driving force is?

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[NPR]

$$$$$$$$$$

 

[TupacalipseT96]

$$$$$$$$$$

Is that what it is? I seem to read here a lot that reconstructive work doesn't reimburse amazingly well and many don't like to deal with cosmo patients. Ive also seen AAMC surveys thrown around where Med students/interns rate "lifestyle/income-potential" low on their list for choosing plastics.

But if in truth $ is a big unspoken factor over other surgical subspecialties, that'd be good to know.

 

[NPR]

Is that what it is? I seem to read here a lot that reconstructive work doesn't reimburse amazingly well and many don't like to deal with cosmo patients. Ive also seen AAMC surveys thrown around where Med students/interns rate "lifestyle/income-potential" low on their list for choosing plastics.

But if in truth $ is a big unspoken factor over other surgical subspecialties, that'd be good to know.

Maybe I'm cynical but I think they're lying.

 

[H_Caulfield]

People either:

1. See it as a way around the impending socialization of medicine (and of everything else...!!). Little do they realize that breast augmentations and rhinoplasties will soon be considered "natural human rights," along with every other ability successful, driven people have worked hard for. Goooo Obama!!

2. LOVE the "image," e.g. Doctor 90210, nip tuck, etc. These are the same people who watch "The O.C"...: Pretty on the outside but lined with hooker muff-juice on the inside.

3. Are women or touchie-feelie men who look at young children's cleft palates and go "awwwww! Somebody needs to fix that poor child's face!" Good for you...go to Zimbabwe and make starving children more attractive. 👍 Since I'm sure they were more concerned about that than the fact that Mommy has AIDS and 13 worms spead diffusely throughout her hypodermis and liver.

4. Are too competitive for their own good, and want to go into the most competitive field possible simply because they can. Amazing how many people fall into this category. They'll feel superior on match day, but these guys and gals are destined to be miserable.

That's all I can think of. It blows my mind too, bro.

 

[dilated]

Maybe I'm cynical but I think they're lying.

Wow, not only are they lying but they're going so far as to actually earn less money than some other surgical subspecialties just to hide their desire for money!

http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

If you really are obsessed with "$$$" you would go nsurg or ortho (especially spine).

 

[maxheadroom]

People either:

1. See it as a way around the impending socialization of medicine (and of everything else...!!). Little do they realize that breast augmentations and rhinoplasties will soon be considered "natural human rights," along with every other ability successful, driven people have worked hard for. Goooo Obama!!

2. LOVE the "image," e.g. Doctor 90210, nip tuck, etc. These are the same people who watch the O.C...: Pretty on the outside but lined with hooker muff-juice on the inside.

3. Are women or touchie-feelie men who look at young children's cleft palates and go "awwwww! Somebody needs to fix that poor child's face!" Good for you...go to Zimbabwe and make starving children more attractive. 👍 Since I'm sure they were more concerned about that than the fact that Mommy has AIDS and 13 worms spead diffusely throughout her hypodermis and liver.

4. Are too competitive for their own good, and want to go into the most competitive field possible simply because they can. Amazing how many people fall into this category. These guys and gals are destined to be miserable.

That's all I can think of. It blows my mind too, bro.

Wow, uh, bitter much? I go to work everyday and love my job. I get to fix broken hands. I get to reconstruct breasts, returning women to a physical and emotional wholeness after cancer. And yes, I do cosmetic surgery, too. Plastics is great because we get to operate all over the body on healthy people and improve their quality of life.

 

[NPR]

Wow, not only are they lying but they're going so far as to actually earn less money than some other surgical subspecialties just to hide their desire for money!

http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

If you really are obsessed with "$$$" you would go nsurg or ortho (especially spine).

1. Outdated ---> 2006

2. Lifestyle factors in too.

 

[SouthernSurgeon]

4. Are too competitive for their own good, and want to go into the most competitive field possible simply because they can. Amazing how many people fall into this category. They'll feel superior on match day, but these guys and gals are destined to be miserable.

That pretty much perfectly describes the integrated plastics gunner in my class...

