Why Plastics? Abstracts from recent articles

[Moravian]

Greetings all,

There were a couple of articles I thought might be of interest that were published in the current “Journal of Plastic and Reconstructive Surgery.”

--Moravian


Selection Criteria for the Integrated Model of
Plastic Surgery Residency

Background: The purpose of this study was to identify those qualities and
characteristics of fourth-year medical students applying for the Integrated
Model of Plastic Surgery residency training that will make a successful plastic surgery resident.

Methods: A three-part questionnaire was distributed to the training program
directors of the 20 Integrated Model of Plastic Surgery programs accredited by the Residency Review Committee for Plastic Surgery by the Accreditation Council on Graduate Medical Education. The first section focused on 19 objective characteristics that directors use to evaluate applicants (e.g., Alpha Omega Alpha Honor Society membership, United States Medical Licensing Examination scores). The second section consisted of 20 subjective characteristics commonly used to evaluate applicants during the interview process. The third section consisted of reasons why, if any, residents failed to successfully complete the training program.

Results: Fifteen of the 20 program directors responded to the questionnaire. The results showed that they considered membership in the Alpha Omega Alpha Honor Society to be the most important objective criterion, followed by publications in peer-reviewed journals and letters of recommendation from plastic surgeons known to the director. Leadership capabilities were considered the most important subjective criterion, followed by maturity and interest in academics. Reasons residents failed to complete the training program included illness or death, academic inadequacies, and family demands.

Conclusions: The authors conclude that applicants who have achieved high academic honors and demonstrate leadership ability with interest in academics were viewed most likely to succeed as plastic surgery residents by program directors of Integrated Model of Plastic Surgery residencies. (Plast. Reconstr. Surg. 121: 121e,
2008.)


Applying to Plastic Surgery Residency:
Factors Associated with Medical Student
Career Choice

Background: Applications to plastic surgery residency increased 34 percent
from 2002 to 2005, despite decreasing applications to other surgical subspecialties. During this period, medical education, reimbursement, work hours, and media coverage have changed.

Methods: To determine factors responsible for rising applications to plastic
surgery residencies, medical student applicants to plastic surgery residencies for 2005 were surveyed. Applicants recorded exposure to plastic surgery during medical school and graded the influence of personality, lifestyle, income potential, and media coverage on their decision to choose plastic surgery training. To further study the effects of plastic surgery exposure on career choice, the percentage of graduating students applying to plastic surgery residency was compared between medical schools with and without plastic surgery training programs.

Results: Medical schools that provided greater exposure to plastic surgery and schools with plastic surgery training programs had a higher percentage of graduates applying to plastic surgery residency (p 0.001). Applicants rated compatibility with the personality of plastic surgeons as a significant factor in their career choice. Lifestyle and income potential were moderately important, whereas media coverage minimally affected career decision. Applicants typically decided on a plastic surgical career during the third year of medical school.

Conclusions: Medical student exposure to plastic surgery is the most influential factor in a student’s decision to pursue a career in plastic surgery. To continue the increasing applicant trend toward plastic surgery, plastic surgeon engagement of medical students should be emphasized, ideally before the third year of medical school. (Plast. Reconstr. Surg. 121: 1049, 2008.)


DISCUSSION

Applying to Plastic Surgery Residency: Factors Associated
with Medical Student Career Choice
Thomas Ray Stevenson, M.D.
Sacramento, Calif.

Arin Greene and James May looked at factors affecting medical students’ choice of plastic surgery as a career and confirmed a common belief—early personal contact with satisfied practitioners of a specialty positively influences perception of that specialty. This observation is no surprise, although it is reassuring to have it confirmed with reliable data. In addition to reinforcing a premise previously assumed to be true, Drs. Green and May proceed to demonstrate that factors of future lifestyle and potential income are less compelling for career selection than the personalities of practicing plastic surgeons. Equally interesting, recent media exposure of plastic surgery holds little sway in medical student selection of our specialty.

