Careers in plastic surgeryBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3221 (Published 19 August 2009) Cite this as: BMJ 2009;339:b3221
- Eric Freedlander, vice president of the British Association of Plastic, Reconstructive and Aesthetic Surgeons, and consultant plastic surgeon
Eric Freedlander, vice president of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) and consultant plastic surgeon at Sheffield Teaching Hospitals, discusses how to cut it as a plastic surgeon
Plastic surgery is a varied and rewarding technique based specialty that makes a tangible and visible difference to the lives of many children and adults. The work varies from treating burns and performing 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. Given this broad remit, they collaborate with people from many other specialties including those from ear, nose, and throat; orthopaedics; neurosurgery; dermatology; gynaecology; maxillofacial surgery; and breast surgery, as well as other health professionals.
Box 1: Plastic surgery pros and cons
Extremely rewarding: surgeons have the ability to transform a person’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
Has a range of subspecialties, so most surgeons can carve out a niche
Opportunities to work all over the world
Opportunity to generate separate income through private practice
Very competitive: other medical pathways might be easier to follow
Limited funding: some trainees will need to pay for additional education courses themselves, which can be costly
Plastic surgery procedures
When qualified, most plastic surgeons will work both for the NHS and in 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 owing to a high number of subspecialties they are likely to discover at least one area where they can develop a particular interest.
Plastic surgery procedures include:
Breast surgery (reconstruction after cancer; congenital anomalies; cosmetic breast surgery)
Skin cancer (excision and reconstruction; management of metastases)
Head and neck surgery (mainly reconstruction in oral and aero-digestive tract cancer; 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 and can then apply for two years of core surgical training. This consists of subspecialty placements in different surgical specialties each lasting from four to six months.
The trainee will then apply for their chosen subspecialty training via 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 membership of the Royal College of Surgeons and spent a minimum of six months in plastic surgery posts.
Trainees will go on to do six years of plastic surgery training. To gain their certificate of completion of training, they are required to pass the intercollegiate specialty examination (FRCS Plast). Upon gaining the certificate of completion of training, doctors are then eligible to be placed on the General Medical Council’s specialist register and are able to apply for consultant posts. Many plastic surgery trainees also complete a cosmetic fellowship after their certificate of completion of training to enable them to perform aesthetic surgery.
Depending on their training pathway, a plastic surgeon can expect to qualify in their early to mid-30s.
The following qualities are desirable in a plastic surgeon:
A good eye for aesthetics and attention to detail
Good time management and organisational skills
Ability to handle stressful situations and remain calm under pressure
Ability to balance an extremely varied workload
Achievements and accolades in relevant academic research
Able to foster good working relationships as part of a multidisciplinary team.
The life of a trainee
The life of a trainee plastic surgeon is extremely varied. Generally, they will have four to five operating sessions a 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 include 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. Because of the varied 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, or 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 is also important, as are the trainees’ increasing teaching responsibilities during training. Most trainees will engage in research in order to advance current techniques 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 surgery 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 led to improvements in the management of nerve injury, skin cancers, and wounds.
Plastic and reconstructive surgery dates from as far back as ancient Egypt and has evolved to become one of the most innovative and exciting specialties. 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 United States are making plastic surgery an increasingly exciting career choice.
Plastic surgery is still a relatively small specialty, but the number of consultant posts has doubled in the last 20 years and it has become an integral part of hospital practice. This rise is expected to continue as demand grows for plastic surgeons’ specialist skills, which in turn will open up additional training posts in the future. The specialty is now attracting more women than other surgical specialties, too. Indeed, around 25% of plastic surgery trainees are women.
There are considerable opportunities for plastic surgeons to travel and use their skills overseas, and trainees have the chance to complete subspecialist fellowships in the United Kingdom and abroad towards the end of their training period. Furthermore, many UK plastic surgeons visit disaster zones to provide assistance and specialist experience to treat victims in need of reconstructive surgery. Examples include treating people with acid burns in Bangladesh, earthquake victims in China, and those affected by the tsunami that occurred in the Indian ocean in 2004.
Quite a number of surgeons later in their career get invited to visit, lecture, and teach in other countries, usually in less developed countries where surgery is not as advanced.
Box 2: 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, but after completing a year in a plastic surgery unit as a senior house officer she discovered that it was the specialty she wanted to pursue. Now as a consultant Joy works across the specialty 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 who have cancer. Through surgery we hope not only to 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 George’s 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.
Box 3: Further information
There are plastic surgery training programmes in all the English regions as well as in Scotland, Wales, and Northern Ireland. British trainees are also welcomed for training by units in Ireland.
The British Association of Plastic, Reconstructive and Aesthetic Surgeons will be hosting talks for medical students about careers in plastic surgery later this year. For more details visit www.bapras.org.uk.
The following are also useful links to find out more about a career as a plastic surgeon:
Competing interests: None declared.