General Surgery VS Integrated Plastics

[agreenbe]

I am a 3rd year med student who is pretty much set on doing Plastics. The question that has been on my mind is as follows:

Should I apply to all Integrated Plastics programs and just take whatever program I match with (Even if it is not a pedigree top 10 Academic powerhouse)...OR...Should I try to get into a very STRONG General Surgery program at one of the powerhouse universities and then apply for plastics after doing Gen Surg training???

If anyone has an opinion and can suggest a few programs at which I might be a competitive applicant, I would greatly appreciate it. Here is some info about me...Let me know if you need more. Thanks!

B.A. Johns Hopkins Univ
M.D.(09) Texas Tech Univ
Step 1 255/99
Research with 2 Pubs
Good grades so far...Hoping for AOA

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[exmike]

I am a 3rd year med student who is pretty much set on doing Plastics. The question that has been on my mind is as follows:

Should I apply to all Integrated Plastics programs and just take whatever program I match with (Even if it is not a pedigree top 10 Academic powerhouse)...OR...Should I try to get into a very STRONG General Surgery program at one of the powerhouse universities and then apply for plastics after doing Gen Surg training???

If anyone has an opinion and can suggest a few programs at which I might be a competitive applicant, I would greatly appreciate it. Here is some info about me...Let me know if you need more. Thanks!

B.A. Johns Hopkins Univ
M.D.(09) Texas Tech Univ
Step 1 255/99
Research with 2 Pubs
Good grades so far...Hoping for AOA

Apply to every integrated plastics program, and gsurg as a backup. An guaranteed integrated spot beats a not assured fellowship anyday. Combined programs probably falls in the middle of desirability.

 

[maxheadroom]

One other thing to add . . .

Don't get caught up in the "Academic Powerhouse" program chase. The sad fact is, you're a student at Texas Tech. Unless you do some pretty phenomenal things (and your bio-stats, while good, are middle of the road for integrated PRS), places like Harvard and Stanford aren't going to pursue you. And unless you're looking to be an academic plastic surgeon on the faculty of Harvard or Stanford, you really don't need to train at a Super-Duper Powerhouse.

There are lots of "hidden gem" programs that don't get as much name recognition outside of Plastics even though they offer great training. Texas A&M/Scott and White is in your neighborhood and is a very respectable program. Places like Wake Forest, Mizzou, Southern Illinois, MCW, Las Vegas, and many more offer great training. Don't short change a program just because it doesn't have an Ivy League name -- it's a mistake that many UNMATCHED people have made before you.

 

[BodySculptor]

I am boarded in general and plastics and went through extra time and work to get there.

The advantages for me is that I do a lot of breast and body work, and frequently have difficult abdominal reconstructions to do. I'm comfortable doing those cases, and my general and bariatric surgeons who refer to me appreciate that.

Post bariatric plastics is challenging, and my GS background prepared me for a lot of the complications these patients can run into!

I would not change anything, except perhaps cut the 2 years of research I did to one ! But if you envision a strict cosmetic practice or are not inclined to do the bigger cases in a medical center type environment, then the GS path may not be best.

I agree with the posts about the "powerhouse" Universities. I attended a "small" program here in Houston at UT....I left with a ton of cases (micro, cosmetic, craniofacial, burn) because of the institutions here in the Med Center. We had very little academic focus there, just a lot of cases. That was fine with me and my boards were a breeze.

Best wishes,

John LoMonaco, M.D., F.A.C.S.
Plastic Surgery
Houston, Texas

www.DrLoMonaco.com
www.BodyLiftHouston.com

 

[Dr JPH]

Thanks for the post Dr. LoMonaco

 

[JaggerPlate]

I am boarded in general and plastics and went through extra time and work to get there.

The advantages for me is that I do a lot of breast and body work, and frequently have difficult abdominal reconstructions to do. I'm comfortable doing those cases, and my general and bariatric surgeons who refer to me appreciate that.

Post bariatric plastics is challenging, and my GS background prepared me for a lot of the complications these patients can run into!

I would not change anything, except perhaps cut the 2 years of research I did to one ! But if you envision a strict cosmetic practice or are not inclined to do the bigger cases in a medical center type environment, then the GS path may not be best.

I agree with the posts about the "powerhouse" Universities. I attended a "small" program here in Houston at UT....I left with a ton of cases (micro, cosmetic, craniofacial, burn) because of the institutions here in the Med Center. We had very little academic focus there, just a lot of cases. That was fine with me and my boards were a breeze.

Best wishes,

John LoMonaco, M.D., F.A.C.S.
Plastic Surgery
Houston, Texas

www.DrLoMonaco.com
www.BodyLiftHouston.com

Great post ( and I loved your website ). I had a question though; you stated that if someone wanted a cosmetic practice that the GS to fellowship route might not be the best to take. Does this suggest an integrated program? Also, by cosmetic, do you mean just shooting botox, or an actual private practice that can do rhinoplasty, rhitidectomy, breast augmentation etc etc (sorry for the spelling mistakes there). A little confused. Thanks.

 

[BodySculptor]

Hi jaggerplate. By cosmetic practice, I mean one away from a hospital where you would not be seeing much trauma, cancer reconstruction, or congenital issues.

I think those areas will be easier for a person with some general surgery background.

Best wishes,

John LoMonaco, M.D., F.A.C.S.
Plastic Surgery
Houston, Texas

www.DrLoMonaco.com
www.BodyLiftHouston.com

 

[maxheadroom]

I respectfully disagree with Dr. LoMonaco. I don't think that the direction that general surgery is moving (more and more MIS/Laparoscopy) lends itself to educating future Plastic surgeons. I've addressed more complex abdominal reconstruction as a Plastics resident than I did in the general surgery component of my training. General surgery calls my chairman (who only did three years of gen surg training) to help them with complex abdominal stuff. Sure, we do ask them to do adhesiolyses -- I'd challenge you to find many Plastic surgeons who wouldn't do that.

