ISSUE 1 | FALL 2015
PAGE 28
From the publishers of Plastic Surgery News
Choosing a practice model .............. p.24
IN THIS ISSUE » Breaking up with patients ............ p.18 » 50 journal articles every resident should read ..................... p.32 » Developing your social media presence .............................. p.10
AMERICAN SOCIETY OF PLASTIC SURGEONS 444 E. ALGONQUIN ROAD ARLINGTON HEIGHTS, IL 60005
Accurate Surgical & Scientiic Instruments, Corp. “Your Partner in Plastic & Reconstructive Surgery”
ACCURATE SURGICAL & SCIENTIFIC INSTRUMENTS®
For diamond perfect performance®
accurate surgical & scientific instruments corporation 300 Shames Drive, Westbury, NY 11590
800.645.3569 516.333.2570 fax: 516.997.4948 west coast: 800.255.9378 www.accuratesurgical.com Plastic Surgery Resident | Fall 2015
Plastic surgery: he next generation P
lastic surgery is deined by innovation. he specialty has a rich legacy of creatively solving problems by developing new and better techniques to meet surgical needs. By standing on the shoulders of giants, plastic surgeons gain a clearer view of how to push the boundaries of possibility. our work is both reconstructive and aesthetic; our patients are women and men, young and old, wealthy and poor. no specialty is more generous, competitive, revered and scrutinized. As plastic surgery residents, you should prepare to be challenged every day as you prepare for the most satisfying career imaginable in medicine.
Anu Bajaj, MD PSN Chief Medical Editor oklahoma city
he magazine you hold in your hands, Plastic Surgery Resident, is designed to help you navigate the early part of your career. in it, you will ind advice on selecting a career path after residency, practice management tips, recommended journal articles and a wide range of additional information to prepare you for many of the topics not always covered in your plastic surgical training. Provided to you courtesy of the American Society of Plastic Surgeons (ASPS), this inaugural issue of Plastic Surgery Resident represents a combination of eforts from the editors of Plastic Surgery News and YPS Perspective. We have enlisted the expertise of the Plastic and Reconstructive Surgery (PRS) editorial board, the chair of the ASPS coding and Payment Policy committee, faculty from the ASPS oral and Written Board Preparation course and other plastic surgeons who have walked in the shoes you currently wear and have volunteered to share their experiences with you.
B. Aviva Preminger, MD Young Plastic Surgeons Steering Committee Chair new york
his publication is provided as the latest of many ASPS resources available to residents and young plastic surgeons through the Society’s residents and fellows forum, young Plastic Surgeons forum, PRS residents gateway (prsjournal.com), PSen resident education center (psenetwork.org) and numerous educational oferings (visit plasticsurgery.org or contact ASPS member Services directly at 847-228-9900 for more information). Plastic Surgery Resident would also like to recognize industry support from ASSi, cosmetAssure and Sientra – each of which provided sponsorship of articles truly designed to inform readers rather than promote products. finally, we would like to thank you, the readers of Plastic Surgery Resident, for the work you do, your passion for the specialty and, hopefully, your feedback on ideas for topics in future issues. We hope you enjoy the premiere issue of Plastic Surgery Resident and wish you the best of luck in your training and career. !
Plastic Surgery Resident | Fall 2015
3
Table of
Contents Plastic Surgery Boot Camp ........... 6 UPMC hosts inaugural event
Looking Beyond The Obvious: Benefits of Rotations ‘Away’ ......... 8 Sub-internships are an important prelude to the plastic surgery application process
Developing & Managing A Social Media Presence ..............10 Evidence suggests social media use is driving an increase in cosmetic surgery
Risk Management In Cosmetic Surgery......................14 Industry data sheds light on risk factors associated with combining procedures
CPT 101 Billing And Coding ........................16 Becoming familiar with common CPT codes now will pay dividends later
Plastic Surgery Resident | Fall 2015 | Vol.1 No.1 he mission of the American Society of Plastic Surgeons is to support its members in their eforts to provide the highest quality patient care and maintain professional and ethical standards through education, research and advocacy of socioeconomic and other professional activities. A SPS PR E SI DE N T
Scot Bradley Glasberg, MD | scotbg@gmail.com E DI TOR S Anu Bajaj, MD | anukbajaj.mac@mac.com
B. Aviva Preminger, MD | premingermd@gmail.com E X EC U T I V E V ICE PR E SI DEN T
Michael Costelloe | mcostelloe@plasticsurgery.org S TA F F V I C E P R E S I D E N T/ P RO G R A M S A N D DEV ELOPMEN T
Gina McClure | gmcclure@plasticsurgery.org P U B L I C AT I O N S D I R E C T O R / M A N AG I N G E D I T O R
Mike Stokes | mstokes@plasticsurgery.org GR A PHIC DESIGN ER
Jim Andrews | jandrews@plasticsurgery.org
Breaking Up With Patients ..................................18
A S S I S TA N T E D I T O R
When a doctor-patient relationships turns sour, recognize when – and how – to cut ties
A DV E R T I S I N G S A L E S
Stressing About The Oral Or Written Boards?............... 22 Experts ofer tips to help you prepare for the oral and written board exams
Choose Your Own Adventure ..................................... 24 Two plastic surgeons discuss the allure of private and academic practices
Five Tips For Landing A Great First Job............ 28 Advice for making your foray into the world as a practicing plastic surgeon
50 Journal Articles Every Resident Should Read.................. 32 Members of the PRS editorial board share their recommended reading list
Getting Involved............................ 37 Early involvement in organized plastic surgery has long-term benefits
Jim Leonardo | jleonardo@plasticsurgery.org Brian Parker (215) 521-8969 Wolters Kluwer Health Printed by Ripon Printers 656 S Douglas Street Ripon, WI 54971 POSTMASTER: Send address changes to ASPS Membership Department Plastic Surgery Resident 444 E. Algonquin Road Arlington Heights, IL 60005 Postage paid at Arlington Heights, IL, and at additional mailing oices. he views expressed in articles, editorials, letters and other publications published by Plastic Surgery Resident (PSR) are those of the authors and do not necessarily relect the opinions of ASPS. Acceptance of advertisements for PSR is at the sole discretion of ASPS. ASPS does not guarantee, warrant or endorse any product, program or service advertised. PSR is published four times per year and distributed free to members of the ASPS Residents and Fellows Forum and plastic surgery training programs. Letters, questions or comments should be addressed to: Editor, Plastic Surgery Resident, 444 E. Algonquin Road, Arlington Heights, IL 60005. ASPS Home Page: www.plasticsurgery.org
4
Plastic Surgery Resident | Fall 2015
Accurate Surgical & Scientiic Instruments, Corp. “Your Partner in Plastic & Reconstructive Surgery”
ACCURATE SURGICAL & SCIENTIFIC INSTRUMENTS®
For diamond perfect performance®
accurate surgical & scientific instruments corporation 300 Shames Drive, Westbury, NY 11590
800.645.3569 516.333.2570 fax: 516.997.4948 west coast: 800.255.9378 www.accuratesurgical.com
UPMC hosts inaugural Plastic Surgery Boot Camp Innovation in surgical education in progress
by Francesco M. Egro, MBChB, MSc, MRCS
T
he inaugural ACAPS-sponsored Plastic Surgery Boot Camp program held July 31-Aug. 2 was developed in response to ongoing changes in graduate medical education. he program’s purpose is to facilitate the transition of both integrated and independent residents into plastic surgery training. We believe the Boot Camp will provide standardized and timely exposure to critical clinical content in plastic surgery, thereby helping to keep plastic surgery educators both accountable for the global education of our trainees and on the forefront of adult surgical education. his program is a “hands on,” practicum-based weekend course that focuses on high-yield topics in a “low/no risk” educational environment. – Vu Nguyen, MD, associate program director, UPMC Plastic Surgery Residency Program To help facilitate the transition of both integrated and independent residents into plastic surgery training, the University of Pittsburgh Medical Center (UPMC) hosted the inaugural 6
Plastic Surgery Resident | Fall 2015
Plastic Surgery Boot Camp from July 31-Aug. 2. Sponsored by the American Council of Academic Plastic Surgeons (ACAPS), the Boot Camp was developed by the Intern Boot Camp Task Force initiated by ACAPS President Jefrey Janis, MD, and arranged by Vu Nguyen, MD. he three-day event, which was co-directed by Dr. Nguyen and Edward Davidson, MD, was supported by Acelity, Allergan Inc., and Sientra. Forty-ive irst-year plastic surgery residents (37 integrated and eight independent residents) from 22 plastic surgery programs across 15 states took part in the Boot Camp, which “provided a great exposure to essential plastic surgery topics in a fun, collegial environment,” according to Rebecca Knackstedt, MD, integrated program resident at Cleveland Clinic. “It was great to see friends from the interview trail, hear from excellent speakers and
connect with colleagues from across the country.” he curriculum of the event was built on ive main principles designed to: • Introduce irst-year plastic surgery residents, in both the integrated and independent tracks, to core concepts in plastic surgery • Provide standardized and timely exposure to fundamental clinical content in plastic surgery • Provide practical, clinically relevant experience and insight into these core topics and procedures • Establish a collegial, collaborative and supportive educational environment that fosters learning, as well as the opportunity for dynamic interaction between residents and instructors • Establish a sense of camaraderie, foster and build relationships, and
opportunity to pose questions to experts in the ield.” homas Paliga, md, integrated resident at university of Pennsylvania, says the Boot camp “allowed me to ill some basic knowledge gaps caused by the variability in exposure to plastic surgery at medical school. he event provided an introduction to the key concepts of plastic surgery, which builds the foundation for further learning.”
