Case Load

[Stare Decisis]

When discussing the amount of procedures performed during the length of a plastic surgery residency, what is considered poor, fair, or exceptional? Unprovoked, one of the program directors told me that their residents graduate with an average of 2500 procedures and I nodded like it was amazing but I have no idea what that means in the scheme of things. While I do not have an idea of the variety of procedures performed or how much involvement the residents get in any particular case, I was wondering if this was a solid experience. Does the number of procedures accurately represent resident experience? Are there other questions that i should be asking to evaluate operative experience?

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[droliver]

Unprovoked, one of the program directors told me that their residents graduate with an average of 2500 procedures and I nodded like it was amazing but I have no idea what that means in the scheme of things

It means
1) the residents are likely inflating their role in many procedures in their case logs
2) there's a lot of "unbundling" going on with how they're logging cases

 

[Shibumi]

2500 sounds like an impressive amount of cases, especially for a 2-year program. I have just graduated with 2200 cases, and I went to a 3-year independent program.

 

[Moravian]

I have just graduated with 2200 cases, and I went to a 3-year independent program.

That is indeed an impressive number and I wonder if you're quoting actual cases or CPT codes. That would be 733.3 cases a year (as a busy attending I do over 350) or 2 cases a day (every day counting weekends). What most residents report as "cases" are actually the total number of CPT codes. And, Droliver mentioned, many of you are unbundling your codes in order to increase your numbers.

This means, for example, that for billing purposes, I can code for creation of a surgical site or a debridement but not for the actual closure of the wound because that's included in the original code. I can code for a lesion excision and a closure code, but a rotation flap includes the the closure code. You can't legally bill for CMS services (or any other insurance for that matter) by unbundling to increase payment unless you add an appropriate modifier. Since my intention is not to have mini coding workshop, I won't bore you any further.

The case log system doesn't stop you from unbundling, and since you're not getting reimbursed, there's no foul except in falsely reporting numbers to make the program ( and yourself) look really good. If you actually had that number of actual patients, then my hat is off to you. However, when the rest of you are evaluating program numbers, please keep the above in mind.

--M

 

[Shibumi]

Hello, Moravian,

If you don't mind me asking you a question which is off-topic, how did you study for your written board? What study material did you use? Most people I have asked told me they did old in-service questions. What I am looking for is more of a blueprint for the overall preparation. I am asking you because I think you are one of the few more senior surgeons here. Thanks!

 

[Moravian]

Hello, Moravian,

If you don't mind me asking you a question which is off-topic, how did you study for your written board? What study material did you use?

I did a lot of test questions from old exams. I also read the "selected readings" and the CME articles that are posted monthly in PRS. I'm not sure any of it helped. The written exam really doesn't look much like the inservice and there are questions that you will have NO idea of how to answer. Many times the answers given are nothing that you would actually do. It was the hardest, most ridiculous written exam I have ever taken. That being said, I still think the best way to prepare is with doing practice questions. Review the stuff you don't know. Try not to lose too much sleep over it.

I am asking you because I think you are one of the few more senior surgeons here.

I am only senior in age. I haven't been in practice all that long, but if it was a compliment, Thanks.

--M

 

[Shibumi]

That was meant to be a compliment. You show maturity in your comments and I presumed you to be a senior surgeon. My apology if I have overestimated your age.

Thanks for the study tips! I will do as many questions as I can get my hands on. We'll see what happen in October.

 

[Moravian]

That was meant to be a compliment. You show maturity in your comments and I presumed you to be a senior surgeon. My apology if I have overestimated your age.

No worries. You didn't overestimate my age. Just my time in service.

Cheers.