When considering the larger cohort of all applicants to plastic surgery residencies, this publication does exhibit a selection bias. Medical students contacted were ones who applied through the Electronic Residency Application Service to either an integrated or coordinated plastic surgery residency. Other residents who applied to plastic surgery programs with an independent format were not queried. We cannot tell what factors account for the selection of plastic surgery as a career among the entire population of applicants. My suspicion is that there would be no difference, but such remains to be proven. I assume that the majority of students who were influenced by a plastic surgeon met that surgeon while in medical school. This suggests that the plastic surgeon was most likely an academician. If so, how would the influence been felt if the plastic surgeon had been a private practitioner? Would lifestyle and financial issues been more or less important? Possibly, the outcome would have been identical.

There are steps plastic surgery as a whole should consider in response to this publication.
We should encourage academic plastic surgeons to contact medical students in their more formative years (i.e., during years 1 through 3). Teach these young students about plastic surgery’s scope. Let them see what we do that is separate from the public’s perception. We should encourage every medical school to have a plastic surgeon on staff who can serve as a mentor. Medical schools without a plastic surgery division or department deprive their students of an important facet of medical education. Finally, for those students who do not come into contact with a plastic surgeon, our major societies should open an outreach to inform
them about our specialty.

---

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[GSresident]

Thanks for posting the articles. I read them in the actual journal and I thought they had interesting conclusions.

The funny thing is that the applicants said that money and lifestyle weren't as important as the 'personality' of plastic surgeons. I've met some real bozos but buy and large I feel like I am amongst my own when I am with other plastic surgeons. The more I interact with other PRS guys the more I discover how similar our backgrounds and interests are. I won't go into them but I've discovered weird stupid coincidences in how they were raised and what they like to do out of work. This never happened when I rotated through other fields. Oddly, I didn't fit as well with general surgeons either.

Another funny thing is that you would have to be an enormous douchebag to admit that a television show influenced your career choice, but I suspect that shows like Dr. 90210 and The Swan etc have had drastic effects on the young skulls full of mush in medical school. Back when I was in medical school the show ER was #1 and all the little kiddies gunned for ER spots. Its funny how things work out because I am an ER physician on weekends with no specific training in emergency medicine. Go figure.

Finally I would argue that the best thing would be for the number of plastics spots offered in the US to either go down or stay the same. Hopefully as more and more applicants gun for the same number of spots the cream will rise to the top and we'll produce better plastic surgeons.

Greetings all,

There were a couple of articles I thought might be of interest that were published in the current “Journal of Plastic and Reconstructive Surgery.”

--Moravian


Selection Criteria for the Integrated Model of
Plastic Surgery Residency

Background: The purpose of this study was to identify those qualities and
characteristics of fourth-year medical students applying for the Integrated
Model of Plastic Surgery residency training that will make a successful plastic surgery resident.

Methods: A three-part questionnaire was distributed to the training program
directors of the 20 Integrated Model of Plastic Surgery programs accredited by the Residency Review Committee for Plastic Surgery by the Accreditation Council on Graduate Medical Education. The first section focused on 19 objective characteristics that directors use to evaluate applicants (e.g., Alpha Omega Alpha Honor Society membership, United States Medical Licensing Examination scores). The second section consisted of 20 subjective characteristics commonly used to evaluate applicants during the interview process. The third section consisted of reasons why, if any, residents failed to successfully complete the training program.

Results: Fifteen of the 20 program directors responded to the questionnaire. The results showed that they considered membership in the Alpha Omega Alpha Honor Society to be the most important objective criterion, followed by publications in peer-reviewed journals and letters of recommendation from plastic surgeons known to the director. Leadership capabilities were considered the most important subjective criterion, followed by maturity and interest in academics. Reasons residents failed to complete the training program included illness or death, academic inadequacies, and family demands.

Conclusions: The authors conclude that applicants who have achieved high academic honors and demonstrate leadership ability with interest in academics were viewed most likely to succeed as plastic surgery residents by program directors of Integrated Model of Plastic Surgery residencies. (Plast. Reconstr. Surg. 121: 121e,
2008.)


Applying to Plastic Surgery Residency:
Factors Associated with Medical Student
Career Choice

Background: Applications to plastic surgery residency increased 34 percent
from 2002 to 2005, despite decreasing applications to other surgical subspecialties. During this period, medical education, reimbursement, work hours, and media coverage have changed.

Methods: To determine factors responsible for rising applications to plastic
surgery residencies, medical student applicants to plastic surgery residencies for 2005 were surveyed. Applicants recorded exposure to plastic surgery during medical school and graded the influence of personality, lifestyle, income potential, and media coverage on their decision to choose plastic surgery training. To further study the effects of plastic surgery exposure on career choice, the percentage of graduating students applying to plastic surgery residency was compared between medical schools with and without plastic surgery training programs.