Vu Nguyen, MD (right), shares advice with Plastic Surgery Boot Camp residents.
engender professional enculturation among Boot camp participants and with the plastic surgery specialty
STRONG SIGNALS, GOOD RECEPTION Plastic surgery topics that were addressed during Boot camp included perioperative management; gloving, draping and suturing; wound healing and nutrition; pressure sores and chronic wounds; lower-extremity trauma and reconstruction; professionalism; breast examination, markings and implants; breast reconstruction, reduction and augmentation; basics of microsurgery; anatomy of the hand, and head and neck; craniofacial and hand radiology; common “hand and face call” consults and management; injectables and non-operative facial management; rhinoplasty; operative facial rejuvenation; body contouring and liposuction; pediatric plastic surgery; syndromes and craniosynostosis; the mechanics of local laps, Z-plasty and cleft repair. An evening reception dedicated to the integrated residents served as a welcome close to the irst day of the Boot camp. he event provided an opportunity for these young physicians to discuss residency-related challenges, and it allowed them to pose questions to an experienced panel. An additional reception was organized on the second night as a social event for Boot camp
attendees, uPmc faculty and all residents.
‘INVALUABLE AND AMAZING’ he event was termed a success – and a welcome entry into plastic surgery – by integrated and independent residents alike. duncan mackay, md, integrated resident at university of Pennsylvania, calls it “an invaluable and amazing experience,” while Joshua Kelley, md, integrated resident at grand rapids medical education Partners/michigan State university, says he appreciated the opportunity for a “hands-on experience in a low-stress environment, and the
given the success of the AcAPS Boot camp, discussions have begun on the possibility of expanding the event to six regional centers across the united States, which would in part allow minimization of traveling cost and time commitment from Boot camp participants. Plastic surgery education and innovation is in the making – and it’s exciting to see how the Plastic Surgery Boot camp can provide standardized and timely exposure to critical clinical content in plastic surgery; helping to keep the specialty both accountable for the global education of its trainees and on the forefront of adult surgical education. ! Dr. Egro is a resident in the integrated plastic surgery program in the Department of Plastic Surgery, University of Pittsburgh Medical Center.
ASPS task force seeks resident papers on professionalism, ethics in plastic surgery ASPS has taken the initiative to encourage thought and focus on ethics and professionalism in plastic surgery – particularly for plastic surgeons in training. he importance of incorporating this into the current curriculum and discourse cannot be overstated. To further stimulate discussion on this critical issue, ASPS is seeking papers from plastic surgery residents on a topic pertaining to Professionalism/Ethics and Plastic Surgery. Submissions will be reviewed for an award from the ASPS Professionalism Task Force. Entries should not exceed 2,000 words. Please submit all entries by Jan. 15, 2016, via e-mail to ASPS Member Programs Administrator Julie Buscemi at jbuscemi@plasticsurgery.org. he task force encourages all plastic surgery program directors to encourage residents to submit papers. Please direct any questions to Buscemi via e-mail or call 847-228-3309. !
Plastic Surgery Resident | Fall 2015
7
he beneits of rotations ‘away’ by Lauren Zammerilla, MD
“Congratulations, you have been selected for a plastic surgery sub-internship.”
preventing students from pursuing more broad rotations such as critical care, where they could learn comprehensive patient management.
T
However, many students still have time to pursue such electives in the months after interviews. in addition, some medical schools require students to complete a general surgery actinginternship in addition to a plastic surgery rotation. even with away rotations, fourth-year students have ample time to take intense electives that theoretically may make them more well-rounded doctors. in all honesty, however, by this point in medical school, many students choose to take lighter courses and start preparing for the transition to residency.
o any fourth-year medical student vying for a spot in the plastic surgery match, these words are as sweet as the smell of benzoin. After years of basic science curriculum and medical school clerkships, it’s inally time to explore plastic surgery. Sub-internships, or away rotations, are an important prelude to the plastic surgery application process – yet relections on the experiences are rarely formally discussed or published. As a recent plastic surgery away-rotator and applicant, i would like to share my opinion of these rotations and how they can inluence the transition to residency.
BEYOND THE NUMBERS he literature continues to support the importance of away rotations in the plastic surgery match. An article published in the July 2015 issue of PRS (“What makes a Plastic Surgery residency Program Attractive?”) noted that 43 percent of applicants matched at an institution where they rotated. However, on a personal level, away rotations provide students with the opportunity to get to know the residents, faculty and culture of a program, and to determine if they could potentially see themselves itting-in as residents. it’s diicult to know the true workings of a program after only an interview, despite the efort that goes into making the experience informative and personal. Pre-interview social functions strive to help ill this void by providing applicants with a chance to meet residents and faculty in a casual setting, but the logistics of interview season often require applicants to miss these functions due to travel. he interview day, therefore, is the only exposure an applicant may have to a program if he or she did not rotate at that institution – and applicants may feel more comfortable with the familiarity of the places they have rotated.
‘AWAY’ GAME rotating at an institution does not come without risks. A student may be working as hard as he or she can but does not impress or mesh with the residents and faculty. in this situation, the student may not receive a strong letter of recommendation and/or may not receive an invitation to interview at the program. Hopefully, the student is provided with honest feedback about his or her performance, with suggestions on how to improve. While not getting an interview may initially seem frustrating to the rotator, ultimately it would be the best action for a program to take if there are no intentions to rank the student. in this situation, the program is being honest, thereby saving the applicant the expenses of the interview and enabling him or her to interview at a program that may be a better it. With almost 70 percent of applicants performing more than two away rotations, according to the PRS article, the majority of the fourth year becomes devoted to plastic surgery and interviewing. Some mentors argue that this narrow focus is detrimental, 8
Plastic Surgery Resident | Fall 2015
he opportunity to perform multiple away-rotations becomes a great advantage for students to juxtapose diferent programs so that they can decide what they value and desire in their training. in addition, spending multiple months on plastic surgery services provides students with time to acquire more knowledge. As students become more comfortable with the anatomy and basic principles of cases, they can further explore the plastic surgery literature, thereby obtaining a more comprehensive understanding of the procedures. he curricula of most medical schools allow little exposure to plastic surgery, so the weeks spent on such rotations is the only time that students have to fully dedicate their studies to the ield.
FAMILIAR SCENARIOS little discussion exists on how away rotations inluence the transition to residency. in general, away rotations teach students how to adapt quickly, which is an important trait to have as an intern. As a rotator, you move to an unfamiliar city, start working in a new hospital, and are often changing surgical services. his scenario is not too diferent from the start of residency, except that interns have the added responsibility of patient care. he work ethic and communication skills that students acquire while performing sub-internships are invaluable. from a more technical perspective, away rotations often provide students with the opportunity to improve surgical skills. Although these skills will be greatly enhanced throughout residency training, having such experiences as a medical student enables interns to feel more comfortable in the o.r. or emergency department. taking call with the residents was one of the most educational aspects of my experience. it taught me how to fully evaluate a consult, write a note, develop a plan, gather appropriate supplies and present to the team. Having such responsibility as an away rotator has greatly helped in my transition to intern year. Away rotations provide future applicants with the opportunity to explore diferent programs, decide what aspects of a training program are important to them, and devote time to plastic surgery. Although they come with great expenses and commitment, they help to improve the application process and transition to residency –and will remain a signiicant component of plastic surgery training. ! Dr. Zammerilla is a irst-year plastic surgery resident at the University of Texas Southwestern Medical Center, Dallas.
