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Business-oriented person - "tough" specialties still an option?


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3 hours ago, zoxy said:

I was under the impression that most closures are done by Plastic Surgeons. This is particularity true if it's a complicated closure. I'm neither a dermatologist nor a plastics surgeon so I could be wrong.

3 hours ago, Aetherus said:

That is partially correct. Most closures are simple and closed by the MOHS surgeon. Some closures are complicated (around the eye) and are closed by Oculoplastics. I’m sure some are also closed by plastics as well. I think it depends on the mohs surgeon’s comfort, but they can do some pretty complex closures if they are comfortable with it.

When I encountered plastcs & Mohs working together, it was exactly for what was mentioned - complex closures.  The Mohs surgeons even assisted plastics directly with one closure that I recall.  

Plastics would handle many of the cases that could also be done my Mohs - much shorter wait-list and operation time at the centre that I was in.  

 

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1 hour ago, indefatigable said:

When I encountered plastcs & Mohs working together, it was exactly for what was mentioned - complex closures.  The Mohs surgeons even assisted plastics directly with one closure that I recall.  

Plastics would handle many of the cases that could also be done my Mohs - much shorter wait-list and operation time at the centre that I was in.  

 

Not sure what center you are referring to but MOHS surgery is not equivalent to an excisional biopsy. You can do frozen sections to pseudoreplicate MOHS. Otherwise, MOHS is far superior.

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3 hours ago, Aetherus said:

Not sure what center you are referring to but MOHS surgery is not equivalent to an excisional biopsy. You can do frozen sections to pseudoreplicate MOHS. Otherwise, MOHS is far superior.

I've seen both - frozen sections and straight excision for facial BCCs done by plastics rather than MMS.  The difference in cure rate is about 95% vs 99% for excision vs MOHS - very comparable.

When both were available, sometimes MMS was the clear choice if the location would be difficult for a standard excision (i.e. not a lot of tissue).

I agree that the cosmetics could be better with MOHS, but it's not available everywhere or can have a long wait list.  Plus patients also seemed to prefer shorter procedures.  An excision that could be done in a few minutes vs much longer with MMS - going down south for a longer winter vacation was a higher priority with one memorable patient.

Same logic applies for blephoroplasties which can be done by oculoplastics, but are often done by plastics when there is no service available.  

Outside of very major urban centers, the division of labour is different.    

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I would argue that business oriented people should do family medicine, lots of flexibility to shape your practice and to innovate/feel fulfilled in the "business" aspects of running a clinic.

As someone who is business oriented, I find working in a hospital sucks the soul out of my body because there are too many factors outside of my control that could so easily be optimized. And most specialists end up working in a hospital.

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