Results: Medical schools that provided greater exposure to plastic surgery and schools with plastic surgery training programs had a higher percentage of graduates applying to plastic surgery residency (p 0.001). Applicants rated compatibility with the personality of plastic surgeons as a significant factor in their career choice. Lifestyle and income potential were moderately important, whereas media coverage minimally affected career decision. Applicants typically decided on a plastic surgical career during the third year of medical school.

Conclusions: Medical student exposure to plastic surgery is the most influential factor in a student’s decision to pursue a career in plastic surgery. To continue the increasing applicant trend toward plastic surgery, plastic surgeon engagement of medical students should be emphasized, ideally before the third year of medical school. (Plast. Reconstr. Surg. 121: 1049, 2008.)


DISCUSSION

Applying to Plastic Surgery Residency: Factors Associated
with Medical Student Career Choice
Thomas Ray Stevenson, M.D.
Sacramento, Calif.

Arin Greene and James May looked at factors affecting medical students’ choice of plastic surgery as a career and confirmed a common belief—early personal contact with satisfied practitioners of a specialty positively influences perception of that specialty. This observation is no surprise, although it is reassuring to have it confirmed with reliable data. In addition to reinforcing a premise previously assumed to be true, Drs. Green and May proceed to demonstrate that factors of future lifestyle and potential income are less compelling for career selection than the personalities of practicing plastic surgeons. Equally interesting, recent media exposure of plastic surgery holds little sway in medical student selection of our specialty.

When considering the larger cohort of all applicants to plastic surgery residencies, this publication does exhibit a selection bias. Medical students contacted were ones who applied through the Electronic Residency Application Service to either an integrated or coordinated plastic surgery residency. Other residents who applied to plastic surgery programs with an independent format were not queried. We cannot tell what factors account for the selection of plastic surgery as a career among the entire population of applicants. My suspicion is that there would be no difference, but such remains to be proven. I assume that the majority of students who were influenced by a plastic surgeon met that surgeon while in medical school. This suggests that the plastic surgeon was most likely an academician. If so, how would the influence been felt if the plastic surgeon had been a private practitioner? Would lifestyle and financial issues been more or less important? Possibly, the outcome would have been identical.

There are steps plastic surgery as a whole should consider in response to this publication.
We should encourage academic plastic surgeons to contact medical students in their more formative years (i.e., during years 1 through 3). Teach these young students about plastic surgery’s scope. Let them see what we do that is separate from the public’s perception. We should encourage every medical school to have a plastic surgeon on staff who can serve as a mentor. Medical schools without a plastic surgery division or department deprive their students of an important facet of medical education. Finally, for those students who do not come into contact with a plastic surgeon, our major societies should open an outreach to inform
them about our specialty.

 

[GSresident]

One other thing. When I was in medical school we started a surgical interest group. We got speakers from each specialty to come in and talk about the field and the path to get a spot. When the plastics guy came he said:

"Plastic surgery is very competitive. In fact it is the most competitive field and its only going to get more so as reimbursements fall for other fields. Plastic surgeons have cash paying patients. None of you will ever become plastic surgeons."

Then he walked out the door. Classic, truly classic.

Greetings all,

There were a couple of articles I thought might be of interest that were published in the current “Journal of Plastic and Reconstructive Surgery.”

--Moravian


Selection Criteria for the Integrated Model of
Plastic Surgery Residency

Background: The purpose of this study was to identify those qualities and
characteristics of fourth-year medical students applying for the Integrated
Model of Plastic Surgery residency training that will make a successful plastic surgery resident.

Methods: A three-part questionnaire was distributed to the training program
directors of the 20 Integrated Model of Plastic Surgery programs accredited by the Residency Review Committee for Plastic Surgery by the Accreditation Council on Graduate Medical Education. The first section focused on 19 objective characteristics that directors use to evaluate applicants (e.g., Alpha Omega Alpha Honor Society membership, United States Medical Licensing Examination scores). The second section consisted of 20 subjective characteristics commonly used to evaluate applicants during the interview process. The third section consisted of reasons why, if any, residents failed to successfully complete the training program.