INTRODUCING The Sientra PatientMatch App ®
™
Innovation. Leadership. Simplicity.
INCLUDING THE NEW 107 HSC SMOOTH ROUND IMPLANTS
The Industry’s First Mobile Interactive Implant Selection Platform Designed to assist plastic surgeons in selecting the Sientra breast implant best suited for each individual patient
Improve eficiency of implant selection Streamline patient experience Enhance ordering process Include in EMR systems
Download today at sientraapp.com or Contact your local Plastic Surgery Consultant.
MDC-0178 R1
888.708.0808
DEVELOPING & MANAGING A SOCIAL MEDIA PRESENCE
10
Plastic Surgery Resident | Fall 2015
A UCLA study investigating how plastic surgeons use social media discovered that roughly half of ASPS members actively use social media networks such as Facebook, Twitter, LinkedIn and others to support their professional practices. The study, led by Reza Jarrahy, MD, and published in the May 2013 issue of Plastic and Reconstructive Surgery (“Social Media Use and Impact on Plastic Surgery Practice”), also found that half of the 500 respondents reported that “social media was an effective marketing tool and a useful forum for patient education” that boosted patient referrals, awareness and general goodwill toward the practice. At the same time, there’s strong evidence that widespread social media use in the United States is also driving an increase in cosmetic surgery procedures of the face, as an increasingly image-conscious “selfie generation” reaches out for advice about correcting or enhancing cosmetic issues. Plastic surgeons with robust social media presences will be well positioned to harvest this demand.
Photo Credit: Bloomua Shutterst r ock.com
Developing your social media presence
O
ne natural question that arises when any professional decides to develop a social media presence is “Where should I begin?” It’s generally best to start out with one service, get comfortable with the production routine associated with producing fresh, relevant content and promoting this presence vigorously through one’s existing marketing channels – then add another service only after one has mastered the irst. Currently, Facebook, Twitter and LinkedIn are the social media services most favored by plastic surgeons.
FACEBOOK Facebook, with 1.19 billion users, is the world’s largest social media service, and it appears to be the service currently favored by the majority of plastic surgeons. Facebook, like all contemporary social media services, is built to highlight the images posted by its users. In fact, according to Emarketer, image posts represent about 75 percent of total posts on Facebook. Plastic surgeons can use the natural imagefriendliness of Facebook to post images such as “before/after” photos (with patient consents and following HIPAA guidelines, of course), attractive images of their facilities, photos of staf, infographics or other appealing visual content. Facebook ofers plastic surgeons another advantage: Its pages are extensively customizable. Custom tabs can easily be programmed to highlight practice areas the plastic surgeon wishes to showcase. For example, photo galleries can be set up, as can areas dedicated to reviews and testimonials, events and other engagement-building content. Additionally, speciic “calls to action” can be added to the page, providing potential patients with a direct link to special ofers and products.
Facebook’s biggest problem for those who want to use it for business purposes is that it has throttled back the ability of businesses and individuals to reach “fans” who “like” them. Facebook’s intention is to instead drive its users toward paid promotion, which can make reaching one’s Facebook community more expensive than it used to be.
TWITTER Twitter, like Facebook, is image-friendly, and while its user base is much smaller (232 million), it does not limit the ability of its members to reach all who “follow” them. While Twitter does not ofer the extensive customization features ofered by Facebook, it remains an excellent place to build an online community.
LINKEDIN While branded as a business-networking service, LinkedIn (with 259 million users) provides plastic surgeons a place to demonstrate their credentials, endorsements and other professional content, as well as a way to network with professional peers via LinkedIn Groups. Currently, plastic surgeons with an online presence do not appear to be promoting their LinkedIn areas as vigorously as they do their pages on Facebook and Twitter.
EMERGING SERVICES hough gaining in popularity, Pinterest, Instagram, Tumblr and Google Plus do not yet ofer the mass audience of Facebook, Twitter or LinkedIn. All these image-oriented/ video-oriented services, however, can be excellent places for the plastic surgeon to market and share useful information. Lately, video platforms such as Periscope and Meerkat have joined the fray, providing the capability to transmit real-time video content. Plastic Surgery Resident | Fall 2015
11
Photo Credit: Bloomua / Shutterstock.com
Managing your social media presence
T
here’s no question that managing a single, robust social media presence, even a single Facebook page, takes time and effort. Social media users expect the areas they visit will be chock full of fresh, relevant content. Sometimes this task can be performed by someone on the plastic surgeon’s staff; but when multiple, active presences must be maintained, the associated workload can become a full-time job. Automation can often help with the problem of simultaneously managing more than one social media platform; for example, HootSuite, a popular social media publishing tool, provides a one-stop way to schedule, publish and manage the distribution of content to multiple services. Keeping on top of user engagement, tracking how often your content is shared by followers, friends and fans, and other positive user-behavior can also be daunting. While all of these services provide their own analytics panels, it can be a challenge to summarize this information into reports. Therefore, placing analytics code on all of the pages of your practice’s website is strongly encouraged to help track all of this. Google Analytics is an excellent platform that can provide comprehensive intelligence on traffic originating from multiple social media networks. Another common concern relates to the frequency with which you should update a given social media page. While there are plastic surgeons who post very frequently (multiple times each day), it’s not clear whether accelerating one’s posting schedule will result in either increased engagement or increased business results. One thing, however, is clear: It’s bad form to maintain social media areas that look untended or abandoned, because such derelict areas could raise questions in users’ minds about the attentiveness of the practitioner. If maintaining a particular social media presence is determined to be too 12
Plastic Surgery Resident | Fall 2015
labor-intensive or not conducive to meaningful business ROI, it is better to terminate this presence and focus scarce resources on a smaller set of social media outlets. Finally, while developing and maintaining your social media presence, it’s crucial not to overlook the importance of maintaining an active, mobile-friendly website. Conceptually, such a site works as a “hub” from which different social media “spokes” radiate. More often than not, URLs posted on social media sites will direct visitors to content placed on this site’s blog area, so, naturally, it’s important to keep this area as up-to-date as the practitioner’s social streams. Building and managing a robust social media presence takes time and effort, but the rewards for practitioners making good use of social media are real and tangible. Prospects for plastic surgery, especially cosmetic procedures, actively use social media to evaluate plastic surgeons, and those whose social presences are more appealing will win more of this new business. !
his article was sponsored by
Plastic and Reconstructive Surgery–Global Open
HOT OFF THE PRESS The newest peer-reviewed literature in the plastic surgery world!
Get it while it’s hot! The “Hot Off the Press” feature delivers the very latest plastic surgery content from around the world, updated daily. Gain a global perspective and stay current on new plastic surgery research.
Read articles Hot Off the Press at:
www.PRSGlobalOpen.com Need information on submitting your manuscript to PRS Global Open? Contact us at prsglobalopen@plasticsurgery.org
5-Q616
: y er
g tabase r u S Da e r c tismetAssu e Co sm m o o s fr C n o in ess L
by Varun Gupta, MD, MPH ; R. Bruce Shack, MD, FACS ; James C Grotting, MD, FACS ; & Kent “Kye” Higdon, MD, FACS
very surgery carries the risk of a complication, and cosmetic plastic surgery is no diferent. Similarly, every patient is diferent, and an array of factors – which include the patient’s body mass index, age, whether she or he smokes, or the presence of co-morbidities such as diabetes – can increase the risk of an adverse surgical event.
