Is money your motivation?

Lately, I have a number emails and questions regarding the salary or the earning potential of plastic surgeons.  Some have also explained to me that money is their key motivation to become a plastic surgeon.   Those of you considering a career in plastic surgery who are focused on money should look elsewhere for a profession.    I say this not because money cannot be made as a plastic surgeon, but because money should not be your motivator for anything, let alone for a long, arduous education and training program path as plastic and reconstructive surgery.   

If money is your object, there are many other ways to start earning money with much less education and training.  Four years of college, 4 years of medical school, 6-8 years of surgical residency training, possible fellowship training  = 14 - 17 + years before you start earning anything of substance.  This means that you are about 30-33 years old.  That's 10 years of serious earning potential gone down the drain.  During those 10 years as a resident, you will be earning barely enough to scrape by and likely will be accumulating more debt.   If money is your key motivator, you will be easily disillusioned.     

The difficult paths in life are filled with obstacles that make money the weakest motivator.   If you embark on a career in plastic and reconstructive surgery, you have to love what you do, have passion, and high ideals.   Money will come with hard work, creating quality, and improving people's lives.   These values will always be rewarded and people will seek your expertise for many years to come -- and that, is something that money cannot buy.

Plastic Surgery Training Programs

Plastic Surgery training has been rooted in the principles of general surgery training for many decades. The traditional path to become a plastic surgeon usually meant you completed 5-7 years of general surgery, and then completed another 2-3 years of "plastic and reconstructive surgery" fellowship. That's almost 10 years of training after your 8 years of undergrad/med school.

Most specialties, such as orthopedic, neurosurgery, etc, have moved beyond so many years of general surgery, and have abbreviated time (1 year), and the rest of the their training is in their specific field. Plastic Surgery has also moved toward this route with "Integrated" programs. These programs have typically 3 years of general surgery, and 3 years of plastic surgery, hence the term "3 and 3 program." The vast majority of the top plastic surgery institutions at major academic centers have moved toward this model.

The advantage of these programs is that you have an earlier start and focus to plastic surgery training. In your junior years, you will also have exposure to other specialties such as ENT, Dermatology, Orthopedic, etc, making your background that much more focused and relevant. You will be in "plastic surgery" much sooner than the usual 5 years and will finish sooner. It is the future of training and the way most programs have moved toward. It is the way I trained at the University of Chicago, and I am most grateful for my program's opportunities and forward thinking.

The disadvantage is that these programs are highly competitive. Usually there are 2 spots per medical center, and there are probably 50 programs at this time. The other disadvantage that most people don't realize is that you have made the "early decision" to go into plastic surgery. This is often times a premature decision when you see the number of people who drop out of the programs. You might think that no one would do this, but it happens more often than you think. The reasons are many: burnout, change of heart to different specialty, dislike for general surgery, etc.

There are many changes going in plastic surgery education. The breadth of plastic surgery is great, and our time in training is limited. To gain depth in the specialty requires one to start training earlier in the field. This is the way all surgical specialties are headed.

What is the difference between a Plastic Surgeon and a Cosmetic Surgeon?

The difference is everything, the difference is nothing.

It depends on whose perspective it's coming from. By definition, all plastic surgeons are trained and capable of performing "cosmetic surgery," but not all Cosmetic Surgeons are Plastic Surgeons. What does this mean? It means that the true education, training, and ability of a Plastic Surgeon encompasses ALL that is cosmetic surgery, but those who call themsevles "cosmetic surgeons or cosmetic doctors" are not all Plastic Surgeons. The reason is that there are many different groups of doctors and even nondoctors, who would like to have the mystique and therefore the "confusion" of cosmetic surgery or plastic surgery next to their names without the true training of a plastic surgeon. In other words, there is the "real deal" and then the "wannabes."

This distinction is extremely important if you consider the importance of education, training, and ability of the person who will be making permanent changes to your face, hands, breast, body, etc with such instruments as a scalpel, electrocautery, or a suction cannula. Much of what is done in surgery is irreversible and the best chance for success is always the first chance. Why would you risk your face to someone who might have taken a weekend course to call themsevles a "cosmetic doctor"?

