How to become a plastic surgeon:
- Integrated track: Most programs are 6 years, but a few have an additional research year. The amount of general surgery varies from 1 to 3 years. This is the more competitive route but it is also shorter with a few new programs added each year.
- Independent track: 3 year plastics “fellowship” after 5-7 years general surgery. Interestingly, you can also apply for plastic surgery fellowship after completing a residency in orthopedic surgery, ENT, neurosurgery, or urology. There seems to be fewer programs that offer the independent track each year.
Unfortunately, there are few positions available for the integrated track (~159 nationwide). Look at the NRMP’s “Charting Outcomes in the Match” to get a good sense of where you stand. The competition is keen. Therefore, you should not set your hopes on being accepted to these programs. You should be prepared to enter a general surgery program and enter plastic surgery via the classical route. This means that, while you are completing plastic surgery applications, you should also strongly consider preparing general surgery applications. Talk to Dr. Slezak or any of the other faculty for advice on whether or not you should dual apply. If you apply to a general surgery program, present yourself as a general surgery candidate and not as a plastic surgery applicant to avoid bias against you.
Why do you want to be a plastic surgeon?
Please think about this question seriously. First of all, you will be asked this question repeatedly as you discuss your future with people and as you interview with programs. More importantly, you need to make the right career decision for you. Consider that surgery requires a great deal of personal sacrifice. You should be absolutely sure that you are prepared for the lifestyle of a surgeon. Thinking about this question will help you to write your personal statement.
Talk to Dr. Slezak and the other plastic surgery faculty. They are all extremely friendly and approachable. They can help you plan your 4th year schedule and suggest programs for both general and plastic surgery. Aim high but also include a range of programs. Many applicants apply to every plastic surgery program in the US.
If you are interested, there is a plastic surgery teaching conference at Maryland on Tuesday mornings and grand rounds at Hopkins on Thursday mornings. Show up and see if you like what you see. If you do, keep going when you have time – people will be impressed by your interest.
Plastic Surgery Sub-I’s and Away Electives
Do a plastic surgery elective at Maryland, this will be important for getting a home program letter of recommendation. Schedule your plastic surgery away sub-I’s as early as possible: July-Oct are prime months for away rotations and positions fill up fast. Some places use VSLO (Visiting Student Learning Opportunities), while others require an individualized application through their registrar. Check out their website for details. VSLO
How to choose away rotations
- If you want to get interviews on the west coast, you should consider completing one of your away rotations on the west coast. It demonstrates interest and signals to the programs that if they give you an interview you will seriously consider ranking them highly.
- If you want to stay at the UMD/ Hopkins program, you should seriously consider doing an away rotation at Hopkins. Even though you will know the Maryland faculty well, it is very important to get to know the faculty over there!
- You will need to use at least one away rotation to get a strong letter of recommendation. Plastic surgery is a small community so everyone knows each other. It is helpful to get a letter from someone who is well known in the field or who has connections to various programs you are interested in.
- When considering away rotations, look at the rotation schedule. Some places will have you rotate at a different site each week, while others will have you on the same service for the whole month which is a helpful to get to know a particular attending better for a stronger letter of recommendation.
- It is very difficult for me to advise you on the number of programs you should apply to for Sub-Is. Most people do two or three away rotations. I only applied for three but had a few backups ready to be sent if needed. If you are applying to more popular programs such as UTSW, Pitt, UW, NYU, or Hopkins, I would have definitely have a backup. A word of caution - I have heard from many fellow co-applicants, if you apply to an away rotation, get accepted and then turn it down, they will not grant you an interview when you actually apply there for residency. Applying early is key so submit your applications as soon as VSAS allows you to. For the programs that do not use VSAS, contact the program in February/March to set up your away month.
- Away rotations are very important – making a good impression during that month definitely increases your chances of matching there. If there is a program that you are really interested in, do an away rotation there! It’s also the best way to see what a program is really like and how you might fit in there.
How to prepare for your Sub-Is
- Smile, be friendly to everyone including other sub-Is, and show enthusiasm. It sounds obvious, but you would be amazed how far doing just those three things will get you. Try to work well with your co-sub-I's. It is a competitive field and everyone wants to be the "best sub-I" but showing you are a good team player will go far. Residents are evaluating you as a potential colleague for the next 6-7 years, they want to know you will be a good teammate. Their opinions of you, in terms of landing an interview at that program are very important.
- To prepare for a case, know the indications for the procedure, the anatomy of the case, and think about why the attending chose one reconstructive option vs. another. Additionally, briefly review articles/ book chapters written by the attending completing the case. If the attending has written a large body of literature on abdominal wall reconstruction, you will want to be familiar with it before he/she asks you about it in the OR!