 

[BlondeDocteur]

I think the variety, the descriptor of a "surgeon's surgeon," and the on-the-spot problem-solving attract a certain sort of person. That person tends to be both very detail-oriented and meticulous (necessary for the small scale and delicacy of microvascular work, for example) while being analytical and unwilling to be constrained by precedent. In *general* such people are perfectionists and very driven, and thus have done well in medical school.

But yeah, I think money + lifestyle + ability to do surgery = ultra-competitive.

 

[Samoa]

No offense to BD, but for the PRS residents I know, their motivations seem to be:
1) money
2) lifestyle
3) prestige
4) because they can

Some of them are truly excellent surgeons, in the way that only a meticulous and driven person can be. But many of them instead give the impression of people who are incredibly smart and for whom medicine is just a means to an end.

Edit: No flames, please. Obviously this could just be the facade they like to wear, but that is how they appear to those of us on the outside.

 

[dilated]

Is this post-residency lifestyle you guys are talking about? Because the PRS residents here take it as bad as gen surg. Occasionally even worse (recon). Or is there a holy land where ENT does all the free fibs and it's carpal tunnels and breast augs all day?

 

[NPR]

Is this post-residency lifestyle you guys are talking about? Because the PRS residents here take it as bad as gen surg. Occasionally even worse (recon). Or is there a holy land where ENT does all the free fibs and it's carpal tunnels and breast augs all day?

I'm pretty sure its post-residency.

PRS residents are whailed on pretty bad at my home program too.

 

[FatPigeon]

I really have a difficult time understanding med students who equate plastic surgery with "prestige." Anyone who thinks plastic surgery carries much respect and prestige has spent too much time within the walls of their medical school, where it's considered a big deal simply because it's hard to get into.

Plastic surgery, to anyone outside of the medical profession, amounts to something like "face lifts and boob surgery." I even had a friend from highschool be surprised to hear that plastic surgeons were physicians.

 

[NPR]

I really have a difficult time understanding med students who equate plastic surgery with "prestige." Anyone who thinks plastic surgery carries much respect and prestige has spent too much time within the walls of their medical school, where it's considered a big deal simply because it's hard to get into.

Plastic surgery, to anyone outside of the medical profession, amounts to something like "face lifts and boob surgery." I even had a friend from highschool be surprised to hear that plastic surgeons were physicians.

Yea, that's pretty much what prestige is.

 

[BlondeDocteur]

No offense to BD, but for the PRS residents I know, their motivations seem to be:
1) money
2) lifestyle
3) prestige
4) because they can

Some of them are truly excellent surgeons, in the way that only a meticulous and driven person can be. But many of them instead give the impression of people who are incredibly smart and for whom medicine is just a means to an end.

Edit: No flames, please. Obviously this could just be the facade they like to wear, but that is how they appear to those of us on the outside.

At risk of imperiling myself as a future applicant, I think there's a sharp divide in the field. The people genuinely mesmerized by recon generally fit the mold I described. Those heading into the cosmo Happy Hunting Grounds are... different.

I think Fat Pigeon's right, too-- the public has no idea plastic surgery is competitive, nor do they consider it prestigious. Hell, I didn't know myself, before starting med school.

Neurosurgeons still win, hands down, in the status wars.

 

[PeepshowJohnny]

I do agree there's a divide in the applicants applying for PRS as BlondeDocteur has referenced, but I don't think it's unique to Plastics at all.

Just off the top of my head:

Radiology: Divide between the geeks and nerds who love pathology, anatomy, and all the technology vs. those who realize they can make a ton of money with less effort and not deal with patients. A similar case could be made for anesthesia: physiology/procedure junkies vs. lifestyle concerns.

Pediatrics: Divide between the people that think kids are just the CUTEST and just LUV to work with them and go into general peds vs. those who are interested more in the pathology of childhood disease and go into more subspecialty areas.

 

[GSresident]

Man there sure are a lot of sour grapes touting playah haytaz out there. Hate the game, not the players. Hehehe. (I'm joking, don't be so sensitive.) (Yes you.)