Results: Fifteen of the 20 program directors responded to the questionnaire. The results showed that they considered membership in the Alpha Omega Alpha Honor Society to be the most important objective criterion, followed by publications in peer-reviewed journals and letters of recommendation from plastic surgeons known to the director. Leadership capabilities were considered the most important subjective criterion, followed by maturity and interest in academics. Reasons residents failed to complete the training program included illness or death, academic inadequacies, and family demands.

Conclusions: The authors conclude that applicants who have achieved high academic honors and demonstrate leadership ability with interest in academics were viewed most likely to succeed as plastic surgery residents by program directors of Integrated Model of Plastic Surgery residencies. (Plast. Reconstr. Surg. 121: 121e,
2008.)


Applying to Plastic Surgery Residency:
Factors Associated with Medical Student
Career Choice

Background: Applications to plastic surgery residency increased 34 percent
from 2002 to 2005, despite decreasing applications to other surgical subspecialties. During this period, medical education, reimbursement, work hours, and media coverage have changed.

Methods: To determine factors responsible for rising applications to plastic
surgery residencies, medical student applicants to plastic surgery residencies for 2005 were surveyed. Applicants recorded exposure to plastic surgery during medical school and graded the influence of personality, lifestyle, income potential, and media coverage on their decision to choose plastic surgery training. To further study the effects of plastic surgery exposure on career choice, the percentage of graduating students applying to plastic surgery residency was compared between medical schools with and without plastic surgery training programs.

Results: Medical schools that provided greater exposure to plastic surgery and schools with plastic surgery training programs had a higher percentage of graduates applying to plastic surgery residency (p 0.001). Applicants rated compatibility with the personality of plastic surgeons as a significant factor in their career choice. Lifestyle and income potential were moderately important, whereas media coverage minimally affected career decision. Applicants typically decided on a plastic surgical career during the third year of medical school.

Conclusions: Medical student exposure to plastic surgery is the most influential factor in a student’s decision to pursue a career in plastic surgery. To continue the increasing applicant trend toward plastic surgery, plastic surgeon engagement of medical students should be emphasized, ideally before the third year of medical school. (Plast. Reconstr. Surg. 121: 1049, 2008.)


DISCUSSION

Applying to Plastic Surgery Residency: Factors Associated
with Medical Student Career Choice
Thomas Ray Stevenson, M.D.
Sacramento, Calif.

Arin Greene and James May looked at factors affecting medical students’ choice of plastic surgery as a career and confirmed a common belief—early personal contact with satisfied practitioners of a specialty positively influences perception of that specialty. This observation is no surprise, although it is reassuring to have it confirmed with reliable data. In addition to reinforcing a premise previously assumed to be true, Drs. Green and May proceed to demonstrate that factors of future lifestyle and potential income are less compelling for career selection than the personalities of practicing plastic surgeons. Equally interesting, recent media exposure of plastic surgery holds little sway in medical student selection of our specialty.

When considering the larger cohort of all applicants to plastic surgery residencies, this publication does exhibit a selection bias. Medical students contacted were ones who applied through the Electronic Residency Application Service to either an integrated or coordinated plastic surgery residency. Other residents who applied to plastic surgery programs with an independent format were not queried. We cannot tell what factors account for the selection of plastic surgery as a career among the entire population of applicants. My suspicion is that there would be no difference, but such remains to be proven. I assume that the majority of students who were influenced by a plastic surgeon met that surgeon while in medical school. This suggests that the plastic surgeon was most likely an academician. If so, how would the influence been felt if the plastic surgeon had been a private practitioner? Would lifestyle and financial issues been more or less important? Possibly, the outcome would have been identical.

There are steps plastic surgery as a whole should consider in response to this publication.
We should encourage academic plastic surgeons to contact medical students in their more formative years (i.e., during years 1 through 3). Teach these young students about plastic surgery’s scope. Let them see what we do that is separate from the public’s perception. We should encourage every medical school to have a plastic surgeon on staff who can serve as a mentor. Medical schools without a plastic surgery division or department deprive their students of an important facet of medical education. Finally, for those students who do not come into contact with a plastic surgeon, our major societies should open an outreach to inform
them about our specialty.

 

[droliver]

The funny thing is that the applicants said that money and lifestyle weren't as important as the 'personality' of plastic surgeons. I've met some real bozos but buy and large I feel like I am amongst my own when I am with other plastic surgeons.