- In terms of resources, there are several very helpful books. The first is a textbook- Grabb and Smith's Plastic Surgery it is around 150 bucks and written at a good level for a medical student (or you can easily find pdf online!). The other is Essentials of Plastic Surgery by Jeffrey Janis which will become your best friend during your away rotations!
- A Sub-I month is essentially a month long interview. If it goes well, you will have an advantage over other applicants when you interview there later on. But, if it doesn't go well, you may not even receive an interview invitation to that program. Some programs have interviews for rotaters during their away rotation which is very helpful and saves money and time. Some programs do not invite all of their rotaters back for interviews so that is also something to consider.
Plastic Surgery Research
To be a competitive applicant you need to do research, preferably plastic surgery research. Having actual publications is even better. When you do your plastic surgery rotations, talk to the residents and attendings about their current research projects. Join a project that will be completed before the match if possible. Choose faculty that have a strong record of publications are actively publishing – pubmed them to find out. On your interviews, be prepared to talk about any research project that you have listed on your application, even if it is something you did 10 years ago in undergrad!
Letters of Recommendation
Plastic surgery is a very small community. You need letters of recommendation from program directors and other well-known plastic surgeons. There is debate about whether getting a strong letter is better than getting a generic letter from a big name. Because plastic surgery is such a small community, whom you get your letters from is very important. Letters will open doors for you across the country. After you complete a rotation, arrange a meeting to present your interest and CV. Request the letters of recommendation ASAP. Some people will tell you to get letters from only plastic surgeons. A previous student was advised by multiple division chiefs that they like to see one strong general surgery letter. Discuss your potential letters in May with Dr. Slezak.
Plastic surgery participates in the regular match and all programs use ERAS for the application. You can find programs by searching on ERAS for “plastic surgery” (“combined” curriculum) and “plastic surgery – integrated” by state. Do not limit yourself geographically. Most of these programs only accept one or two medical students per year. A handful of programs take three and a few take four. Complete your application as soon as possible. Do not wait for the AOA selection, or letters of recommendation to come in. The earlier your application is submitted the better, though it as not as crucial as it is for specialties like Medicine to get it submitted that first day, within the first week is fine. You can always add letters of recommendation as they come in. Plastic surgery interview invitations come out much later than most other specialties. If you get a strong letter later in October or even November, it’s not too late. My last letter was submitted at the end of October so do not worry.
Most programs wait until after the MSPE letters come out to offer interviews. After Nov 1, the flood gates open and hopefully you will have so many interview invitations that you are happily overwhelmed. Keep your phone with you or check your email often during Nov and Dec. Reply to interview invitations ASAP, as preferred dates may fill up within minutes (yes, minutes). I cannot stress this enough – if you cannot be glued to your phone 24/7, ask a friend, family member or significant other to do so for you. December and January are the busiest months for plastics interviews – so try to take off if possible. Keep December relatively free as well. Do a light elective, i.e. dermatology, radiology, pathology, or subspecialty surgery. Do not do a sub-I or away elective during this time! Be prepared to spend several thousand dollars on travel arrangements. With all programs interviewing in a few short weeks, dates will conflict. You will be forced to decide which interviews to accept. Prioritize plastic surgery interviews over general surgery interviews if you co-applied. Then consider reputation and location.
At the interview, try to relax and be yourself. Be prepared to talk about how you became interested in plastic surgery. People will ask how you can be sure that you want to be a plastic surgeon at a relatively early stage in your career. They will ask you about your mentors, special cases, research experiences, and other programs. Remember specific names and cases at programs where you rotated. You may be asked to discuss these at the interview.
In addition to the interview day itself, most programs host a dinner the night before (or sometimes after). Make every effort to attend these events. It shows your interest in the program and allows you to gain valuable (i.e. candid) information from the residents outside the confines of the formal interview. You will meet a lot of the same people at various interviews so be friendly and get to know them – who knows, they could be your future co-resident! Even though timing is very tight and travel plans may get changed last minute, try to enjoy the city that you are going to. If you are not pressed for time, go out and explore the city and try to do one fun thing! You could be living there for the next 6-7 years of your life so location is something to keep in mind.
When you interview with a general surgery program, you are, for all intents and purposes, primarily interested in general surgery, with a possible interest in plastic surgery. Most general surgery residency programs do not want to train future plastic surgeons.
Thank You Notes
DO NOT send them. There is a rule that strictly prohibits any contact between plastic surgery programs and applicants after the interview date. This is to avoid any potential strategizing about rank lists and to level the playing field for those who cannot afford to do “second looks.”
This is a very personal decision. Weigh the factors that are important to you. Ultimately your goal should be to get the best surgical training possible. You have to balance this with (sometimes) competing desires to be near family/friends, in a certain geographic location, at a “big name” program, available research opportunities, etc. Consider ranking every program at which you interviewed. Meet with the faculty and the residents for advice.
Please feel free to contact me and good luck!
Last Revision: May 3, 2018