I looked at the salary survey. Don't put too much stock in those things. For instance, it listed the max for neurosurg at just over 900K. I am friends with someone who signed with a rural hospital for 1.2 million salary, not including the benefits they heaped on him. His signing bonus was high enough that he bought a new ferarri and was driving it around Louisville the last few months of his residency. Also the max for plastics is WAY low. Maybe they are only talking about people who sign up with hospitals or something and excluding people who own their own practices. I tend to ignore salary surveys because they have little relevance and are mostly just bogus.

 

[NPR]

Man there sure are a lot of sour grapes touting playah haytaz out there. Hate the game, not the players. Hehehe. (I'm joking, don't be so sensitive.) (Yes you.)

I looked at the salary survey. Don't put too much stock in those things. For instance, it listed the max for neurosurg at just over 900K. I am friends with someone who signed with a rural hospital for 1.2 million salary, not including the benefits they heaped on him. His signing bonus was high enough that he bought a new ferarri and was driving it around Louisville the last few months of his residency. Also the max for plastics is WAY low. Maybe they are only talking about people who sign up with hospitals or something and excluding people who own their own practices. I tend to ignore salary surveys because they have little relevance and are mostly just bogus.

Plus those who are really making bank aren't loudly advertising it. (Or at least, shouldn't be loudly advertising it)

 

[MOHS_01]

GS,

The "max" corresponds to the 90th percentile in their survey. Let's see how long DD continues making that cash.... they lured him in with a fat guarantee, and in order to support that guarantee his life will be absolute sh**, especially where he went. The demographics of the region dictates a high MA & MC % in the patient mix, and we all know how they pay.

Anyone who believes that people do not go into plastics for prestige, cash, and the potential freedom from HMO, MC, MA, etc hassles are too naive to be entering the workforce.

It's not a pretty world out there right now for providers, and continuing to believe in the illusion that the past will hold into the future will not serve anyone well going forward.

 

[NPR]

Anyone who believes that people do not go into plastics for prestige, cash, and the potential freedom from HMO, MC, MA, etc hassles are too naive to be entering the workforce.

You can do the same thing in derm, without the brutal residency. You will lose the prestige portion though.

 

[maxheadroom]

Anyone who believes that people do not go into plastics for prestige, cash, and the potential freedom from HMO, MC, MA, etc hassles are too naive to be entering the workforce.

This is certainly a big deal for lots of us. If you know that you have the option of just dropping or significantly reducing your insurance cases, it makes some of the current climate of medicine a bit more tenable.

 

[GSresident]

GS,

The "max" corresponds to the 90th percentile in their survey. Let's see how long DD continues making that cash.... they lured him in with a fat guarantee, and in order to support that guarantee his life will be absolute sh**, especially where he went. The demographics of the region dictates a high MA & MC % in the patient mix, and we all know how they pay.

He won't make that cash past his guarantee unless he becomes an employee of the hospital and is contracted to make that much. There simply aren't enough hours in the day to be doing enough surgeries to earn that much in surgical fees/consultations etc. unless you have a significant cosmetics practice. If he was able to negotiate, however, a revenue sharing arrangement with the hospital, which would be legal if he was an employee, he could continue to make that much.

The other alternative would be to just move on to greener pastures. A lot of physicians jump around the country and do 2 year stints. He wouldn't have to work very long if he found a couple more of those gigs.

Anyone who believes that people do not go into plastics for prestige, cash, and the potential freedom from HMO, MC, MA, etc hassles are too naive to be entering the workforce.

That is a HUGE reason to go into plastics. My practice is about 90% insurance/medicare based right now. Even with all the hassles I still love my life and I wouldn't do anything else. If my cosmetic business ever picks up to the point that I can drop insurance and medicare I would probably keep them because I enjoy the cases. If, however, Obama gets a socialized system through congress, it is another story entirely. I am the slave of no man or society.

It's not a pretty world out there right now for providers, and continuing to believe in the illusion that the past will hold into the future will not serve anyone well going forward.

Again, even with all the BS going on in medicine right now I am extremely happy with my life. Lets hope it holds.

 

[MOHS_01]

The only problem with a guarantee is that it really should be called "loan", and not thought of as salary at all. Geographic locales that find it difficult to recruit quality physicians often dangle an enticing carrot in front of folks who have spent nearly a decade in residency... knowing full well that they have the doc locked in for a specified time period when they come off the guarantee. The only way that I see him staying there is if he becomes an employee (which I still have a hard time picturing him living there...talk about a fish out of water).