You might ask, "So what is the big deal? So what if a family practice doctor or a chiropractor says s/he is a 'cosmetic doctor/surgeon'?" The problem is that those who don't know the difference will likely think that this "cosmetic doctor" is a plastic surgeon. Next thing you know, you've just had your face or body irreversibly botched up by this person. It's about safety and real credentials. If you had trained to be an elite in the special forces of the military, a Navy SEAL or an Army Green Beret, you would not take kindly to someone military or nonmilitary stating they were something "like a SEAL or Green Beret." You either are the real thing, or are not. You either took the difficult, real path to the destination, or you did not.

There is only one plastic surgery board that is sanctioned by the American Board of Medical Specialities (AMBS), the gold standard of medical specialties, and it the American Board of Plastic Surgery (ABPS). For those of you who are embarking on the path to become a plastic surgeon, you need to know this difference and understand what it takes to become a part of an elite specialty where only 200 true plastic surgeons are produced per year at major academic medical centers. You can choose to join other boards with "plastic or cosmetic" in their names, but they are not true speciality boards. Some of these boards do carry some weight, but there is still only one that is part of the ABMS.

So back to the question. It depends on who you are. If you are a real plastic surgeon, the difference is everything; if you are not, you'd like to say the difference is nothing.

Healthcare reform and its meaning to plastic surgeons.

Health-care reform is essential to the well-being of this country and to the well-being of medicine as a profession. The government has taken on a very complicated problem that seems to have very few good solutions. I do believe that the United States, as the most advanced and industrialized nation in the world, should have health care for every citizen. This must be balanced with continued research and advancement, and the least amount of government intervention in the doctor-patient relationship. For the medical profession, this means that we must continue our autonomy to advance the science and the art of medicine and surgery.

Some of you may be embarking on a career in plastic surgery, thinking that health-care reform and health care issues are not that relevant to a cosmetic surgery practice. This could not be further from the truth. Plastic surgery is rooted in the basic principles of wound healing, improving lives, and restoring lost form and function. Health care reform is more relevant to our profession today as the services we provide as plastic surgeons are being constantly monitored and valued by outside organizations that know little about what we do. Because the media have stereotyped plastic surgeons as being only about "nip and tuck," people forget about the major reconstructive surgical procedures that we perform on a daily basis. My practice is somewhat unique in that it is balanced with both cosmetic surgery and reconstructive surgery. I enjoy this balance, and I am passionate about my work.

Becoming a plastic surgeon is about helping your fellow man or woman. Healthcare reform in its principles is about this very same issue. We need to balance this goal with the conflicting political forces that seem to make this goal much more difficult than it has to be.

Science major or humanities major?

I have been asked this question by many high school and college students. My reply has always been to follow your true interests and thirst for knowledge. I do not believe that you should cut your education short during college just to play it safe to get into medical school. In other words, there are many students who would much rather study English literature or a Romance language than to be a biochemistry major. On the other hand, there are many students who truly enjoy biochemistry, and therefore should follow their hearts. So the direct answer to this question is “either or both.”

Acceptance into medical school is not an easy process. There are multiple parameters that are measured during the application process. The GPA and standardized exam scores, such as the MCAT, are a given into what category of school will view your application. Basic, prerequisite requirements need to be completed--such as biology, biochemistry, physics, etc. These prequisite requirements are usually enough to obtain a biology minor. My advice is to study subjects you will unlikely have another chance to study again in a college setting.

I studied philosophy as my major to answer the age old question of “what is the meaning of life?” I can't say that I found the answer, but the process and the opportunity to do so has served me well. To this day, I look back upon the outstanding professors, books, and ideas that challenged me to think about the world in a different light. This is in contrast to the many basic science courses that I took that are mainly irrelevant to me now. Four years of college go by very quickly…. There are many subjects from college which will be repeated in the first year of medical school. The second-year will be quite new, learning pathophysiology-- everything that can go wrong in the human body. Needless to say, the first year of medical school can be quite easy for some and more difficult for others. A big advantage of being a science major during college is a much easier first year of medical school. But this is not the main reason to do so, because by the second and third year, things will have equalized.