E
experienced plastic surgeons will tell you that it is really not a question of whether a complication will occur – the skill comes in predicting with whom a complication will occur and minimizing that patient’s risk. understanding that complications will occur is an important step toward reducing their frequency and protecting your patients. A ive-year statistical analysis of cosmetic procedural data from patients covered by cosmetAssure, an insurance program that covers the costs of complications arising from aesthetic surgery, has revealed ive key risk-factor analyses for cosmetic surgery patients. he following information on complications is based on proprietary data compiled by cosmetAssure’s parent company, Alabama-based Aesthetic Surgeons’ financial group (ASfg). he data is based on 183,914 cosmetic procedures performed on more than 129,000 patients in the ASfg database. readers are advised that as they review each analysis, they should note that the majority of the costs associated with these complications are usually not covered by a patient’s major medical insurance – treatment of a complication is an additional expense to the patient that can lead to a inancial loss for the surgeon. 14
Plastic Surgery Resident | Fall 2015
ABDOMINOPLASTY: COMBINING RISK A total of 25,478 abdominoplasties were identiied in the ASfg database – nearly 2/3 of which were performed in combination with another procedure. four (4) percent of all the abdominoplasty procedures in the database experienced a complication (compared to 1.4 percent for all other aesthetic surgery procedures). of these abdominoplastyonly complications, 31.5 percent were hematomas, 27.2 percent were infections, 11.4 percent were possible dVt/ Pe, 8.8 percent were conirmed dVt/Pe and 7.0 percent were pulmonary dysfunction. on multivariate logistic regression, statistically signiicant risk factors include being a man (relative risk [rr] of 1.8), being over age 55 (rr 1.4), having a body-mass index (Bmi) greater than 30 (rr 1.3) and having the procedure done in a hospital/surgical center rather than an oicebased surgical suite (rr 1.6). diabetes and smoking were not found to be signiicant risk factors. risk for patients undergoing abdominoplasty in combination with one or more additional procedures (rr 1.5) was found to statistically increase the risk of complication (complication rate for abdominoplasty alone was 3.1 percent, increasing to 3.8 percent when combined with liposuction, 4.3 percent with a breast procedure, 4.6 percent when combined with liposuction and a breast procedure, 6.8 percent when combined with a bodycontouring procedure, and 10.4 percent when combined with liposuction and a body-contouring procedure).
Analysis of the database further showed that combining abdominoplasty and liposuction with abdominoplasty increased the risk of possible or conirmed dVt/Pe from 0.5 percent to 1.1 percent.
FACELIFT RISK FACTORS of the 11,300 facelift procedures represented in the ASfg database, this cohort had a higher percentage of men (majority) (8.8 percent), diabetics (2.7 percent), elderly (mean age 59.2 years) and obese patients (38.5 percent), but fewer smokers (4.8 percent). in addition, slightly more than 57 percent of facelifts were combined with other procedures. overall, facelifts had a 1.8 percent complication rate, with hematoma (1.1 percent) and infection (0.3 percent) emerging as the most common. combining a facelift with another procedure, however, resulted in a 3.7 percent complication rate compared to a 1.5 percent complication rate for facelifts alone. independent predictors of hematoma were being male (rr 3.9) and having the procedure in a hospital/surgical center rather than oice-based surgical suites (rr 2.6). Patients who combined procedures (rr 3.5) or had a Bmi of 25 or more (rr 2.8) were at increased risk of infection.
LIPOSUCTION here were more than 31,000 liposuction procedures in the data set, of which 37 percent were performed as a solitary procedure, which saw an incidence of signiicant complications of 0.7 percent. When combined with abdominoplasty, the rate of complication grew to 3.8 percent, and when combined with abdominoplasty, breast and another body contouring procedure, the rate of complication hit 12 percent. he most common complications related to liposuction were infection (0.7 percent), hemorrhage (0.6 percent) and possible or conirmed dVt/Pe (0.6 percent). combining procedures (rr 4.75), having a Bmi of 25 or more (rr 1.58), or undergoing the procedure in a hospital/surgical center rather than oicebased surgical suites (rr 1.65) were independent predictors of complications.
AESTHETIC BREAST SURGERY fifty-seven (57) percent of all patients in the database underwent breast surgery. hese patients were younger – the mean age is 36.7 vs. 46.3 years, more likely to be smokers (10 percent vs. 5.9 percent) and less likely to be diabetic (1.2 percent vs. 2.7 percent) or overweight (25 percent vs. 51 percent) compared to other patients. he overall complication rate after breast surgery was 1.9 percent with hematoma (1.1 percent) being the most-common major complication, followed by infection (0.4 percent) and suspected or conirmed Vte (0.2 percent). Breast procedures included augmentation, mastopexy, augmentation-mastopexy and reduction mammaplasty. rates of complication after augmentation-mastopexy were higher (1.9 percent) compared to augmentation or mastopexy alone (1.4 and 1.2 percent, respectively). more complications occurred in older patients (0.7 percent in those under age
20 to 2 percent in those age 60 or more). Higher Bmi was associated with increased risk of infection (0.1 percent in those patients with a Bmi under 18.5 to 1.5 percent in those whose Bmi is 40 or more). on multivariate analysis, patients over age 40 and the type of surgical facility in which the procedure was performed (hospital or ambulatory center vs. oice suites) were risk factors of any complication (rr 1.26 and 1.32, respectively). Patients age 40 or older and those with a Bmi of 30 or more were at higher risk for postoperative infection (rr 1.52 and 2.57, respectively). twenty-one (21) percent of cosmetic breast patients underwent combined procedures. concomitant abdominoplasty was performed in 5.8 percent of these patients, which was associated with a greater rate of complications (7.1 percent). Smoking increased complications in combined breast-abdominoplasty cases, as well as for gynecomastia surgery.
AESTHETIC SURGERY IN THE OVERWEIGHT PATIENT more than one-third of the patients in the database had a Bmi of 25 or higher. hese overweight patients were more likely to be male (12.5 percent), diabetic (3.3 percent), non-smokers (92.8 percent), have multiple procedures (41 percent) and be operated on in a hospital (31.3 percent). complication rates steadily increased with higher Bmi: 1.4 percent for those with a Bmi under 18.5; 1.6 percent for those with a Bmi from 18.5-24.9; 2.3 percent for those with a Bmi from 25-29.9; 3.1 percent for those with a Bmi from 30-39.9, and 4.2 percent for those whose Bmi was 40 or more. infection (0.8 percent of these patients), suspected Vte (0.4 percent) and pulmonary dysfunction (0.2 percent) were twice as common among overweight patients. incidence of hematoma was similar in the two groups (0.9 percent). incidence of any complications following abdominoplasty (3.5 percent), liposuction (0.9 percent), lower body lift (8.8 percent) or combined breast and body contouring procedures (4.2 percent) were signiicantly higher in overweight patients. his group also had signiicantly more infections after abdominoplasty (1.2 percent), breast augmentation (0.3 percent) and lower body lift (2.7 percent). on multivariate analysis, those with a Bmi of 25 or more remained an independent predictor of infection (rr 2.0), Vte (rr 2.0) or any complication (rr1.3) following aesthetic surgery. When providing elective surgery, it’s important for patients to understand the risks, however remote they may be. As ASPS notes in its public outreach eforts, cosmetic surgery is real surgery that is best performed by a plastic surgeon certiied by the American Board of Plastic Surgery. ! Dr. Shack is a professor and chair of the Department of Plastic Surgery at Vanderbilt University in Nashville, Tenn., where Dr. Higdon is an assistant professor and Dr. Gupta is a resident. Dr. Grotting is a clinical professor in the Division of Plastic Surgery at the University of Alabama at Birmingham. his article was sponsored by CosmetAssure. A complete statistical report of this data can be obtained through the company’s website at cosmetassure.com. Plastic Surgery Resident | Fall 2015
15
Procedures new plastic surgeons will see early and oten by Mark Villa, MD
C
urrent Procedural Terminology, more commonly known as “CPT,” encompasses a vast set of codes, descriptions and guidelines used to distinguish medical procedures performed by physicians and other health-care providers – including physician assistants and nurse practitioners. Each code carries a value based on its complexity, intensity, resource utilization, etc., and each describes the steps involved in performing whatever procedure the code denotes from start to inish. he purpose of CPT is to provide a uniform language that describes medical, surgical and diagnostic services among payers. It’s important to order a new CPT book each year, since a large number of codes are routinely added, deleted or changed during any 12-month period. he CPT book is broken down into eight sections or code sets. Preceding each section are guidelines that include speciic coding rules. Each section also includes hundreds of notes and parenthetical instructions speciic to a certain set of codes, which are designed to help ensure correct code assignment. New plastic surgeons will want to become familiar with three sections of the book: • Evaluation and Management Codes (codes 99201–99499), to understand the diference between a new and established patient and the diferent levels of consultation codes that may be reported • Integumentary and Breast Codes (11021–19380), to review the most-often reported codes by plastic surgery • Additional Surgical Procedures of Interest (20005–69999), which are arranged by body system he CPT codes reported to a payer should relect the services actually delivered – and the level of those services. However, there often can be more than one way to correctly code for a service or procedure. It’s also important to know that codes do not exist for every procedure or combination of procedures under 16
Plastic Surgery Resident | Fall 2015
the sun, and there are times when what a surgeon does is not neatly described by existing codes. A service can be further described by the addition of two-digit codes, known as modiiers. hese are generally divided into two categories: “Pricing modiiers,” also called functional modiiers, afect reimbursements by providing information as to whether the case was more or less involved than the “typical” code and, therefore, should be reimbursed at a higher or lower rate. “Informational modiiers” do not afect reimbursement; rather, they provide additional information about the procedure such as the timing and whether treatment represents staged procedures, complications from the original procedure, etc. – and they can determine whether the code will be reimbursed or not.