I hope that your happiness with medicine continues as well. The thrill of starting and running a new practice lasts for a couple of years; after that you will settle into a groove and hopefully find that the time and sacrifices were worth it. The loss of the multiple surgery exemption siphoned much of the profitability of my most common procedure, which consequently sucked the life out of practice bottom line... and my pleasure in providing the now undervalued service. Plastics is the best strategically positioned specialty, but the low cost procedures will become progressively at risk; basically, your FP's, OB's, NP's, etc can and will undercut your prices. Going forward I would focus on procedures with a steep learning curve and become great at those.

Best of luck.

 

[Fah-Q]

MOHS_01, are you now referring your post-Moh's recon cases to a surgeon or are you still doing them at the lower reimbursement? I'm curious as to what derm guys are doing now that they can't bill 100% for the recon.

 

[cdql]

That's only the surgical portion.

I think PRS and derm are both well positioned. Cosmetic procedures are still available and there's the opportunity to decline insurance plans because of the low supply of physicians.

 

[MOHS_01]

MOHS_01, are you now referring your post-Moh's recon cases to a surgeon or are you still doing them at the lower reimbursement? I'm curious as to what derm guys are doing now that they can't bill 100% for the recon.

Most everyone that I know is still doing them -- you would not believe how hard it is to find a PRS interested in doing any reconstructions. The logistics of coordinating schedules is not an easy task either, patients complain about waits and wound care, and the number of late night calls for some minor bleeding was enough to ensure same day reconstruction despite the >30% revenue reduction. What I have noticed, however, is that less efforts are being devoted to building a MMS only practice, preferring to pick the low lying fruit across the board for diversification purposes.

I know what you mean, but, being stubborn as I am, I still bill at 100%... it's just that those greedy #*&$&*(% no longer pay it. 😉

 

[Fah-Q]

Most everyone that I know is still doing them -- you would not believe how hard it is to find a PRS interested in doing any reconstructions. The logistics of coordinating schedules is not an easy task either, patients complain about waits and wound care, and the number of late night calls for some minor bleeding was enough to ensure same day reconstruction despite the >30% revenue reduction. What I have noticed, however, is that less efforts are being devoted to building a MMS only practice, preferring to pick the low lying fruit across the board for diversification purposes.

I know what you mean, but, being stubborn as I am, I still bill at 100%... it's just that those greedy #*&$&*(% no longer pay it. 😉

What advice would you give a surgeon just starting out and wanting to build a post-Moh's recon practice? Is it all about being available and affable? Do derm guys want something in return for the business? Thanks.

 

[MOHS_01]

It really depends on where you set up shop... some MOHS guys will gladly send you reconstructions if you reciprocate and let them clear the tumors that are referred directly to you. The best of both worlds would be to have a joint venture with an ASC thrown into the mix... Some will only send you the stuff they don't want to deal with (patients with unrealistic expectations, needy patients, eyelid tumors, etc), while some will understand the reciprocal nature of a mutually beneficial relationship. One thing that you will need to keep in the back of your mind when approaching or dealing with the MOHS guys is their respective level of training (not all "MOHS surgeons" are adequately fellowship trained) The majority of us who are actually enjoy the recons more than the Mohs portion... and the main reason that we did the fellowship was to be good at recons. We feel that you really need the exposure and repetitiveness that is only gained through a fellowship (sorry any lurking weekend warriors, but a learning curve does exist) in order to be better than "competent", as "competent" really is not that flattering a descriptor and most certainly should not be deemed adequate....but that is a different argument for another day.

 

[maxheadroom]

It really depends on where you set up shop... some MOHS guys will gladly send you reconstructions if you reciprocate and let them clear the tumors that are referred directly to you. The best of both worlds would be to have a joint venture with an ASC thrown into the mix... Some will only send you the stuff they don't want to deal with (patients with unrealistic expectations, needy patients, eyelid tumors, etc), while some will understand the reciprocal nature of a mutually beneficial relationship.

