lifestyle of plastic surgery

[MarsRover]

I was just curious if anyone could talk about the lifestyle of a plastic surgeon. I know that likely varies between community and academic hospitals. But just say for community hospitals. There is a lot of talk about surgeons working long hours and little vacation time, but can plastics get around this where they tend to be more private practice than some other surgical specialties? 

[ZBL]

Here’s what my discussions and experience with plastic surgeons has turned up:

 

Academic plastics is extremely busy. Usually there are tons of plastics inpatients at a big academic hospitals - the bulk of procedures seems to relate to burns, hands, cancer reconstruction (esp head/neck and breast), trauma, and a bit of primary skin cancer treatment. They will also essentially be the hospital wound service. The days are long, the call is frequent, and the pay is maybe not as high as it should - those 12 hour flaps are not huge money making surgeries. Often, these folk don’t have much if any private practice. Actual call schedule is centre dependent, but probably 5-6 days on call per month including every 3rd ish weekend. 

 

In the community it is a is a bit better. They are still covering hand, trauma, nec fasc, and any on call recon work and ward consults so can still be busy but usually the call schedule is a bit better. At a mid sized community hospital, there are probably ~3-4 plastic surgeons that share call, and it’s probably not as heavy as the main academic centre. The day for elective cases will usually comprise a slate of some hand, breast recon, and maybe some facial stuff depending on how things are shared with ENT at that centre. Typical elective OR day probably 7am to 4pm. On call days can go much longer, but usually not too much to do emergently past 10pm. On call schedule is variable - can be 1 in 4, but as mentioned, it’s lighter than academia so sometimes you may not get called at all.

 

working in private practice is apparently increasingly difficult in plastics. Many major cities are saturated and the costs of starting your own surgical facility is not affordable as a new grad. So most will join some sort of partnership with existing surgeons. Overhead is extremely high - like massive. Massive to the point that for many new grads it doesn’t make sense to do private work initially as they don’t have the clientele or financial resources to sustain it at first. I assume once those shops are up and running, they are very busy - probably clinic until 6 or so to get clients into the OR, and OR days probably until late as well to maximize your private days. All those patients are also your sole responsibility so you can get called in the middle of the night for post op issues. So all that to say, to mix private and community practice as a plastic surgeon it can be extremely busy. They can obviously make a lot of money, but it’s not lifestyle in the way psych, derm or PMR is - it’s lifestyle because they work for themselves, but as a consequence work their butt off to keep things afloat. 

 

In terms of jobs, I’m told it’s much better than ortho, not as good as ophtho if that means anything. The going rate is at least one fellowship, usually two. 

 

 

[DermJuly2018PGY1]

sounds like shit - FM is the way to go

[Edict]

If you enjoy it, nothing "sounds like shit". As long as you are aware of the lifestyle going in and are accepting of that, then you are set. Most people value lifestyle, for good reason, and you will get a lot of advice to that end during medical school. However, remember, there are people who become surgeons and many actually do enjoy it. You aren't going to hear these people because they are happily enjoying their jobs. If you find yourself accepting the lifestyle and you find yourself really passionate about a surgical specialty, don't listen to the naysayers.  

 

[MarsRover]

Yes, I definitely agree with that. It is unfortunate, that I am definitely accepting of long hours during the weeks, and even being on-call/working weekends. But I would like 6-8 weeks off a year with blocks of 2-3 to then travel to see family that lives further away and such. Not really possible in surgery it seems.. 

[ZBL]

1 hour ago, MarsRover said:

Yes, I definitely agree with that. It is unfortunate, that I am definitely accepting of long hours during the weeks, and even being on-call/working weekends. But I would like 6-8 weeks off a year with blocks of 2-3 to then travel to see family that lives further away and such. Not really possible in surgery it seems.. 

I think it becomes less feasible for specialties where there is a defined call arrangement with colleagues, and where your private practice NEEDS to continue in order to maintain yourself financially. So taking that much time off in plastics (when you also run your own shop) is probably not easy for most surgeons. Even if you look at the fancy cosmetic plastics  guys in California, they work like slaves but do drive back and forth to work in a Ferrari. 

