Plastics vs Ophtalmology

[Kemien]

Hey guys,

I am a MSIII very confused trying to decide between plastics vs ophthalmology. I have sufficient scores and multiple publications in medical school which could me competitive for both. I am interested in dealing with patients for whom my interventions can make marked improvements in their lives, which has drawn me to these two fields. I'm also looking for a reasonable lifestyle as an attending and the possibility to do research as an aside to my practice.

Here are my pros and cons for both:

Plastics
Pros: Huge diversity of cases, multiple interesting sub-specialties (drawn particularly to recons, burns, microsurgery, pediatrics and nerve surgery which I think are very rewarding). Ability to operate on every part of the body and work with every type of tissue (skin, vascular, nerve, bone,...). Intellectually stimulating cases which vary even with the same procedure from one pt to another. Opportunity for creativity. Very interesting research opportunities (stem cell, synthetic grafts, nerve,...). Good salary (from what I understand).

Cons: Busier lifestyle (how is the lifestyle of a non-cosmetic plastics attending in an academic center? how busy is it vs gen sx or orthopedics?). Cosmetic surgery (not against but no interest whatsoever). More competitive than optho.

Ophtho
Pros: Excellent lifestyle. Excellent outcomes and very thankful patients.

Cons: Very limited diversity of procedures and tissue to work on (I find cataract sx boring. No interest in glaucoma. I could see myself doing retina but even then they have really 2-3 procedures, diversity is very very limited. No interest in oculoplastics which is very limited.). Low and decreasing salary. Not very academic field, mostly work in private clinics with little research involvement (I may be wrong on this one). ODs creeping on field.

(I know this was briefly discussed previously but I am looking for more input.)

---

Members don't see this ad.

 

[drpatelplasticsurgery]

Decide in part by which bread and butter cases you would enjoy more and see yourself doing and enjoying when you're 60. If you can't stand the downsides (e.g. pressure sore management and needy patients in aesthetic plastic surgery), forget the specialty. It's strange that you are not interested in oculoplastic surgery yet you're interested in plastic & reconstructive surgery, and oculoplastic surgery is the overlap realm between ophthalmology and PRS. No interest in aesthetic surgery, huh? Have you even scrubbed an open rhinoplasty or a rhytidectomy (facelift)? Or a challenging breast asymmetry case? Don't pick your specialty based on competitiveness or "salary." If you want to be your own boss and have the autonomy that is getting eroded in American medicine, consider that PRS is one of the last bastions for solo private practice. Also, you don't have to be a University attending to contribute to the surgical specialty literature. At your current stage in education, you have your work cut out for you to do your due diligence, investigate each field in depth, and generate face time with program directors, chairmen, and residents - get on some research projects in both disciplines, attend Grand Rounds, participate in Journal Clubs, get mentors for each field, and scrub a variety of cases for each field, even on your free time. Both fields offer the chance for a "controllable" lifestyle. Just keep in mind that the more leisure time you have, the less you're working and less money/RVUs you're generating. Everything has its opportunity cost and you need to know thyself. Ignore the prestige-whoring and Ivory Tower climbing and pick the field in which you'll be happiest.


Sent from my iPhone using SDN mobile

 

[ctusfinest]

Just want to piggy back on the previous comment and emphasize that it is weird that you do not like Oculoplastic surgery if you are interested in PRS. Even if aesthetics isn't your cup of tea the ptosis repairs, facial fractures, tumor excisions, and other surgeries around the eyelid are quite interesting and important to understand for a PRS resident.

 

[droliver]

These two fields are absolutely nothing alike in most respects on a day to day basis, and the personalities of the specialties are pretty opposite. Opthamology is fairly leisurely, a LOT of short clinic visits, and generally short cases. Plastics is pretty long hours, long surgeries mostly, a lot less clinic time (but longer encounters). If you think you'd really like Optho, you'd be pretty miserable as a PS resident or attending.

 

[caffeinemia]

These two fields are absolutely nothing alike in most respects on a day to day basis, and the personalities of the specialties are pretty opposite. Opthamology is fairly leisurely, a LOT of short clinic visits, and generally short cases. Plastics is pretty long hours, long surgeries mostly, a lot less clinic time (but longer encounters). If you think you'd really like Optho, you'd be pretty miserable as a PS resident or attending.

Agreed.

Now let me tell you about the time I did a 12 hour, two finger replant for an un-insured undocumented worker while on "home call," rounded, took a two hour nap, applied some leeches, and then did an elective abdominoplasty. That doesn't happen in ophthalmology.