That's about the only way that I plan on doing skin cancer. I HATE sitting in the OR waiting on frozen sections. I will gladly give up that part of the practice if there's a MOHS guy who wants to take them off and just send me the closures.

 

[Habeed]

Question : are you sure plastics is the most competitive? I thought Derm was #1, with plastics a close second.

 

[maxheadroom]

Question : are you sure plastics is the most competitive? I thought Derm was #1, with plastics a close second.

What the F*** does it matter? Do we need to have an annual pissing contest about whose specialty is more competitive?

 

[Habeed]

It matters a ton if you're a sweaty palmed medical student deciding what specialty to go in to. Even a small change in the relative competitiveness can actually be pretty huge if you are deciding whether to attempt to match a particular specialty. The "failure to match" rates are generally fairly low, so a small difference in competitiveness could change your chance of matching by 25% or more.

It takes a tremendous amount of effort to even attempt plastics. Not only do your basic grades have to be good, and your boards, but you have to do your summer research fellowship in plastics, and do elective rotations angling for that critical letter of recommendation.

If you thought you might not match, it might be a smarter idea to switch to Optho or some other specialty, since you can't really have a different highly competitive residency as a backup plan. For highly competitive residencies (ENT, Optho, neurosurg, derm, ect) the optimal strategy is to go all out for that particular specialty from the start, instead of dividing your efforts between more than one specialty.

 

[maxheadroom]

It matters a ton if you're a sweaty palmed medical student deciding what specialty to go in to. Even a small change in the relative competitiveness can actually be pretty huge if you are deciding whether to attempt to match a particular specialty. The "failure to match" rates are generally fairly low, so a small difference in competitiveness could change your chance of matching by 25% or more.

It takes a tremendous amount of effort to even attempt plastics. Not only do your basic grades have to be good, and your boards, but you have to do your summer research fellowship in plastics, and do elective rotations angling for that critical letter of recommendation.

If you thought you might not match, it might be a smarter idea to switch to Optho or some other specialty, since you can't really have a different highly competitive residency as a backup plan. For highly competitive residencies (ENT, Optho, neurosurg, derm, ect) the optimal strategy is to go all out for that particular specialty from the start, instead of dividing your efforts between more than one specialty.

So you're going to make a decision between Plastics and Derm based upon the perceived competitiveness of the two specialties? One is a six year surgical program that requires three years of General Surgery (getting less), lots of late nights and sometimes brutal call. One is a four year medical residency where a late night is considered clinic running past 4:30!! They're totally different!! Decide on what you want and then figure out what you have to do to get there.

 

[cdql]

So you're going to make a decision between Plastics and Derm based upon the perceived competitiveness of the two specialties? One is a six year surgical program that requires three years of General Surgery (getting less), lots of late nights and sometimes brutal call. One is a four year medical residency where a late night is considered clinic running past 4:30!! They're totally different!! Decide on what you want and then figure out what you have to do to get there.

👍

I would personally be drawn to the lifestyle friendly one. But I've met a surprising amount of people who would hang themselves if asked to attend clinic every single day, seeing patients roughly every 15-20 minutes.

 

[GSresident]

The only problem with a guarantee is that it really should be called "loan", and not thought of as salary at all. Geographic locales that find it difficult to recruit quality physicians often dangle an enticing carrot in front of folks who have spent nearly a decade in residency... knowing full well that they have the doc locked in for a specified time period when they come off the guarantee. The only way that I see him staying there is if he becomes an employee (which I still have a hard time picturing him living there...talk about a fish out of water).

Yeah I always warn people about salaries actually being loans. No one ever listens. I'm not sure if he got that deal or not. He is a fish out of water down there, driving a Ferrari and all. It reminds me of something Miles Davis once said about a Ferrari.

I hope that your happiness with medicine continues as well. The thrill of starting and running a new practice lasts for a couple of years; after that you will settle into a groove and hopefully find that the time and sacrifices were worth it.

I hope so too because I sure am having a good time.

The loss of the multiple surgery exemption siphoned much of the profitability of my most common procedure, which consequently sucked the life out of practice bottom line... and my pleasure in providing the now undervalued service.