PROPER CODING Consider the excision of three benign lesions of the face, each measuring 8 mm. he introductory information in this section of the CPT book clearly states that each excised lesion should be reported separately. he correct method of coding this procedure, using CPT guidelines, is: • 11401 Excision of lesion • 11401-51 Excision of lesion • 11401-51 Excision of lesion As shown above, the use of a modiier can often provide more information to a payer. In this case, the informational modiier -51 indicates that multiple procedures were performed at the same operative session. Some payers, including some Medicare Administrative Contractors, will only reimburse for the irst lesion if the procedures are correctly reported with the multiple procedure modiier, -51. Other carriers require the use of a diferent informational modiier, -59, which indicates a distinct procedure, to show that the surgeon is not billing three times for the same excision:
• 11401 Excision of lesion • 11401-59 Excision of lesion • 11401-59 Excision of lesion Almost 20 years ago, the Medicare program initiated an extensive system of electronic claim edits to ensure codes were appropriately processed and paid according to their interpretation of CPT coding. Many private payers have adopted these edits, while others continue to create speciic edits to address issues they believe are inappropriate. Unfortunately, there’s often no way to know what set of rules, or edits, a private payer may be using. Only after a claim is rejected, and an appeal is made, will the surgeon learn how that payer is interpreting the CPT billing rules. One of the most often discussed areas in plastic surgery billing is the coding for breast reconstruction. Most CPT books do not include a description of all the work that’s recognized as part of a particular CPT code – and here again, some payers will have speciic rules for how they want to see codes submitted. As an example, all free-lap breast reconstructions are reported with code 19364. his code includes the elevation and transfer of the lap, closure of the donor site, rib resection and microvascular anastomosis of one artery and two veins. Most payers have edits in place to disallow coding of the closure, rib resection, etc., as a secondary code. Submitting a code for any of these individual elements of the procedure is known as “unbundling.” For certain types of laps, including the Deep Inferior Epigastric Artery Perforator (DIEP) lap and the Superior or Inferior Gluteal Artery Perforator (SGAP and IGAP) lap, a -22 pricing
modiier may be added to denote the additional work involved in the performance of these techniques in relation to a standard full or muscle-sparing, or full Transverse Rectus Abdominis Myocutaneous (TRAM) lap, but the increased work must be adequately documented in the operative report. After a claim for this procedure has been billed, many plastic surgeons are bewildered to learn that there are three other codes (HCPCS codes S2066, S2067 and S2068) that also describe various free lap breast reconstructions. hese codes are not universally recognized by payers (including Medicare) but are required by some payers for coverage. he general rule for all breast reconstruction procedures is to preauthorize the care, sharing the description of and reason for the procedure with the payer. Only report one of the three HCPCS codes if a payer speciies that these codes should be used. Navigating the coding and reimbursement process can be a frustrating experience; however, ASPS has worked diligently for more than 25 years to provide the most up-to-date coding advice to its members. An archive of “CPT Corner” columns from Plastic Surgery News highlights speciic billing situations a surgeon may encounter – and ofers explanations for how such cases should be coded. he archive is available on the Plastic Surgery Education Network (PSENetwork.org/CPTCorner). ASPS encourages residents and new plastic surgeons to become familiar with the site – and to contact the ASPS Executive Oice at 847-228-9900 for help with any unique coding issues. u Mark Villa, MD, is chair of the ASPS Coding and Payment Policy Committee and associate professor of Plastic Surgery at the University of Texas MD Anderson Cancer Center in Houston. Plastic Surgery Resident | Fall 2015
17
by Anu Bajaj, MD
A
t some point during our careers, all of us will have patients with whom we’ll wish we’d never become involved. Several years ago, I found myself in a doctor-patient relationship that had deteriorated to the point that it was unhealthy – for me and my patient – both physically and emotionally. Once we parted ways, my emotional well-being greatly improved. By paying attention to the red lags that pop up early with certain patients, plastic surgeons may be better able to decide when not to enter into the patient-doctor relationship. Occasionally, however, you don’t realize that the relationship isn’t a good it until it’s too late. A question that many young surgeons may ask is How do we part ways with a patient - and when is it appropriate to do so? 18
Plastic Surgery Resident | Fall 2015
‘More is lost through indecision...’ After my personal experience, I suggest that once you determine that a relationship isn’t functional, begin to take steps to correct the situation sooner than later. Face it, you may never reach the point where efective communication exists – and efective communication is key to the success of any relationship. As soon as issues began to arise with my problem patient, I discussed the situation with a good friend of mine who is also an oncologist. She said: “In my practice, I’ve had discussions with certain patients about ending our physician-patient relationship if I don’t think I can meet their expectations regarding my care of him or her. I typically say that although it’s a privilege to be their physician, if they cannot comply with the steps I have set forward to ensure their success
and safety, then they will need to ind another physician.”
will receive, and with the documentation that you’ve already provided.
in researching this article, i spoke with neal reisman, md, Jd, Houston, who has written numerous articles for Plastic Surgery News on legal issues and currently writes the publication’s “on legal grounds” column. He reiterated the importance of documentation – particularly when a patient is not following your instructions. He notes that you may consider using phrases such as “i can no longer be responsible for the patient’s outcome, because he or she continues to not follow medical care and recommendations.”
unfortunately, there are situations where ending the relationship may not be an option – speciically, if no other physician is able to assume the patient’s medical care. dr. reisman advises that some exclusive contracts for managed care may require speciic approval to release a patient, particularly if you’re the only physician able to provide the service. his may also apply to a patient who doesn’t have insurance.
one may also choose to end the doctorpatient relationship when a patient becomes abusive. my oncologist friend described a situation in which a patient referred to her as “a (blanking) foreigner.” She appropriately documented the episode, sent the patient a letter and gave her the names of other physicians who would be able to treat her.
He advises that documentation in these situations is critical – both in terms of describing the additional care you have provided, the patient’s lack of following instructions, and how you tried to help ind or recommend other physicians to assume the care of the patient.
ultimately, whether we need to end the relationship because of a patient’s noncompliance, abuse or unreasonable expectations and demands, the process is the same – and appropriate documentation is extremely important.
i also found it helpful to discuss these issues with my malpractice insurance carrier. once i realized that i had an issue with a patient, i spoke with my insurance representatives who provided me with advice on how to deal with the patient – helping me to draft letters and allowing me to discuss these issues with an attorney. After all, as your malpractice insurance carrier, they don’t want you to get sued, either.
Legal questions
Firing lines
in my case, i was concerned as to when a surgeon could legally end the doctor-patient relationship, particularly during the postoperative period. dr. reisman explained that while the 90day post-op period is important, it’s not as critical as ensuring that another physician is willing to assume care of the patient. if you ire the patient during the 90-day global period, it could potentially be considered abandonment if you do not facilitate follow-up care in some fashion.
dr. reisman ofers several additional tips about the process of iring a patient, including:
“you do not have the responsibility to make them go – just arrange it,” dr. reisman says. He also advises that plastic surgeons should be comfortable with the new care their soon-to-be-former patient
• make sure you can ire them. exclusive contracts for managed care may require speciic approval to release the patient if you are the only one able to provide the service.
• Allow a reasonable time to continue to care for the patient – seven days or so – enough time for them to ind another caregiver. • Provide sources of other physicians to the patient – regional medical society, yellow Pages, websites, etc. • notify the e.r., everyone in practice, and referrals who see the patient that you are no longer the patient’s physician. Sample language to use in your letter to the patient may include: It’s unfortunate that I can no longer provide care for you. You have been noncompliant by (not keeping appointments despite contacts, not following suggested and required medical advice such as smoking, alcohol, etc. – be speciic but not accusatory, factual but not blaming). I regret that I can no longer be responsible for your care as a result of this noncompliance. After 8:00 a.m. _________ (date), I will no longer be your physician of record and require you seek care elsewhere. Sources to ind another physician are: _________. I am sorry it has come to this, and I wish you well. Respectfully, ______________.
