Careers in plastic surgery
7th February 2013
Plastic surgery is a varied and rewarding technique-based speciality making a tangible and visible difference to the lives of many children and adults. The work varies from treating burns and breast reconstruction after cancer to carrying out a rhinoplasty, operating on skin cancer or repairing a cleft lip and palate.
Plastic surgeons will operate on all parts of the body, from head to toe. Because of this they collaborate with many other specialties including ENT, orthopaedic, neurosurgical, dermatology, gynaecology, maxillofacial and breast surgery, as well as other health professionals.
Plastic surgery procedures
When qualified, the majority of plastic surgeons will work across both an NHS and private practice. Estimates show that around 80% of the workload is reconstructive, although misconceptions remain that plastic surgery is predominantly cosmetic. Many plastic surgeons work across the specialty but due to a high number of sub-specialties are likely to discover at least one area where they can develop a particular interest.
Plastic surgery procedures include:
• Breast surgery (Reconstruction following cancer, congenital anomalies, cosmetic breast surgery)
• Burns
• Skin Cancer (excision and reconstruction; management of metastases)
• Head and Neck Surgery (mainly oral and aero-digestive tract cancer reconstruction, facial reanimation, craniofacial surgery)
• Children (cleft lip and palate, hypospadias, ear anomalies, skin conditions, rare conditions)
• Hand and upper limb surgery (congenital anomalies, hand trauma, degenerative conditions such as arthritis)
• Lower limb trauma reconstruction
• Microsurgery for bone and soft-tissue reconstruction
• Cutaneous laser surgery
• Pelvic oncology reconstruction
• Soft tissue sarcoma
• Aesthetic (cosmetic) surgery
The training pathway
Surgery is an extremely popular career choice for medical students and entry to each surgical training stage is via a competitive selection process.
After finishing medical school, trainees will spend two years in a foundation programme to gain experience in a variety of specialties and healthcare settings. By the time this is completed, trainees will have acquired full registration with the General Medical Council (GMC) and can then apply for two years of core surgical training. This involves sub-specialty placements in different surgical specialities each lasting from four to six months.
The trainee will then apply for their chosen sub-specialty training, involving a highly competitive national selection process. The selection process for plastic surgery is held twice a year and is often oversubscribed - during March 2009, 145 applications were submitted for the nine training places available. Successful applicants will have obtained the MRCS and spent a minimum of six months in plastic surgery posts.
Trainees will go on to undertake six years of plastic surgery training. To gain their Certificate of Completion of Training (CCT), they are required to pass the Intercollegiate Specialty Examination (FRCS Plast). Upon gaining the CCT, doctors are then eligible to be placed on the GMC specialist register and are able to apply for consultant posts. Many plastic surgery trainees also complete a cosmetic fellowship following their CCT to enable them to perform aesthetic surgery.
Depending on their training pathway, a plastic surgeon can expect to qualify in their early to mid thirties.
Desirable qualities
• A good eye for aesthetics and attention to detail
• Meticulous technique
• Good time management and organisational skills
• Ability to handle stressful situations and remain calm under pressure
• Hard working and ability to balance an extremely varied workload
• Achievements and accolades in relevant academic research
• Able to foster good working relationships as part of a multi-disciplinary team
The life of a trainee
The life of a trainee plastic surgeon is extremely varied. Generally, they will be involved in four to five operating session per week, in addition to one or two outpatient clinics. They will also complete ward visits to monitor the progress of patients. As they develop, their daily role will also involve increasing amounts of administration, management and teaching.
The most common procedures that trainees will be involved in are hand operations, skin cancer procedures, breast reconstruction, head and neck reconstruction, treatment for cleft lip and palate, and burns surgery. Due to the varying nature of these operations, trainees will be expected to work effectively with other surgeons and healthcare professionals within the hospital.
Emergency work is another core part of daily life and much of a trainee’s workload will involve dealing with urgent cases. They will take part in an on call rota and could be called upon to work on patients with burns or severe hand, facial and lower limb injuries.