Is there any way for you to lower your overhead?

Plastics is the best strategically positioned specialty, but the low cost procedures will become progressively at risk; basically, your FP's, OB's, NP's, etc can and will undercut your prices. Going forward I would focus on procedures with a steep learning curve and become great at those.

Best of luck.

Right now about 90% of what I do is reconstructive and the cosmetic cases I do are either abdominoplasty, face lift, blepharoplasty or breast augmentation. I have heard of OB's doing abdominoplasty but I would love to see them try it in my neck of the woods. The rest of it is fairly off limits. Thanks for the good wishes.

 

[Long Dong]

👍

I would personally be drawn to the lifestyle friendly one. But I've met a surprising amount of people who would hang themselves if asked to attend clinic every single day, seeing patients roughly every 15-20 minutes.

That's the thing though you don't have to see patients in clinic every single day. I'm on derm surgery/procedure clinic for 2 months doing melanoma's, BCC, SCC, cyst, lipomas etc cases range from half hour to 3 hours. Next year I get 2 months of mohs some cases go all day. Once done the best thing for me would be to mix it up seeing patients 3 days a week in clinic, doing procedures one day a week and reading slides 1-2 days a week (if I can get a dermpath fellowship). This would prevent any tendency to hang myself.

 

[MOHS_01]

Let's just say a Mohs weekend warrior scoped out the cancers and let's say a PRS was willing to work out of the same off (cause let's say that PRS is family/friend) would that set up work? Having that PRS guy do the repair next day or different day get reimbursed better? Sorry about the naivete of my questions? Don't know much about mohs, cause I don't do that rotation tell next year.

My advice is to stay away from the weekend warrior altogether... anyone who does not appreciate their inadequacies or limits is not someone who you want to be associated with. I would also shy away from a pattern of delaying reconstructions unless you want to defend a fraudulent / abusive billing claim.

Your proposed situation would work, just maintain separate legal entities and know the quality of the individual who you associate yourself with. It would also serve you well to know the overall environment of the community in which you intend to practice, because accepted "standards" of practice vary between communities more than they should.... Best of luck.

 

[Long Dong]

It reminds me of something Miles Davis once said about a Ferrari.

I think it was something about guys who buy Ferraris having a small penis.😀

 

[MOHS_01]

Yeah I always warn people about salaries actually being loans. No one ever listens. I'm not sure if he got that deal or not. He is a fish out of water down there, driving a Ferrari and all. It reminds me of something Miles Davis once said about a Ferrari.



I hope so too because I sure am having a good time.



Is there any way for you to lower your overhead?



Right now about 90% of what I do is reconstructive and the cosmetic cases I do are either abdominoplasty, face lift, blepharoplasty or breast augmentation. I have heard of OB's doing abdominoplasty but I would love to see them try it in my neck of the woods. The rest of it is fairly off limits. Thanks for the good wishes.

As a solo provider my overhead was quite low... unfortunately, as a referral driven subspecialty practice, it became apparent after a few short years that joining a group that would afford in house referrals would be necessary. Fixed costs remained constant, and are kept to a respectable minimum, but as revenues were cut the % was adversely impacted.

 

[Habeed]

So you're going to make a decision between Plastics and Derm based upon the perceived competitiveness of the two specialties? One is a six year surgical program that requires three years of General Surgery (getting less), lots of late nights and sometimes brutal call. One is a four year medical residency where a late night is considered clinic running past 4:30!! They're totally different!! Decide on what you want and then figure out what you have to do to get there.

The comparison I gave was to Optho. As far as I know, plastics is significantly easier to match than derm, with a 91% success rate for those who have AOA and try to match it. The numbers seem to show that plastics, while competitive, selects heavily for those with high grades and boards. Derm, on the other hand, cares about boards/grades but "who you know" is probably a much larger factor, as high grades and boards do not seem to help as much.

But maybe that changed this year, and now plastics is #1, and consequently a large risk to even try for.

 

[smq123]

The comparison I gave was to Optho. As far as I know, plastics is significantly easier to match than derm, with a 91% success rate for those who have AOA and try to match it. The numbers seem to show that plastics, while competitive, selects heavily for those with high grades and boards. Derm, on the other hand, cares about boards/grades but "who you know" is probably a much larger factor, as high grades and boards do not seem to help as much.

