would you trust a fresh-out-of-residency surgeon to operate on you??

[Jessica]

I have a question for all of you, a family friend of mine is having her eyes done (blepheroplasty -sp?-) and her surgeon is just a year out of his residency. I know that a surgeon must be competent by this time, he graduated AOA from UCSF and was chief resident in PS at NYU, but would you trust someone at this level to operate on you? I want her to go to a board certified surgeon with more experience... I figure that plastics is like an art, the more practice you have, the better results you can give your patients. What do you all think?

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[Voxel]

It's very hard to say. How many of these blepheroplasties has s/he done? How easy technicaly is this surgery?

 

[jargon124]

My opinion is no better than yours Jessica (I'm a fellow incoming med student) - but those credentials are absolutely impeccable and my understanding is that the procedure you speak of is fairly simple (correct me if I'm wrong people). Given this, I think I would be comfortable with a surgeon "fresh out of residency". Of course, to really feel comfortable you would have to meet with and talk to the doctor yourself.

 

[jargon124]

Another thought - I would think that it's GOOD that she's going to a Plastics guy/gal - because I would much rather be in the hands of someone who has done an all out plastics residency than someone from Opthalmology or ENT with just a plastics fellowship. Not that those peeps aren't qualified, but my personal feeling is that if you are gonna have plastic surgery go to someone whose training has been geared specifically towards plastics (i.e. board certified/board eligible plastic surgeon).

 

[arthur v]

To Jessica,

The choice depends on the price your family friend is willing to pay for the procedure, both monetarily and for peace of mind. Blephs are really no big deal, and anyone completing a plastics fellowship should be ready and able to perform them. A newly minted PS may even be willing to do it for less money than more seasoned practitioners so as to gain further experience (which is what I suspect is going on in this case). My advice: go ahead and let him do it. He needs the experience, your friend will have saved some cash, and the outcome will almost assuredly be excellent. Everyone wins.

To Jargon,

Don't be so quick to judge. Some of the finest artists with a knife I know are oculoplastic surgeons and facial plastic surgeons. Look at it this way: what does three to five years of general surgery (with hemorrhoidectomies, lap choles, colon resections, etc.) have to do with operating on the face? As much as ophtho and ENT, I guarantee you. No one does an "all-out" plastics residency. The combined or integrated programs begin with three to four years of general surgery training, and there are fewer of these programs by the year. The vast majority of plastics surgeons are still board eligible/certified general/ENT/ortho surgeons (five years) who complete a 2-3 year fellowship in plastics.

AV

 

[jargon124]

arthur v,

Points taken - that's why I preface all my so-called advice with "I'm just an incoming med student" - My thought was that a plastics resident will be doing GS stuff but will be getting PS experience also - such that he/she will have been exposed to plastics for 6-7 years (the duration of the residency) plus possible fellowship time whereas ENT/Opthal people doing plastics would not have gotten much exposure outside of fellowship. I wonder how much plastics work ENT/Opthal residents do? I'm guessing not much at all - that's the plastics resident/fellow's job! I dunno, just my 2 cents, which are probably worth considerably less - :wink: Regardless, I am sure there are fabulous plastic surgeons who went the ENT/Opthal+ fellowship route - so I shouldn't generalize...

 

[pimmar]

Hi,

Plastics is an art, and is only perfected over time. I have assisted several plastic surgeons, and although I know the newer ones need the practice, personally I would go to someone who has been out of residency/fellowship for awhile. Another important factor is results, it is important to see the outcomes or hear what patients have to say. Good luck.

 

[neutropeniaboy]

•••quote:•••Originally posted by jargon124:
•Another thought - I would think that it's GOOD that she's going to a Plastics guy/gal - because I would much rather be in the hands of someone who has done an all out plastics residency than someone from Opthalmology or ENT with just a plastics fellowship.•••••As someone going into otolaryngology and as someone who has actually done a blepharoplasty (one eye), I really object to this kind of statement. A blepharoplasty is a painfully simple procedure; it is literally one of those see one-do one-teach one type of procedures.

Additionally, a plastic surgeon spends his residency doing all types of plastic surgical procedures, not just facial plastics like a fellowship-trained otolaryngologist who performs exclusively facial plastics. Unless the plastic surgeon exclusively does facial plastics, he could be debriding someone's foot ulcer one day and then performing a breast augmentation the next day. Their experience is one of breadth.

Truth be told, there is a lot less in facial plastics than one thinks. Many of the procedures can be done by a resident finishing an otolaryngology residency or a plastic surgeon fresh out of residency.