 

That said, consider ophtho. I think that will give you what you seek, or at least as much as possible in surgery. 

[NeuroD]

15 hours ago, ZBL said:

In terms of jobs, I’m told it’s much better than ortho, not as good as ophtho if that means anything. The going rate is at least one fellowship, usually two. 

I thought ophtho was pretty bad with existing groups crowding new grads out so as not to lose the little OHIP covered OR time they get.

[ZBL]

6 minutes ago, PhD2MD said:

I thought ophtho was pretty bad with existing groups crowding new grads out so as not to lose the little OHIP covered OR time they get.

And that puts plastics in perspective. No surgical specialty has tons of jobs. 

[MarsRover]

20 hours ago, ZBL said:

I think it becomes less feasible for specialties where there is a defined call arrangement with colleagues, and where your private practice NEEDS to continue in order to maintain yourself financially. So taking that much time off in plastics (when you also run your own shop) is probably not easy for most surgeons. Even if you look at the fancy cosmetic plastics  guys in California, they work like slaves but do drive back and forth to work in a Ferrari. 

 

That said, consider ophtho. I think that will give you what you seek, or at least as much as possible in surgery. 

Do you mean in terms of ophtho tends to have less hours per day, or that they can take a few 2 week vacations if they want? I know people have mentioned income as a reason that isn't possible, but if taking 8 weeks of 52 off means a 15-20% pay cut I don't terribly care. 200k vs 160k after over head doesn't really matter to me if it means more time to go do the other things i like. Mind you when i am not on vacation I have no problem with 60+ hour weeks. 

[goleafsgochris]

It sort of depends on the group and how you approach it.  They will very likely expect you to make up for "missed" call.  It may help to be flexible/take some additional call shifts to compensate for taking time off that increases the frequency of everyone else's call during the time.  You also need to get someone to cover your inpatients during that time, so again, you need to have a good relationship with your colleagues.  4x2 weeks a year isn't crazy but it is certainly more than average.  It can be done it just takes some effort--and its certainly not as easy as if you were doing outpatient work

[MarsRover]

4 hours ago, goleafsgochris said:

It sort of depends on the group and how you approach it.  They will very likely expect you to make up for "missed" call.  It may help to be flexible/take some additional call shifts to compensate for taking time off that increases the frequency of everyone else's call during the time.  You also need to get someone to cover your inpatients during that time, so again, you need to have a good relationship with your colleagues.  4x2 weeks a year isn't crazy but it is certainly more than average.  It can be done it just takes some effort--and its certainly not as easy as if you were doing outpatient work

It doesn't seem to be any specialty is able to do it easily minus ER and RADs really. peds seems to be a lot of salaried positions so just 4 weeks vacation, surgery call and practice requirements seem to push it out, internal/neurology the call schedules seem to prevent taking 2 week vacations 3 times a year too (at least specialties i have been interested in), family is possible but maybe less from a financial standpoint i seem to hear. Derm potentially, but i haven't ever been interested in it on a personal level enough enough to investigate. 

[quickdraw_mcgraw]

If you get a needle stick and test positive for HIV or Hep C the following July in Ontario, you will have to stop practive.  The CPSO requires you have clean blood every year to practice.

Dr. McGraw

[rmorelan]

On 3/25/2018 at 3:41 PM, MarsRover said:

It doesn't seem to be any specialty is able to do it easily minus ER and RADs really. peds seems to be a lot of salaried positions so just 4 weeks vacation, surgery call and practice requirements seem to push it out, internal/neurology the call schedules seem to prevent taking 2 week vacations 3 times a year too (at least specialties i have been interested in), family is possible but maybe less from a financial standpoint i seem to hear. Derm potentially, but i haven't ever been interested in it on a personal level enough enough to investigate. 

Depends on where you are for Rads as well - I mean there is a lot of call there too in smaller groups there can be issues etc. There is flexibility in the right position if you can get it