I just don't believe that full general surgery training offers enough benefits to be worth the wasted training. I feel confident doing the body lifts (and dealing with their complications) -- although those can be some of the more painful cases in PRS and I don't see myself as billing myself as a body sculptor (especially if people try to get insurance to underpay me for a long, painful case).

 

[droliver]

Sorry Maxie, I'm going to have to throw in with Dr. LoMonaco.

It's silly to suggest the type of abdominal surgery you become familiar with in an integrated Plastic Surgery model is analogous to the perspective you have coming from General Surgery with a traditional Plastic Surgery residency. You will just never have the background of dealing with hundreds of hernias, ostomy issues, re-operative abdomens, open abdomens from trauma, etc... to get as fluent. One interesting trend has been that abdominal wall reconstruction has now been "reclaimed" by general surgeons in a number of institutions as they've learned component separation techniques and embraced Alloderm

All you have to do is look at the strengths and weaknesses that other specialties have when they've done Plastic Surgery training. I worked with surgeons from ENT, OMFS, Orthopedics, & Surgery backgrounds (I even worked at the Kleinert Clinic with some fellows from SE Asia who were in "integrated" hand surgery residencies in their countries, which I'd never heard of before) and you definitely see different levels of skill and comfort with certain procedures. I can do a rhinoplasty, but my understanding of the nose and airway is never going to be like someone who did hundreds of sinus surgeries. I can do mandible fractures, but I'll never understand dental mechanics like an Oral Surgeon. I can fix distal radius fractures, but I won't be able to put the big picture (shoulder -> digits) together like an orthopedist would.

I just don't think the more superficial exposure you get in plastic surgery with the nuances of different & distinct discplines is as good as the primary sources in many instances.

THAT LONG WINDED POINT BEING SAID.....

I'm not really sure it matters with the way most people practice. As compared to Plastic Surgeons of the past, most of us no longer seek to be "masters of all" and frequently shed areas like hand, peds, burns, microsurgery etc... The compromises of the integrated model seem to not be such an issue several years out. While I still think the integrated push is more of a financial & manpower issue rather then some great advance, it clearly is the way nearly all will be training.

 

[GSresident]

This discussion has been going on for so long that I want to slowly close my head in an industrial press.

 

[maxheadroom]

GSresident, please don't put you head in a press when I'm on call for face. I had something similar a few months ago . . . literally a "face crunch". That was a fun 14 hour facial fracture ORIF.

Surprise, Ollie and I disagree about this issue! No one would ever guess that based on our previous posts. This is the heart of the debate amongst the decision-makers. Some people believe that full general surgery training is better, others don't. Some think that ideal plastics training would be 1+4 (talk to Andy Lee, he's a super-smart guy and he seems to be a big proponent of this).

And yes, if I get roped into some big, nasty body contouring case that involves a significant hernia, I'm going to invite a general surgeon along for the ride. So you and Dr. LoMonaco have that on me (but I'm not wild about body contouring despite everything that Rubin tries to sell).

 

[Pir8DeacDoc]

Max:

you must be a resident at Pitt. Did a rotation there as a medical student and really enjoyed the place. Awesome training and great autonomy.

 

[maxheadroom]

Nope, not at Pitt, but I know several of the faculty there and a couple of the residents. It is a great program, but when I was interviewing things were still in flux with Futrell's retirement and Lee's hiring was still a rumor. Joe Losee is a stud -- he's all about resident education.

 

[Moravian]

Nope, not at Pitt, but I know several of the faculty there and a couple of the residents. It is a great program, but when I was interviewing things were still in flux with Futrell's retirement and Lee's hiring was still a rumor. Joe Losee is a stud -- he's all about resident education.

Correction Max...Futrell was fired by Tim Biliar who took over as chairman of the surgery department (this was in 2000). He's working, or at least was as of a year ago, over at Allegheny General.

--M

 

[Pir8DeacDoc]

Yeah Dr. Futrell was working at one of the other hospitals in town when I was there in fall '05. He still came to the journal clubs and grand rounds stuff so there must not have been terribly hard feelings??

 

[maxheadroom]

I knew that he'd been pushed out, but I figured it would sound better on the boards to say "retired". Maybe "retired with prejudice?" ;-)

OK, back to waiting for my Friday night melanoma case . . . big fun here.

 

[Moravian]

I knew that he'd been pushed out, but I figured it would sound better on the boards to say "retired". Maybe "retired with prejudice?" ;-)

Risking prolonging this for a thread that didn't start out in this direction, I think this provides a fairly good example of what can happen in academics. The Futrell "retirement with prejudice" was a big shock to everyone at the time, including Dr. Futrell. He'd been the plastics chief for as long as anyone could remember and he's a really great guy on top of everything else (as evidenced by his continued support at journal clubs). Since most plastic surgery sections are not "departments," the chiefs basically serve at the pleasure of the surgery department chair. While the reasons Biliar had for moving Futrell out didn't become public knowledge (at least not at my level), and in all deference to Dr. Futrell, the result turned out to be a good one.

There were many at the time who thought the the Pittsburgh program was doomed, faculty were up in arms and threatened to leave, and prospective residents were wary of possible instability. In reality, most of the faculty are still there, the ship righted itself after a couple of years, and is a much a better place than in 2000.

I'm not sure what the point is here, except to say that flux is not always a bad thing, faculty come and go, and programs seem not only to survive, but gain new life with new leadership.

--M