Nevertheless, word of mouth and personal satisfaction with the results is the ultimate indicator of how good a plastic surgeon/facial ENT surgeon is, regardless of training.

I know an ENT doc who does breast implants, and he does them well. There are dermatologists doing facelifts and breast augmentations. But, I digress.

My point, again, is that an otolaryngologist with fellowship training exclusive to facial cosmetics and reconstruction is just as qualified -- if not more -- as a plastic surgeon.

 

[neutropeniaboy]

•••quote:•••Originally posted by jargon124:
•arthur v,

...such that he/she will have been exposed to plastics for 6-7 years (the duration of the residency) plus possible fellowship time whereas ENT/Opthal people doing plastics would not have gotten much exposure outside of fellowship. I wonder how much plastics work ENT/Opthal residents do?•••••This is just entirely uninformed, sadly.

I don't think you really understand where plastic surgeons are coming from. The majority of them do 5 years of general surgery -- that's 5 years of GI surgery, endocrine surgery, oncologic surgery, etc. -- and then a 2-3 year fellowship afterwards during which they do plastic surgical procedures from head-to-toe. Two-to-three years of additional plastic surgery experience from head-to-toe does not qualify one to do good facial cosmetics (or any other regional plastics procedures). Certainly a plastic surgeon is more qualified to do breast augmentation than an ENT surgeon (see above response), but a plastic surgeon is not a priori better than an ENT cosmetic surgeon with respect to facial plastics.

Two address another point, depending on where they train, an otolaryngologist can get EXTENSIVE plastic surgery exposure during residency, and it's exclusive to the head an neck. The chair of Univ of Illinois dept of Otolaryngologist is a facial plastic surgeon. Do you think he emphasizes plastics during the residency? Boston Medical has three facial plastic surgeons on faculty. Do you think Boston's ENT residency program incorporates plastics experience?

Seriously, just think about it for a moment. With all the cutting on the face and neck ENT surgeons do for NON-cosmetic cases, isn't it plainly obvious that EVERY head and neck case is to some extent a cosmetic case? Every opening requires a closure; the head and neck is no different.

 

[arthur v]

Tangential I guess, but still in response to Jargon:

Actually, during general surgery training, only a few months (4 months is the most I've heard of) during 5 years would be spent on the plastics service, and of that, the time would be divided among the various areas of plastic surgery. Most ENT training includes upwards of a year in dedicated facial plastics training spread throughout 4 years of sub-specialty training. Ophtho training includes at least 4 months of oculoplastics.

The integrated plastics programs are required to include at least three solid years of general surgery training, so, again, the same 3-4 months on the plastic surgery service during the first 3-4 years of GS training followed by what is essentially a plastics fellowship. Most plastics exposure is thus during fellowship, not residency.

AV

 

[jargon124]

Alright Neutropenia and arthur v,

I am misinformed then and retract what I said - no surprise. That's why I love the Residencies and Rotations board so much, because I learn more on it than any other...Anyhow, I was just commenting on what I, as a lay person, thought would be the case. I was not aware that Opthal/ENT residents were exposed to plastics during residency. I meant no offense to these specialties, I hope that none was taken.

Just a question about plastics though - I undertand that there are two pathways - Integrated plastics residencies and General surgery + fellowship. In my comments, I was thinking about the intergrated plastics residents/graduates. Do you think, in that case, my point about getting plastics exposure all 6-7 years would hold? I that the integrated model residents will still be heavy in GS stuff, but wouldn't training be geared more towards plastics? Just wondering.

I'll just shut my mouth now.

 

[jargon124]

Arthur just answered my question before I asked it - thanks!

 

[warpath]

It's funny, but I witnessed a surgery (ortho) for the first time a few months ago. The whole surgery was done by a 4th year resident. The orthopedic surgeon just observed and gave suggestions a few times. Something to think about when you go to get a surgery done by an "experienced" surgeon at a teaching hospital.
It's important to realize that if residents and newly minted surgeons don't get any experience, there'll be no "experienced" surgeons.

 

[neutropeniaboy]

•••quote:•••Originally posted by warpath:
•
It's important to realize that if residents and newly minted surgeons don't get any experience, there'll be no "experienced" surgeons.•••••Ah, there's the rub.

It's the inevitable conclusion that in order to continue training young physicians that the public has to be largely ignorant and the federal government has to "look the other way."

You never really learn unless you put yourself on the line or do something on your own.