Being unique sets you apart from the crowd. You should strive not only for excellence, but also to be different. Plastic surgery is a unique specialty in that there is no single way to accomplish a task. It is a specialty that allows you to have your own signature, creativity, and inspiration. I encourage you to study life with passion and it will serve you well in your career toward plastic surgery.

Find a Mentor and Role Model

Throughout your professional career, a mentor or role model is critical in guiding your path.

In high school, it is helpful to become involved in the medical community by volunteering at the local hospital. By spending time at the hospital, one can find out if the hospital environment is the right place for you. Being around patients who are in need of medical services will either detract you or inspire you. The desire to help and heal people is at the heart of medicine and surgery.

In college, you will be studying extremely hard through all the basic sciences and premedical courses. It is important at this time to identify professors in areas of your interest who will help shape your professional and scientific interests. These individuals can be at your undergraduate university or at your University associated Medical School. It is at this time that you may be able to identify a plastic surgeon in the academic community with whom you can begin to understand this exciting field.

In medical school, you will be studying twice as hard, but should still find the time to identify a mentor, preferably at this time a plastic surgeon, with whom you can identify and begin some research projects. This will prepare you in multiple ways. It will allow you to see the process of residency training in plastic surgery, spend time with your role model to see what their professional career is like, and begin delving deeper into the science of plastic surgery. The mentor in this position will be critical in helping you obtain a spot in the most competitive residency in medicine.

I have been fortunate in having outstanding mentors and role models in my professional career. In high school, I had teachers in English and History who challenged us to think and write outside our boundaries. In medical school and surgical residency, my mentors and role models were Drs. Susan Mackinnon, Robert L. Walton, Lawrence Gottlieb, and Harry Buncke. Each are considered giants in their field and each shaped and molded my career path in their unique way. Most importantly, my father, a retired MD obstetrician, served as a constant role model with his hard work and dedication to his patients.

I am indebted and grateful for my mentors' leadership and guidance. You will also be lucky to find such outstanding individuals who will help guide your path.

Know your personality when choosing a career in surgery

I knew the moment that I wanted to become a doctor, I also wanted to be a surgeon. This was not because I thought it was "cool or fun," or that I like played the game "operation" when I was a kid, but because I knew that my personality and values matched this profession: I liked working with my hands, the idea of "healing patients with my hands," and requiring technical precision to produce results. I was impatient, and wanted to see the results of my work immediately, not months or years later. I knew the moment that I tied my first knot around a blood vessel, cut out a cancer on the body, and fixed a broken bone, that this was the greatest profession in the world. Every time I stepped foot in the operating room, there was a reaffirming moment or experience that made me certain that surgery was the right field for me.

Understanding your own personality and values will go a long way in determining your fit and longevity in plastic surgery. Surgical training is long and gruelling (between 6-10 years), and plastic surgery training is not a "walk in the park." If you think that the years of training in plastic surgery will be centered around "boob jobs and liposuction," you will be sorely disappointed. Try thinking of days in the burn intensive care unit managing the sickest of patients, 100 degree operating rooms reconstructing a burned child, 10 hour operations reconstructing a mangled face or limb, being wallowed up by the odor of a necrotizing infection, then going home to prepare a power point lecture on a topic you know little about, and giving that lecture to your peers and attendings who will criticize your work--then getting up at 5am to round on your patients to start the cycle all over.

I have seen many in surgery who quit in the middle of training because the surgical lifestyle does not fit their life. When you choose the road to become a surgeon, you need to know your personality, values, and motivators. If you cannot love the operating room like you love your own home, then you need to think twice about embarking on this journey. For those who can, there is an infinitely bright future in this field for you.