....I suspect that shows like Dr. 90210 and The Swan etc have had drastic effects on the young skulls full of mush in medical school. Back when I was in medical school the show ER was #1 and all the little kiddies gunned for ER spots.

....Finally I would argue that the best thing would be for the number of plastics spots offered in the US to either go down or stay the same. Hopefully as more and more applicants gun for the same number of spots the cream will rise to the top and we'll produce better plastic surgeons.

1. In contrast, I'd say that Plastic Surgeons are much more idiosyncratic from their colleagues then most other surgical specialties are from their peers. There are some real strange birds out there in our field!

2. I'd agree. I read those studies yesterday and came away thinking the author's were either ignorant or intellectually dishonest on what's driven the surge in plastic surgery applications. Student's interests (and later Doctor's practices) correspond to market forces above most other considerations. The discussions in those articles was painfully contrived to avoid a more truthful picture.

3. Restricting output of trained plastic surgeons is counter-productive. What you accomplish by that is marginalization of the specialty and less of a voice in medical politics. It's pretty clear that there's actually access problems for reconstructive plastic surgery services in large areas of the country.

 

[GSresident]

3. Restricting output of trained plastic surgeons is counter-productive. What you accomplish by that is marginalization of the specialty and less of a voice in medical politics. It's pretty clear that there's actually access problems for reconstructive plastic surgery services in large areas of the country.

I guess I never thought of the medical politics angle to producing more plastics surgeons. I'm not sure we could produce enough plastics surgeons to make any difference though.

I would argue that the reason there is an access problem in large areas of the country is because there is a reimbursement problem. Adding more plastics surgeons (increasing supply) would only make the root cause of the problem worse. The other part of the problem is that plastic surgeons don't want to move to the middle of nowhere.

I have the choice right now to move to a small town that is an hour and a half away from a small city. The nearest large city is 7 hours away. The small town is my hometown so I would love to move back there. The problem is that I would not be able to build a practice with a balance between reconstruction and cosmetics there. It would be %100 reconstructive with about 75% of that being no pay.

Add to that the fact that the hospital is incredibly aggressive with the physicians already living there because there are no other hospitals of any size in the area. Likely I would get drafted with the threat of losing privileges into at least Q2 plastics/face/hand call (uncompensated with a poor payer mix). I would probably also get drafted into the general surgery trauma call rotation at least Q4, also uncompensated with a poor payer mix.

I am going to predict the future for you right here. 10 years from now look back at this post and see if I'm right. Healthcare will either be nationalized or reimbursements for things that people need will be at a fraction of what they are today. The only thing in medicine that might be safe from that is cosmetic surgery. I say might because medical licenses will likely be tied to things like taking uncompensated call and participation in the socialized medical system. Even if they don't nationalize it, reconstructive is going to continue to pay less and less.

I have a real problem. I have outrageous debt from college and medical school. Tuition for medical school was 40K a year, plus it was in a major city with major city living expenses. Because uncle Sam thought it wise to do away with residency deferments, all of that debt has been accumulating interest except for the couple years where I could afford to pay the $800 monthly payments. We lived on bread and water those 2 years.

I will also incur some debt by starting my own practice. I suppose by the time I am done with everything there will be half a million dollars to pay back. My productive lifetime has already been shortened by 11 years (med school + GS residency + PS residency). How the hell am I supposed to pay off my own debt, pay for my kids' educations, buy a middle class house and save for retirement unless I can earn?

I am still going to serve my hometown by opening a satellite clinic there. I am also going to participate in their wound clinic. But the majority of my practice is going to be in a small city 1 1/2 hours away, where I at least have a chance of building a cosmetic practice. If the small town hospital jerks me around even one time I am dropping it. If the reimbursements do not pay enough for me to drive up there a couple times a month I'm dropping it.

People think I am crazy for moving to a small city in a rural state. They think I've gone batty when I tell them I want to do some reconstructive in my home town. I'm going to try but the hospital and the insurance companies/Uncle Sam are going to have to meet me half way if I am going to continue doing it.

