Plastics

[wvumedicine]

When applying to an integrated plastics program do you do that in your senior year of med school or after a few years of gen surg. Also, how long are the integrated programs? Any other comments about integrated and traditional plastics (pros & cons) would be appreciated.

---

Members don't see this ad.

 

[Winged Scapula]

INTEGRATED programs accept applications from senior medical students. Most are 3 & 3 (3 years General Surgery and 3 years devoted to Plastics) but there are some 2 & 3, some 3 & 2, some 4 & 2. The majority are 6 years in length (so really only "save" you 1 year in the process).

The "rumor" is that some Integrated programs have closed down or not gotten up and running because of disappointment with the candidate pool. As you may imagine, surgical skills and an artistic "eye" are of supreme import in Plastics. A senior medical student is really an untried element. Without the couple of years of General Surery background (and the ability to assess your potential as a surgeon), programs are finding that *some* candidates they've taken have not lived up to their potential.

Hope this helps.

 

[droliver]

As Kimberli pointed out, there has been a mixed experience with the integrated plastic surgery programs. A number of the most prestigious training programs (Emory, Duke, & NYU come to mind)have abandoned the 3+3 model for several reasons including:

- high drop-out rate or non-renewal of their contracts (ie. firing) among the residents. Complicating things is that it is not possible to "plug" people into integrated tracks in the middle of their training if someone else quits. This can create disruptive manpower issues with only 1-2 fellows a year at most places.

- poorly prepared fellows after their preliminary surgery years. This is a common complaint among program directors I understand. What happens frequently is that a good deal of someones' early residency is consumed with general medical training, post-op care, and floor work for the senior surgery residents. Complex cases are in general, usually performed by 4th or 5th year residents. When people have finished 3 years only, you really do not have the skills, experience, or judgement to jump right into many of the advanced plastic surgery techniques and you still require to be taught "how" to operate, a task many Plastic surgery professors would rather have done before you arrive

 

[draper]

wvu,

It's true that there have been problems with some dropouts with combined plastics residents. Many of them don't realize that a 3 year committment to general surgery, which is usually the case, is a serious commitment and with the exception of truly integrated programs (i.e. michigan, baylor), most plastics programs are combined, that is strict 3 years of general surgery and then 3 years of plastics. Most integrated plastics residencies actually have minimal dropout rates because their years are tailored with subspecialty rotations and plastics-oriented rotations.

I'm a combined plastics resident at Yale and there is a 3+3 combined residency in place; for the past 4 years, 2 out of 8 residents have dropped out during their GS years.

That being said, I think the 3+3 or some sort of 6 year format will remain because of the substantial pressure to train plastic surgeons in 6 years rather than 7 or more. Therefore, more and more medical students are being encouraged to match out of medical school. There will, however, remain traditional fellowship spots and programs such as duke and hopkins are trying to retain these spots in spite of the push for more combined programs.

Keep in mind the difference between combined and integrated when looking at plastics programs. There is a big difference and there are positives and negatives to both.

Hope this helps.

 

[droliver]

Draper made some excellent points. The entire move towards an integrated model was due to financial pressures and the way the feds will fund training positions. Few will argue that abbreviated surgical training produces better plastic surgeons, but there are financial penalties that have forced options like combining the programs to be considered. Similar combined training programs are being considered (loosely) for cardiothoracic surgery as 7 or 8 year programs (4+3 or 4+4) by the Thoracic Surgery societies.

As Draper pointed out @ Yale (a fine program incidentally) there has been a 25% dropout rate during the preliminary years of their program, a trend that is frequently seen. I think that this is because there are a # of people who would not have considered PRS as a specialty if they had to do general surgery first due to lifestyle issues and suddenly they see a way for a shortcut. Three years doing something you don't enjoy for 100 hrs a week is a LONG time and this dawns on people after awhile

 

[wvumedicine]

Thanks for the advice. What are some of the programs that offer the combined route in the US. Also how is the competition to get into these spots.

 

[draper]

wvu,

If you search on netscape with "plastics residencies," there should be a number of listings for combined/integrated plastics programs. However, it's actually a very difficult chore to round up all of the programs because they change on a yearly basis. If there are any doubts, get the green book and call the programs to ask if they are taking medical school applicants this year.

When I applied several years ago, approximately 250-300 people applied for about 75 spots at 40 programs. Unless you're fairly certain about matching or you have no desire to do anything else, most people went into the match with a backup plan.

Good luck