ENT-facial plastics in big cities?

[md_doc]

Hi all,

I'm a current medical student with an interest in ENT and a particular interest in facial plastic surgery. I have rotated on ENT and definitely enjoy it and also noticed that a lot of current residents are going into facial plastic surgery fellowships. My question is how competitive is it to make it as an ENT trained facial plastic surgeon in big cities (mainly NY or LA) since there seems to be an abundant of them already?

I know there is stiff competition for a finite number of patients (from plastic surgeons, derm, oculoplastic, OMFS, etc). But anyone know how tough it is to make it in such cities? Starting salaries? Salaries once established? Hard to gauge this information in my current situation.

I'm also interested in another surgical subspecialty, urology. Clearly, ENT and uro have lots of similarities...but was wondering how you think urology compares to ENT-facial plastics in terms of demand, salaries, etc in big cities?

Thanks.

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[Kisangani]

I am a current med student who is also interested in ENT as well. In my research, it seems that most training programs are in large cities. However, most states do have at least one program. I do know that job outlooks (salary, competition, etc) are better in less populated states especially ones that are growing rapidly (ND, CO, AZ, NV to name a few). Could you elaborate on why "big cities" are important to you? Typically these are the worst places to practice medicine (overhead, insurance, cost of living, etc).

 

[HighPriest]

Facial plastics is a fairly common fellowship. That being said, they're not all equivalent. Some are very cosmetic-oriented, and some are more reconstructive-oriented. You can do a fair amount of cosmetic surgery without a fellowship if you're comfortable doing so out of residency. In fact, I think you'll find that a lot of currently practicing "fellowship-certified" facial plastic surgeons are guys who never actually did a fellowship, but instead logged a set number of facial cosmetic cases, and then passed a board certification test. You can no longer do that, but there are still a lot of them out there.

The more populated an area in which you choose to practice, the more competitive, and the more necessary it would be for you to have additional credentials to provide some legitimacy - especially as a facial plastic surgeon. In smaller communities, you probably won't have a PRS guy to compete with, but you will also likely have more trouble supporting yourself doing nothing but cosmetic surgery. In a city, you're going to be competing with everyone: PRS, other facial plastic surgeons, OMFS guys who do cosmetic surgery anyway, etc. You are going to find it highly, highly competitive and probably fairly cut throat as well. Especially for practices that operate entirely on out-of-pocket services, the gloves are usually off when it comes to marketing and competition. Plan on having to moonlight and/or provide general ENT care to supplement your income for years. You'll need to build a name for yourself and keep it from being tarnished by your competitors. Most people won't try to drag you through the mud out of professional courtesy, but there's always a guy. Nonetheless, you have to build a reputation and a word-of-mouth referral base. If you're able to join a practice with other cosmetic surgeons, that makes the process faster. But keep in mind that your partners are going to already have established reputations and an established patient base. People coming to pay you out of pocket are going to prefer your partners until they know who you are. Your partners are also going to take the better cases. You're going to be treating a lot of poor surgical candidates or difficult patients until you have a good reputation.

I'm sure salaries vary pretty dramatically depending upon the situation. The good thing is that it's cosmetic, so you really can charge people whatever you want, at least in theory. There are always competitive price-points. The down side is that, at first, you'll probably be charging less than your competitors. I've met a lot of facial plastics guys trying to start cosmetic-only or cosmetic-heavy clinics that do a lot of trauma and do a lot of moonlighting to support themselves and their staff until their practice gets rooted.

The converse to this is that, the bigger the city the bigger the catch basin. But in any ocean there are guys catching whales and there are guys catching minnows. You're not going to catch a lot of whales up front. Just histrionic, smoking, bipolar minnows with uncontrolled diabetes and three or four other DSM diagnoses who feel like a face lift is going to make their husband come back to them.