 

[giules]

Hi all, I have just had the most awesome time rotating with some craniofacial pediatric plastics docs and have been absolutely blown away. This is the coolest thing in medicine I have seen thus far (altho I haven't seen much being an MS 3!...) And working with kids is perfect. However I am a little hesitant in pursuing this dream of mine in that I am a rather average student. Anatomy was my best and favorite subject, and I have been told I have very good "skills" when it comes to operations, but I doubt that's enough. I know that matching in gen surg is not as difficult as matching in plastics, so that may just be what I'll have to do. But my question is this: does anyone know how competitive a fellowship in craniofacial pediatric plastics is? Because if then I get stuck in gen surg, not to mention working on adults, I think I'll be quite unhappy...
The other thing is that it seems there are multiple ways to get to this end result. Can someone please elaborate on these possibilities, with how much time they take? (ie. gen surg residency- 5yrs, then plastics fellowship- x yrs, etc.)
Thanks!

 

[pagemmapants]

Integrated model: match straight after MS4 via the ERAS; 2-3 years of pre-plastics education (i.e. general surgery) then 2-3 years of dedicated plastic surgery. This is run completely by the plastic surgery department and you are a plastic surgery resident "from day one".

Combined model: match straight after MS4 via the ERAS; 3-4 years of general surgery during which you are considered a general surgery resident, then 2-3 years of dedicated plastic surgery training. Main difference between this and the above is that you might get little to no PRS training in your first few years as a "general" surgery resident; advantage (arguably) being that you get more general training than in the above-listed programs.

Independent model: In this one you match into something not-plastics-related (typically general surgery) and then apply to PRS residencies as a PGY4. This is probably the most common route, as the above-listed programs are *extremely* competitive. Most people match out of general surgery; rarely do some match into PRS as PGY4s in orthopedics or ENT.

Hope that helps, giules; also check this out: www.plasticseducation.com; more information about the match can be found in the link in the yellow box on the right that says "gilman's PRS guide".

 

[pagemmapants]

And a question for the others here that is somewhat on-topic.

These articles are trying to elucidate why medical students want to become plastic surgeons and apply to the direct PRS programs straight out, correct?

Well, my question to all of you residents and above is. . . why do you love it? I know why I think I might love it, but that's all conjecture at this point and I would really like to know what it is about the field that keeps you going to work every day. Variety? Ability to make a substantial change to someone's quality of life? You just really really really like suturing vessels with 8-0 prolene under a gigantic microscope?

 

[giules]

pagemmapants, are you then saying that i would actually have a shot if i matched to gen surg first, and then into plastics? and if i want to do pediatric craniofacial, after the plastics residency would i then do more years of fellowship? would this be in craniofacial plastics or in pediatric plastics, or are these really the same thing since most craniofacial plastics deals with cleft lip, cleft palate, congenital anomalies?? Thanks! Oh, and thanks for that website you offered, that was quite helpful and informative!

 

[Moravian]

Well, my question to all of you residents and above is. . . why do you love it? I know why I think I might love it, but that's all conjecture at this point and I would really like to know what it is about the field that keeps you going to work every day. Variety? Ability to make a substantial change to someone's quality of life? You just really really really like suturing vessels with 8-0 prolene under a gigantic microscope?

It doesn't matter why I love my job, it's why you love your job. I don't like the little blue sutures all that much, but I really like putting someone's face back together after big smash. And I love craniofacial work on the kids. It does involve the things you mention, and intangibles as well. You need to find your own way and decide what's going to make you get up and go to work every day.

--M

 

[Moravian]

if i want to do pediatric craniofacial, after the plastics residency would i then do more years of fellowship? would this be in craniofacial plastics or in pediatric plastics, or are these really the same thing since most craniofacial plastics deals with cleft lip, cleft palate, congenital anomalies??

Craniofacial fellowships are 1 year and come in a couple of different varieties. There are some that offer pediatric stuff (nevi, hand, trauma, tissue expanders, etc.) and some that are mostly, if not all, craniofacial. Then there are a couple of just pediatric plastic surgery fellowships (like at Northwestern and CHOP). These are one year as well.

The only downside to doing either of these fellowships is that the cleft lip and palates are resident cases. During plastics residency, you'll need to have certain numbers of cases of various types, and the lips/palates are among them. I get to do some when the residents aren't around, but not as many I would like. I do get the redo cases (palate fistulas, lip revisions and such) and I suppose it would also depend on the numbers. If you're at a huge center, you'll have more chances to steal some cases.