Plastic Surgery Residency Overview

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Plastic surgery, the branch of surgery dealing with the repair, reconstruction, and replacement of the body and its anatomic systems – including the trunk, extremities, craniofacial structure and more – tops the tables both in pay and in the difficulty of securing a place in its residency program. Perhaps this is largely due to the potential to focus on aesthetic procedures later in one’s career, with the high salaries that go with this decision. Median clinical salaries hover around the $425,000 mark.

Residency Core Requirements

The plastic surgery residency is long – 6 years in total. However, there are two paths through which one can complete this six year total; one can either choose an independent plastic surgery program (three years) or an integrated program (six years). Considering an integrated program first – here a resident enters the plastic surgery residency as a PGY1 but must therefore complete a range of prerequisites for general surgery, which will involve being rotated through a range of different services. This is therefore three years in general surgery, before moving into focusing on plastic surgery. On the other hand, an independent program will accept residents who have completed training in orthopaedics, general surgery, or even ENT or neurosurgery. These programs will also accept those who have completed three years of prerequisite general surgery if it was performed at the same program. Upon completion of residency, subspecialty training is available in craniofacial surgery and hand surgery.

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Application Statistics & Competition

Plastic surgery had 340 applicants for just 194 spots in the most recent available data, which equals 1.75 applicants to each position. Even for US MD seniors, this is a very, very competitive specialty. The mean USMLE Step 1 score for those who matched successfully was 251, and the mean Step 2 score was 257. A Step 1 score of 200 would result in a match probability of just 13%, whilst a step 1 score of 240 would still only mean a match probability of 57%.

Sample Interview questions

What is the typical length of time required to train in plastic surgery? What subspecialty are you interested in?

I expect to undertake a six year residency, potentially followed by a one year fellowship in craniofacial surgery. This is regarding an integrated program, which covers both prerequisite general surgery requirements and further plastic surgery training. Equally, one could take a general surgical residency of three years followed by further independent plastic surgery training for three years. In total, one can therefore spend between 6-7 years in training. I’m interested in craniofacial surgery, having undertaken research in the area and been fascinated by the degree of complexity; however I appreciate that my interests may change during the duration of the residency program.

Tell me about respiratory distress in a patient with burns.

Respiratory distress has three causes in a patient with burns. These are:
– an unyielding burn eschar (area of damaged tissue) covering the chest. Here, distress will be immediately obvious, and an escharotomy will be required.
– carbon monoxide poisoning. This may present immediately or at a later point, and is diagnosed by carboxyhemoglobin levels in ABG – initial treatment is with 100% oxygen.
– smoke inhalation causing pulmonary injury. This will have an insidious onset (18-36 hours) and is to the incomplete products of combustion, rather than heat. Chemical injury to the alveolar basement membrane and pulmonary oedema are both a result of these chemical factors. Treatment is with humidified oxygen, and intubation may be required.

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Important considerations

The two considerations here are the difficulty of matching, and the type of program that you’re interested in. Regarding the former – it would be ill-advised to apply if you are a DO applicant or an IMG. Even US MD applicants will find the process very difficult and run a significant risk of not matching. Meanwhile, you must give due thought to whether you’re more interested in an integrated program, or an independent program. For some, taking on initial residency in general surgery or orthopaedics, for example, might be a more sensible route than applying immediately to plastic surgery. With that residency complete, you can then undertake the three year independent residency program and – this would be advisable if your current scores won’t quite cut it for plastic surgery, but you are confident that hard work in your residency will increase your chance down the line.

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