The trainee will usually undertake training at a number of units on a rotational basis to gain exposure to different needs in different areas. For instance, a trainee based in the Midlands, could work in hospitals in Sheffield, Nottingham and Leicester during their training.
Research
Research is also important, as is the trainees increasing teaching responsibilities during training. The majority of trainees will engage in research in order to advance current and develop new techniques but also to increase their competitive edge. Over time plastic surgeons have conducted research to pioneer many innovative and advanced techniques, including:
• Micro-vascular free tissue transfer - now part of routine plastic surgical practice, the development of microsurgical techniques has made it possible to replant severed body parts ranging from whole limbs to fingertips and move tissues to reconstruct defects
• Pioneering surgery involving neuro-electric stimulation of limb muscles in tetraplegic patients to restore hand function
• A range of technological and tissue engineering advances that have lead to improvements in the management of nerve injury, skin cancers and wounds
Plastic surgery advantages
• Extremely rewarding, surgeons have the ability to transform people’s life
• Varied caseload, surgery is not limited to any one age group or anatomical site
• Fast-moving and advanced, surgeons use the latest technology and techniques
• A range of sub-specialities so most surgeons can carve out a niche
• Opportunities to work all over the world
• Opportunity to generate separate income through private practice
Plastic surgery disadvantages
• Very competitive, there may be others medical pathways that are easier to follow
• Limited funding, some trainees will need to pay for additional education courses themselves, which can be costly
Overseas opportunities
There is a significant opportunity for plastic surgeons to travel and use their skills overseas and trainees have the chance to complete sub-specialist fellowships in the UK and aboard towards the end of their training period. Furthermore many UK plastic surgeons visit disaster zones to provide extra hands and specialist experience to treat victims in need of reconstructive surgery. Examples include treating acid burn sufferers in Bangladesh, earthquake victims in China and also those affected by the Tsunami in 2004.
Quite a number of surgeons later in their career get invited to visit, lecture and teach in other countries. This is usually in less developed countries where surgery is not as advanced.
The future
Plastic and reconstructive surgery dates from as far back as Ancient Egypt, evolving to become, today, one of the most innovative and exciting specialities. It is famous for the advances it has brought to the surgical profession, such as microsurgery and tissue engineering. Meanwhile, developments such as the first 80% facial transplant in the US are making plastic surgery an increasingly exciting career choice.
The speciality is now attracting more women than other surgical specialities too. Indeed, around 25% of plastic surgery trainees are female.
Plastic surgery is still a relatively small specialty. However, the number of consultant posts has doubled in the last twenty years and it has become an integral part of hospital practice. This rise is expected to continue as demand grows for plastic surgeon’s specialist skills, which in turn will open up additional training posts in the future.
Case study
Joy Odili qualified as a consultant plastic surgeon in January this year after six years surgical training. She now runs NHS practices at St George’s in Tooting and Queen Mary’s in Roehampton.
During her studies Joy was, like many other medical students, barely exposed to plastic surgery. However, after completing a year in a plastic surgery unit as a senior house officer she discovered that it was the specialism she wanted to pursue. Now as a consultant Joy works across the speciality but has a particular interest in skin cancer and ear reconstruction.
She says: “The wait to become a registrar can be a frustrating one, but once you get on the training ladder it can become very rewarding. The time slides by, until one day you’re ready to fly solo.”
“A really rewarding part of our work is being able to operate on patients suffering from cancer. Through surgery we hope to not only make them well, but also restore function to the affected area and make it appear as if the cancer was never there.”
“I also enjoy the regular lectures I host for St Georges’ medical students. We teach them the principles of wound healing and introduce them to the range of techniques we use to close wounds. We show them what a career as a plastic surgeon is really like. It’s certainly an eye opener – showing them that plastic surgery is more than just aesthetics and that our true focus is on restoring function as well as appearance.”
Joy successfully balances her career with being a wife and mother of two children.
Further information
There are plastic surgery training programmes in all the English regions as well as Scotland, Wales and Northern Ireland. Outside the UK, British trainees are also welcomed for training by units in Ireland.
Eric Freedlander
Full Member of BAPRAS
This article was originally written for BMJ Careers
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