But maybe that changed this year, and now plastics is #1, and consequently a large risk to even try for.

**facepalm**

No, maxheadroom's point is that no one, aside from some possibly extremely odd and twisted individuals, would ever make a decision on a future specialty based solely on how competitive it is.

Plastics is a surgical residency. They get to operate and work in the OR a lot. For someone who enjoys operating, derm is never really an option, because it's so non-surgical in nature.

Furthermore, derm involves a LOT of clinic. LOTS of it. Considering how much surgeons tend to dislike clinic, I can't see them ever seriously entertaining the idea of doing a mostly clinic-based specialty such as derm.

A lot of people who can't get into plastics end up going into gen surg, not trying for derm. There's a reason for this.

 

[dilated]

The comparison I gave was to Optho. As far as I know, plastics is significantly easier to match than derm, with a 91% success rate for those who have AOA and try to match it..

It's 91% success for those who have AOA and GET AN INTERVIEW. There are literally 3x the number of derm spots as integrated plastics ones to interview for. I don't think there's a meaningful difference in difficulty between them, except for some derm programs that give major preference to their own students. I can't say there's any overlap at all between the "plastics people" and the "derm people" in my class or older classes. The plastics people were considering other surgical specialties and the derm people.. well they figured out derm was a good gig in 2nd year and never looked back. 😛

 

[What the pho]

Plastics is a surgical residency. They get to operate and work in the OR a lot. For someone who enjoys operating, derm is never really an option, because it's so non-surgical in nature.

Furthermore, derm involves a LOT of clinic. LOTS of it. Considering how much surgeons tend to dislike clinic, I can't see them ever seriously entertaining the idea of doing a mostly clinic-based specialty such as derm.

The mohs fellows (dermatologist) operate all day and only do clinic about 1 to 2 times a week only, tell them that their reconstructive surgery isn't surgical. Tell the derm surgeons derm is non surgical, oh yeah tell the guy who invented tumescent liposuction (a dermatologist) that too.

It's 91% success for those who have AOA and GET AN INTERVIEW. There are literally 3x the number of derm spots as integrated plastics ones to interview for. I don't think there's a meaningful difference in difficulty between them, except for some derm programs that give major preference to their own students. I can't say there's any overlap at all between the "plastics people" and the "derm people" in my class or older classes. The plastics people were considering other surgical specialties and the derm people.. well they figured out derm was a good gig in 2nd year and never looked back. 😛

Tell that to the USC guy a few years back who applied derm, didn't match and scrambled into UCLA intergrated plastics. Correct me if I'm wrong but I've never heard of the opposite happening.

I've never heard of anyone with 260+ step 1 not match into plastics, but there are many 260+ unmatched derm applicants. Just look at the NRMP charting match outcomes data.

 

[smq123]

The mohs fellows (dermatologist) operate all day and only do clinic about 1 to 2 times a week only, tell them that their reconstructive surgery isn't surgical. Tell the derm surgeons derm is non surgical, oh yeah tell the guy who invented tumescent liposuction (a dermatologist) that too.

The MOHS fellow got to that position after completing a mostly non-surgical derm residency. That's like saying that radiology ought to be considered a surgical specialty because you can do an IR fellowship after it. 🙄 Please. Let's not start clutching at straws here.

To someone who wants to be a surgeon, that seems like a really round-about route to do a somewhat surgical fellowship. Just take the direct route and become a surgeon.

Look, no one is saying that derm isn't competitive or that it's useless - Lord knows that it's one of the most competitive things out there. But suggesting that someone who first and foremost wants to be a surgeon would actually enjoy a non-surgical residency to get to that point, is pretty ludicrous.

So pull in your nerve endings and calm down.

 

[maxheadroom]

Wow, this thread is really degenerating . . .

OK, Derm is much more competitive than Plastics. And Dermatologists are Bad-Ass Surgeons. And y'all are so much cooler and prettier than any of us lowly Plastic Surgeons. We concede your superiority on all points. Thank you for correcting us.