• Make any notes and letters friendly, and not blaming. remember that all communication is a part of the medical record and may be admissible. • Send any communication through both certiied and regular mail, as there is a mail presumption (rebuttable though) that regular mail is received, and nothing good comes in certiied mail!
fortunately, i love what i do, and most of the patients i treat are wonderful people with whom i have good relationships. my hope is that this information will be helpful for those circumstances when we do encounter diicult patients. ! Anu Bajaj, MD, is a private practitioner in Oklahoma City and chief medical editor of Plastic Surgery news. She can be reached at anukbajaj.mac@mac.com. his is an updated version of an article originally published in “YPS Perspective” in the January/February 2012 issue of Plastic Surgery news.
Plastic Surgery Resident | Fall 2015
19
CosmetAssure 855.874.1230 info@CosmetAssure.com www.CosmetAssure.com
Sere is only ONE
CosmetAssure— the GOLD STANDARD in complications insurance.
As you start your career in Plastic Surgery, let CosmetAssure cover the risk of post-surgical complications, so you can: yp|jl LM ID[ORE@ J[ERWME Y[GW pyyzm JW[YW LU NRMX EL @LDG J[ERWMEF xXX i~sjz EL @LDG JG[YERYW ~[E ML YLFEz {vyyzmzqkv~kz @LDGFWOU UGLN ESW YLNJWERERLM
Did you know? 1 out of 61
Elective surgeries results in a complication 1 out of 32 Abdominoplasty procedures result in a complication 44% Of all complications result from Hematoma. $50,000 Potential cost of a complication $19 Million Amount of claims paid to date by CosmetAssure |pqk~|k jl ELX[@ EL QLRM LDG zsvkz TGLDJ LU wL[GX;vWGERURWX gO[FERY cDGTWLMF8
`RFRE DF RM wLFELM& wLLES .*r*
}
BE PREPARED Stressing about the oral or written boards? Follow these 10 great tips and you’ll be ready by Keith Loria
T
he mission of the American Board of Plastic Surgery (ABPS) is to promote safe, ethical, eicacious plastic surgery to the public by maintaining high standards for the education, examination, certiication and maintenance of certiication (MOC) of plastic surgeons as specialists and subspecialists. A principal method through which the ABPS meets this charge is through the administration of its annual written and oral examinations, held each fall (this year, the written examination took place Oct. 13 and the oral exam is slated to take place Nov. 12-14). “Prospective plastic surgery patients can be assured that a boardcertiied plastic surgeon has at minimum completed an accredited residency training program, has attended an accredited medical school and has successfully met the high ABPS examination standards,” says Richard Ha, MD, Dallas, ASPS Oral and Written Board Preparation Course program co-chair.
Board preparation course faculty member Barry Douglas, MD, Garden City, N.Y., says the board used to require that young physicians complete two years in practice prior to taking the oral boards, but the ABPS recently changed that policy to require one year of practice to be test-eligible. Jason Potter, MD, Dallas, ASPS Oral and Written Board Preparation Course program chair, notes that obtaining ABPS certiication demonstrates to patients – and to colleagues – that the plastic surgeon has taken every step to obtain the highest level of proiciency possible, thereby setting themselves above all other specialties. But young and hopeful plastic surgeons aren’t assured of taking both exams, Dr. Ha notes. “Physicians who’ve just inished residency will irst take the written exam – and to be eligible to take the oral exam, he or she must have successfully passed the written one,” he says.
THE EXAMS Oral exams are set up to run over a three-day period and are generally considered the more anxiety-inducing of the two. Each examinee faces a “case collection period” of approximately eight months, during which he or she must submit data for every case performed. he board selects ive of those eight to be presented to the examiners at the test session (typically located in Scottsdale, Ariz., in October). “he format of the oral exam is that the candidate will enter three testing rooms over the three days,” Dr. Ha says. “One testing room is for an examination based on those ive selected cases, while the other two rooms are for examination of ‘unknown cases’ (ive additional in each of those rooms). Two examiners in each room ask questions of the candidate regarding these case, with his or her competency assessed by the quality of answers for the case – diagnosis, evaluation, 22
Plastic Surgery Resident | Fall 2015
work-up, surgical treatment, alternative management and handling complications.” Dr. Douglas suggests that young plastic surgeons approach the case collection and submission process with urgency, given what will be at stake. Additionally, he recommends keeping answers simple and to the point – and staying away from being confrontational or from challenging the examiner.
‘I DON’T KNOW’ “Also, don’t be afraid to say, ‘I don’t know,’ ” he adds. “he purpose of this exam is to make sure that you’re prepared to treat the general population, and that you’re a safe practitioner.” Acknowledging such unfamiliarity can be a strong example that the young surgeon is willing to work to shore-up deiciencies, Dr. Ha explains.
TOP 10 TIPS to prepare for the boards
1
Review the requirements for the case-collection process before your collection period starts. “his can save a lot of time preparing the case log and ensuring you have proper documentation for every case,” Dr. Potter says. “You don’t want to be sent home from the exam before it starts – but that happens.”
2 3 4
Prepare your cases carefully. “It’s in your best interest to go to a board-certiied plastic surgeon, and participate in as many mock orals as possible with faculty with whom you have trained,” Dr. Douglas says. Take photos and keep records for your known cases. “Start this process early, and it will save you a lot time at the end when you have to prepare your books for the selected cases,” says Dr. Ha. Organize a study group to review and prepare case scenarios. his can help your eiciency in covering the vast material as you simultaneously attempt to start a practice. Vanderbilt University Medical Center Plastic Surgery Residency Program Director Reuben Bueno Jr., MD, believes that study groups can help you reinforce what you know – but they’re only efective if it doesn’t increase your anxiety.
5
Be prepared. Review the rules and regulations for the test site itself, and plan ahead for exam day. “You’ll be in a small room with people taking all types of tests,” Dr. Potter says. “Plan for cold rooms, and bring earplugs and snacks, if allowed.” Additionally, drive to the test center a day or two early, if possible. Learn where to go, where to park and how long it takes to get there. You don’t want be late – or unnecessarily stressed on test day.
ASPS member Frederick Lukash, MD, who took his boards in 1982 and served on the Society’s In-Service Examination Committee in 1983-84, says the oral boards are the most important job interview that a future plastic surgeon will ever have, so they should only approach it with their “A” game. “Similar to any interview, the oral examiners will form subjective opinions of you,” Dr. Lukash says. “In answering questions, examiners are looking for safe and logical solutions to problems. Be humble and be organized, and as Dr. Douglas says, be prepared to say you don’t know when you don’t know it.” u ASPS ofers the Oral and Written Board Preparation Course each summer. For more information, visit plasticsurgery.org or call ASPS at 847-228-9900. Keith Loria is a freelance journalist in Virginia.
Since the oral boards can’t be taken until one has successfully passed the written boards – and accumulated the caseload in categories that meet the board criteria – studying for the oral and the written boards are two diferent entities. he following tips will help to give you the best chance to be prepared:
6
Enroll in a review course such as the ASPS Oral and Written Exam Preparation Course. (Go to plasticsurgery.org, and enter “Oral and Written Boards” in the search ield.) “Board review courses can be a good place to begin your study plan or polish your oral board presentation,” Dr. Potter says. “Begin preparing early and create concise, high-yield notes you can review as the test gets closer.” Also, review and practice questions from old InService exams, study guides, etc. he In-Service exams can be a pretty good indicator of how you will perform on the written board exams.
7 8 9 10
Talk to others – and ind a mentor. “Every candidate should communicate with those who’ve already taken the boards; you can’t go in blind,” Dr. Lukash says. “If you go in ill-prepared, you’ll likely be taking them again.” Review your personal study materials irst. Familiarity with your own study guides, notes and books will improve retention.
Start early. Putting of studying is never a good thing, and it’ll only add anxiety and worry. Start studying sooner rather than later, and you’ll grow more and more relaxed. Practice, practice, practice. “Delivering what you know in an eicient manner is critical,” Dr. Ha says. “Work with peers, mentors and colleagues to help you with mock oral exams.” u
Plastic Surgery Resident | Fall 2015
23
Choose Your Own
ADVENT U R E :
24
Plastic Surgery Resident | Fall 2015
Dueling Perspectives in Academic and Private Practice
Completing your residency is a huge accomplishment, but the end of training is no time to sit back and relax – at least not for very long. he daunting decisions of where you will practice, what type of practice to enter and with whom, if anyone, to partner must be made quickly. To help inform your decision, two ASPS members from the academic and private practice worlds, Mia Talmor, MD, and Bill Kortesis, MD, share their tips for approaching the big decision on landing your irst job as a newly minted plastic surgeon at the end of your residency and fellowship programs.