 

[Kemien]

Thanks for the answers guys. I understand that these two professions are quite variable. I think what attracted me to both was that they offer the ability to obtain quick satisfying results. I am currently leaning more strongly towards plastic surgery.

I actually did two days of oculoplastics early during my clerkship and I did not really enjoy it (although I understand my exposure was limited); the center I was at may be different but we did very little orbital fractures (mostly was done by Plastics and some ENT) and most of it was quite repetitive lacrimal disorders which I did not find appealing.

I had a further inquiry regarding plastics: is a solely non-cosmetic plastic surgery practice feasible? I did a lot of searching and I realized that a lot of craniofacial, pediatric and burn surgeons also did cosmetic work as an aside. Is it because there aren't enough of these sub-specialty cases (excluding of course large centers) to maintain a practice or is it because these cases don't earn enough money so these surgeons supplement with cosmetics? I did a few days of plastics and scrubbed in on some breast augmentation, lipo and abdominoplasty cases and while I find them really cool and interesting technically, I really don't see myself dealing with that patient population. My biggest fear is entering plastic surgery (if I am lucky enough to match) then graduating and being forced to do cosmetics because having a solely non-cosmetic practice is not feasible or economically doesn't make much sense as I am tagging along a significant amount of debt. If anyone could shed light on this, I would be very appreciative.

 

[caffeinemia]

Thanks for the answers guys. I understand that these two professions are quite variable. I think what attracted me to both was that they offer the ability to obtain quick satisfying results. I am currently leaning more strongly towards plastic surgery.

I actually did two days of oculoplastics early during my clerkship and I did not really enjoy it (although I understand my exposure was limited); the center I was at may be different but we did very little orbital fractures (mostly was done by Plastics and some ENT) and most of it was quite repetitive lacrimal disorders which I did not find appealing.

I had a further inquiry regarding plastics: is a solely non-cosmetic plastic surgery practice feasible? I did a lot of searching and I realized that a lot of craniofacial, pediatric and burn surgeons also did cosmetic work as an aside. Is it because there aren't enough of these sub-specialty cases (excluding of course large centers) to maintain a practice or is it because these cases don't earn enough money so these surgeons supplement with cosmetics? I did a few days of plastics and scrubbed in on some breast augmentation, lipo and abdominoplasty cases and while I find them really cool and interesting technically, I really don't see myself dealing with that patient population. My biggest fear is entering plastic surgery (if I am lucky enough to match) then graduating and being forced to do cosmetics because having a solely non-cosmetic practice is not feasible or economically doesn't make much sense as I am tagging along a significant amount of debt. If anyone could shed light on this, I would be very appreciative.

Plastics is such a wide ranging field that it's hard to say whether you'll be pigeon-holed into one thing or another. Your training (if it is good) will be insanely broad. I've worked on face, hand, body all in one day and expect to have a broad practice in my career. From speaking openly with multiple attendings -- many have shifted their practice over the breadth of their careers. Some started doing clefts and then shifted into doing facelifts only. Others were hand microsurgery fellowship trained and then proceeded to only do facial fractures or breast work in practice. One common trend I've noticed is that many start out filling whatever role is available to them in a health system or competitive market and then with seniority and experience, find the niche they truly care about. In short, your training does not predict what you can do -- only your skill, preference, and serendipity.

I would also caution you on what you would consider cosmetic and non cosmetic. Much of what we do will always have an eye on cosmesis as well as function. The two are so often intertwined. What is the function of the face or breast? To look like a face or breast. To be beautiful or sexually appealing. Yet also to allow expression, feed a child, fit clothes, etc etc. To isolate and only look at one functional element would not do these anatomic structures justice. So to use an example that interests you: I can fix a facial fracture, but my goal is not only to restore orbital volume or occlusion, it's also to make sure the patient doesn't look like they have a widened cheek,, depressed globe, or crossbite, all of which would look funny and cause them some level of social distress. Furthermore, I'd caution you that plastic surgery typically makes very non-intuitive/creative use of what the body has to offer to repair, restore, and improve. For example, you may not be interested in liposuction, but I have used liposuction to obtain fat for grafting into radiation burns or the contour defects of a child with a congenital hemifacial microsomia. These are reconstructive efforts (especially the latter), but also very aesthetically minded. The line blurs, and we must be technicians and artists, with broad and flexible understanding and perception.