 

[Habeed]

It's 91% success for those who have AOA and GET AN INTERVIEW.

Please cite your source. Mine is "Charting Outcomes 2007", as published by the NRMP. I saw no reason to even suspect that even one U.S. Senior with AOA failed to get integrated plastics interviews.

And, again, if it turned out that integrated plastics were the hardest residency to match (rather than being significantly easier to match for a top student that Derm is), and I were a student interested in it, I would possibly consider downshifting to Opthalmology or Ortho or ENT or Neurosurgery or Urology. All 5 residencies, while highly competitive, are significantly easier to match than plastics. All 5 are for highly compensated surgical specialists who are generally considered to perform more interesting and complex surgeries for much higher pay than general surgeons. 3 of the 5 are generally considered to have a better lifestyle, relative to general surgery, in terms of call responsibility and hours worked.

 

[dilated]

And, again, if it turned out that integrated plastics were the hardest residency to match (rather than being significantly easier to match for a top student that Derm is), and I were a student interested in it, I would possibly consider downshifting to Opthalmology or Ortho or ENT or Neurosurgery or Urology. All 5 residencies, while highly competitive, are significantly easier to match than plastics.

So if it turned out that integrated plastics was harder than derm you would consider a different surgical specialty, but if it was easier than derm you wouldn't? WTF? Why is derm even in the conversation? Students interested in plastics versus ENT would compare.... plastics to ENT.

I've never heard of anyone with 260+ step 1 not match into plastics, but there are many 260+ unmatched derm applicants. Just look at the NRMP charting match outcomes data.

And the median step 1 score for plastics is 3 points higher than derm!!! OMG SUCK IT DERM!!! This is the stupidest argument ever. I see no evidence that there is a true difference in how difficult either one is to match. They are both as hard as it gets and dependent on whichever one you developed connections in.

 

[Habeed]

And the median step 1 score for plastics is 3 points higher than derm!!! OMG SUCK IT DERM!!! This is the stupidest argument ever. I see no evidence that there is a true difference in how difficult either one is to match. They are both as hard as it gets and dependent on whichever one you developed connections in.

Derm has a low success rate, that's the important thing. If plastics were harder than Derm, then it would also have a low success rate. Trying for a residency with a low success rate, when another form of surgery that is just is interesting is available to you, is a stupid idea.

In plastics, if you have the boards and you earned AOA, your chances are above 95% that you'll get a spot, based on my analysis of the data. You'll know you're probably in before you even start clinicals. (aka if you just honored all of your basic science courses, did a good amount of extracurriculars, and hit above a 250, you have a greater than 80-90% chance to match plastics if you try for it)

The data shows that there are no such near-guarantees for Derm. You'll be sweating bullets all the way until match day. After all, even if your school does have a derm program, and you have 'connections' with the PD, you can never tell for certain what people think of you until the evidence becomes clear.

 

[smq123]

Habeed - The point that you seem to be missing, time and time again, is that there is VERY little overlap between those people who are seriously interested in derm and those people who are seriously interested in plastics.

While, to you, on the surface, they seem to be closely related, they are not. It's not the same relationship that, say, neurology and neurosurgery have. Dermatology, as a specialty, is basically clinic-based. They focus on skin disorders (many of which are genetic or infectious), and sometimes may use CERTAIN SURGICAL TECHNIQUES to remove some skin defects.

Compare that to plastics, which trains its practitioners to surgically address certain problems. This can extend to scar revision (which is outside the dermatologist's usual practice), skin flaps, breast reconstructions, etc. I have never met a dermatologist who has the gall to suggestion that he has the surgical skills to do a breast reconstruction after mastectomy. Nor have I met a dermatologist who would WANT to come in and do a skin flap for a person who has had excessive skin debridement secondary to nec fasc or Fournier's gangrene. Both of those problems that I mentioned are things that a PLASTIC SURGEON can take care of - a dermatologist definitely lacks the training to do that.

This is why, honestly, competitiveness really doesn't enter into the equation. They're such different fields, in terms of day-to-day practice, that comparing the COMPETITIVENESS of each field is simply idiotic and ridiculous.