Plastic Surgery Resident | Fall 2015
25
Coming home to
ACADEMIC MEDICINE
by Mia Talmor, MD Associate professor of Clinical Surgery (Plastic Surgery) at Weill Cornell Medical College and associate attending surgeon at New York-Presbyterian Hospital
A
s the end of my plastic surgery fellowship approached, I felt both relieved and anxious. I was very conident in my surgical skill and in my ability to care for patients. Yet the previous nine years of my life were spent in a state of suspended adolescence where I had neither the privilege nor the burden of making any life decisions. I (mostly) cheerfully did what I was told to do, when and where I was told to do it. I did it well enough (mostly), and the timing was favorable enough that I had a choice of several good positions when my training was done. he fact that I lacked the experience to make an informed decision was not apparent to me at the time, though it is now. Fortunately, I chose well and had the energy and support to make my irst job my “dream job,” though I realize how lucky I am that things worked out that way. he vast majority of my fellow residents left their irst job after a year or two, with a few more gray hairs, a bit of disappointment, and a lot more life experience. As I considered a small versus large private practice – versus a full-time academic practice – I could see myself itting in to all three: the “Doc Hollywood” feeling and inancial control of the irst, the camaraderie and pace of the second, and the academic environment of the third all appealed to me. I ultimately chose an academic practice and became an assistant professor of Plastic Surgery and full-time attending at Weill Cornell, the same institution where I had completed medical school, general surgery residency, a research fellowship and two-year plastic surgery residency. While I was initially concerned about the acute transition from resident to attending in the institution where I had “grown up,” I was pleasantly surprised by how seamless it was. I had already garnered the respect of the nursing staf, 26
Plastic Surgery Resident | Fall 2015
my attendings (who were now my associates) and my junior residents; I truly felt these folks were rooting for my success, which I quickly realized was more signiicant than whether or not they called me by my irst or last name – and I took every advantage of the familiarity and support I was ofered. While the start of my own career was uneventful, now after 15 years of training residents, I have witnessed both the good and the bad. It’s based on my own experiences as well as my experience watching so many others launch their own careers that I ofer the following tips: • START PLANNING EARLY. Start to think about what you want to do and where you want to do it a full two years before you have to make any decisions. • TALK TO FRIENDS AND MENTORS and begin to make contacts within your ield and location of interest. • TALK TO YOUR FAMILY. You have likely put their desires and needs on the back-burner for the past six to 10 years, but if you want to be happy, they have to be happy, too. • DON’T FOCUS ON THE STARTING SALARY – instead, focus on the opportunity. If you are thriving in your job, your salary will likely relect it. However, be certain to research the dollar amounts, and be certain to ask for what you are worth. (Ladies, this means you, too.) • BE FLEXIBLE AND AVAILABLE. Look for a clinical niche that is not being illed and igure out a way to ill it. • STEP OUT OF YOUR COMFORT ZONE. If that which is familiar is not best for you, look outside and ind what is. • BE SAFE. As the youngest member of a faculty or practice, you are expected to “take care of it.” It is not uncommon to ind yourself in a situation that is neither familiar nor comfortable. Do not be afraid to ask for help. Don’t ever forget that the ultimate goal is the health and well-being of our patients. • ENJOY. We are the privileged few who get to pursue the career of our dreams. Have fun! u
Shape your own future in
PRIVATE PR ACTICE B.Brown/Shutterstock.com
by Bill G. Kortesis, MD Partner and co-owner, Hunstad/KortesisCenter for Cosmetic Plastic Surgery and Med Spa
very plastic surgery resident will face a major series of decisions once the training process has inished – and many things to consider in choosing the right type of practice model. Your ultimate goal should be to end up in a situation where you can be happy. In order to do so, there are certain particulars that you should look for when choosing the type of practice that best suits your personality and needs.
E
If you join a group practice, I recommend surrounding yourself with like-minded people. his means joining a practice that shares your values and goals. In the right situation, you will ind yourself lourishing. If your partners have diferent core values and beliefs, however, it could make building your practice diicult. herefore, it’s a 100-percent necessity to ind a group where you want to mimic and/or emulate the senior partners in the practice because they are the standard by which the practice has been built. Try to place yourself in a situation where mirroring the senior partners is possible
and encouraged. his mentor/mentee relationship helps to maintain appropriate standards and will help you succeed in your practice. Finally, you need to be in a location that you and your family desire. Regardless of the situation and the practice, it’s important to place yourself in an environment that is conducive to success. Select a location where you’re excited to be, where you love the community and, if possible, where you’re surrounded by friends and family. his support system will help you be and do your best – and be the plastic surgeon you want to be. Deciding which path is right for your future can be daunting, but it’s imperative to look deep down and ask yourself where you want be in two years, ive years and 10 years. Once you know that answer, the road to get there is ready to be paved. Only when you know where you are going, can you decide on how to get there. u
The preceding article was sponsored by
Plastic Surgery Resident | Fall 2015
27
T
o some degree, we’ve all been institutionalized – eight years of post-graduate training will do that! We can easily take call for 24 hours, “round” on a busy service and get the team through a busy day of microsurgical and cosmetic cases while managing all the paperwork and home issues that arise. What we haven’t done is solve the complexity involved in choosing where to practice and how to get there.
by Bahair “Bair” Ghazi, MD
If you’ve seen the film “Shawshank Redemption” (and if you haven’t, go rent it now), you’ll know what I intend by this sentence: Every graduating plastic surgery Fellow has felt like “Red,” (the character played by Morgan Freeman), when beginning his or her job search. 28
Plastic Surg Surgery ery Resident Re sident | Fall 2015 2015
I always thought that when I reached the “end of the road” and was inally ready to graduate, some formally dressed man with a stern face would hand me a bag of money and welcome me into the world of the practicing plastic surgeon. In a way, I suppose we’re programmed to believe this – otherwise how could you get through it all? Newslash: hat bag of money never shows up on its own. Please, if you are looking for a job as a newly minted plastic surgeon or reconsidering your options (perhaps because the irst job-search round didn’t go so well), heed these points of advice that I and my fellow colleagues have gleaned – from having recently gone through it all.
START EARLY I’ve been taught to be considerate and not intrusive; Southern training will do that. One thing is for sure, when looking for a job, be proactive. Go out and meet people at informal physician gatherings and introduce yourself at department reunions. In the beginning of your fellowship, be outgoing and interact with your alumni. (As the years press on, reach out to these alumni and ask about their experiences and whether they know of any jobs.) Be respectful, but remain eager! I can assure you, the best advice you’ll receive regarding navigating the job market will come from those ahead of you – who just went through it. Set a goal of interviewing heavily by the early fall of your senior year. hat way, you’ll have several months to decide and at least six to eight months to ill out paperwork. Yes, it will take that long (and occasionally longer) to get on many insurance plans!
BE HONEST WITH YOURSELF If you’ve always seen yourself as a small-town surgeon, don’t interview for a job in Manhattan or Atlanta. Conversely, if you can’t imagine doing anything but cosmetic surgery in a metropolitan area, don’t waste your time interviewing in a rural small town. his may seem simplistic, but it also can be the hardest part of the job search. It means we have to be realistic with ourselves. Where do you want to live, what type of patients are you happiest with, what type of practice would you like (group, academic or solo), and what do you think you will need to be successful? Try not to be swayed too much by really big or really small paychecks. hese may not present the true path to happiness. Essentially, what’s the most important thing you want? For me, it was a group, with great partners and an opportunity to grow my practice in a coastal area. I got lucky – but I tried to convince myself otherwise; early-on, I wasn’t sure I could make it happen!
DO YOUR HOMEWORK! Once you ind an area that you might enjoy, establish contacts there. Do you know alumni who practice in the vicinity, or any old colleagues who know of anyone who’s looking? If you have no idea, start cold-calling – or better yet, send a hand-written note with your CV and follow-up with phone calls. Almost every plastic surgery group or department has a website, and hospitals list most doctors on staf. Before an institution or group sends you an invitation, just remember you will be checked out to the max. Make sure your letter writers can still say nice things! Furthermore, don’t be surprised if you’re expected to foot the bill for the irst interview. I found this all too common. he second trip should deinitely be on their dime. If you decide to go on an interview, do your due diligence. Determine the size of the general population and determine the number of plastic surgeons and hospitals in the area. he ASPS website has a great deal of information on physician numbers and locations. (Log-in to the ASPS website at plasticsurgery.org, and click on Medical Professionals, then click on “Surgeon Community” followed by “Member Roster.”) You can gather more information at the interview; just be sure to ask the questions that you need to know! Ask about E.R. call, overhead, salary structure and the practice’s history. his is your time to begin learning about the business of medicine, so if you don’t understand a P & L sheet, then ask for a deinition. As you log more interviews, you’ll develop an inner “spidey sense” that sounds an alarm when you hear something that’s not to your liking. Long story short? You should have an answer to this question: What will this potential employer do to ensure my success? If they can’t answer that question, listen to your “spidey sense!”
Plastic Surgery Resident | Fall 2015
29
FIGURE OUT WHAT YOUR FAMILY NEEDS! his consideration may help you signiicantly narrow your list: Once you’ve established where and how, then bring signiicant others, children or close relatives into the decision process. Often this will help you reduce a glut of choices into a smaller, manageable list of excellent choices. he availability of excellent schools and the proximity to my wife’s family ended up being very important in our decision. his didn’t create a new list for me; however, it did eliminate a few options that I liked, but that were not ideal for my family.
COMFORTABLE WITH THE ENVIRONMENT? At this point, soak it all in and try your very best to give a “thumbs up” or “down” to the potential for a happy practice. Do the partners get along? Is the division run well? Will I be on call every night for two weeks? Can my wife endure the winters? hese are all parts of being comfortable with the environment. But remember, cold winters may be ofset by a fantastic group of partners and a supportive hospital! Try your best to make an ordered list of how you felt when you visited a location. hen try to recall where you felt you were most coveted. After all, those who like you may have a greater efect on your comfort level. In the end, it will be entirely up to the practice or division to ofer you a job! If you’ve opted for a solo practice, then bless you – and please write an article for YPS Perspective, in which you let us know how that went! For the rest of us, an ofer will usually be made after two or more interviews. When the ofer is initially made, you owe it to yourself to take the opportunity to clarify any points that you still do not understand. he one thing that I appreciated about my experience was that only a few followup interviews ended with an open explanation of the “books.” To me, that was a sign of access and clarity – and I place a premium on those! Always, take a week or two to think about the ofer and compare it to others. For the most part, plastic surgeons are realists, and those doing the hiring understand you’re still looking at other jobs. Just be honest and true. Let people know when you’ll have an answer for them and stick to that deadline. Most people will appreciate your honesty – and they’re likely happy to see that others are interested in you as well. (Most people like to see their decisions validated.) Once you’ve made your decision, run with it! And once in possession of a contract, swallow the bitter pill of having a medical-contracts attorney review it. his will cost you a pretty penny, but it can do several things for your mental well-being. First, you’ll be able to understand most of the jargon in the contract and better negotiate or discuss it with your future employer – and even if nothing changes, you’ll have the peace of mind of knowing that you looked for hidden surprises. As one of my favorite mentors once said: “here is no perfect irst job, just a perfect attempt at inding one.” It’s worth the time. After all, it’s the inal hoop to jump through before starting your career. u Bahair Ghazi, MD, is a private practitioner in Atlanta. his article originally appeared in YPS Perspective in the October/November 2012 issue of Plastic Surgery News.
30
Plastic Surgery Resident | Fall 2015
Dr. Ash Patel, MBChB FACS Video Discussant: The First Smartphone Application for Microsurgery Monitoring
“
Plastic and Reconstructive Surgery has done a great job embracing multimedia technology. Innovations like the video discussions and the PRS app show why PRS is the world’s premier plastic surgery journal.
Watch all Video Discussions at
www.PRSJournal.com Click the “videos” tab
” 5-Q156
JOUR NA L CLU B
JOURNAL ARTICLES
EVERY PLASTIC SURGERY RESIDENT SHOULD READ
A
s young physicians entering a surgical specialty with a scope that runs from the top of the head to the tip of the toes, plastic surgery residents are motivated to cover the wide spectrum of the specialty during the course of their training program. Members of the editorial board of Plastic and Reconstructive Surgery – each of them renowned in the specialty and many who are currently leaders of prestigious plastic surgery training programs worldwide – have recommended the following 50 articles – some classics, some original papers – for residents to ill those brief periods of downtime away from the O.R. For additional articles that are also must-read material for residents, visit “he Resident Reader” collection available in the PRS Residents Gateway portal at prsjournal.com. 32
Plastic Surgery Resident | Fall 2015
JOUR NA L CLU B
AESTHETIC / BREAST Aesthetic Applications of Brava-Assisted Megavolume Fat Grafting to the Breasts: A 9-Year, 476-Patient, Multicenter Experience RK Khouri, RK Khouri Jr, G Rigotti, et al. Plastic & Reconstructive Surgery A PR IL 2014; 133(4)
Five Critical Decisions In Breast Augmentation Using Five Measurements In 5 Minutes: he High Five Decision Support Process
Advances in Facial Rejuvenation: Botulinum Toxin Type A, Hyaluronic Acid Dermal Fillers, and Combination herapies – Consensus Recommendations
JB Tebbetts, WP Adams Plastic & Reconstructive Surgery
J Carruthers, R Glogau, A Blitzer, et al. Plastic & Reconstructive Surgery
DECEMBER 2005; 116(7)
M AY 2008; 121(5S)
FACE
Breast Augmentation
Functional Considerations in Aesthetic Eyelid Surgery
D Hidalgo, J Spector Plastic & Reconstructive Surgery
M Codner, M Sarcia, K Jindal Plastic & Reconstructive Surgery
A PR IL 2014; 133(4)
DECEMBER 2014; 134(6)
Composite Breast Augmentation: Soft-Tissue Planning Using Implants and Fat
Relationship of the Zygomatic Facial Nerve to the Retaining Ligaments of the Face: he Sub-SMAS Danger Zone
E Auclair, P Blondeel, DA Del Vecchio Plastic & Reconstructive Surgery SEP TEMBER 2013; 132(3)
Mastopexy D Hidalgo, J Spector Plastic & Reconstructive Surgery OCTOBER 2013; 132(4)
M Alghoul, O Bitik, J McBride, JE Zins Plastic & Reconstructive Surgery FEBRUARY 2013; 131(2)
Rhinoplasty RJ Rohrich, J Ahmad Plastic & Reconstructive Surgery AUGUST 2011; 128(2)
he Double-Bubble Deformity: Cause, Prevention and Treatment
Face Lift
N Handel Plastic & Reconstructive Surgery
RJ Warren, SJ Aston, BC Mendelson Plastic & Reconstructive Surgery
DECEMBER 2013; 132(6)
DECEMBER 2011; 128(6)
he Process of Breast Augmentation: Four Sequential Steps for Optimizing Outcomes for Patients
he Frontal Branch of the Facial Nerve Across the Zygomatic Arch: Anatomical Relevance of the High-SMAS Technique
WP Adams Plastic & Reconstructive Surgery DECEMBER 2008; 122(6)
Enhancing Patient Outcomes in Aesthetic and Reconstructive Breast Surgery Using Triple Antibiotic Breast Irrigation: SixYear Prospective Clinical Study WP Adams, J Rios, S Smith Plastic & Reconstructive Surgery
FE Barton, R Meade, M Schaverien, et al. Plastic & Reconstructive Surgery A PR IL 2010; 125(4)
Tip Shaping in Primary Rhinoplasty: An Algorithmic Approach A Ghavami, JE Janis, C Acikel, RJ Rohrich Plastic & Reconstructive Surgery OCTOBER 2008; 122(4)
Restoring Facial Shape in Face Lifting: he Role of Skeletal Support in Facial Analysis and Midface Soft-Tissue Repositioning (Baker Gordon Sympsium Cosmetic Series) JM Stuzin Plastic & Reconstructive Surgery JA N UARY 2007; 119(1)
he Fat Compartments of the Face: Anatomy and Clinical Implications for Cosmetic Surgery RJ Rohrich, JE Pessa Plastic & Reconstructive Surgery. J U NE 2007; 119(7)
Management of Complications and Sequelae with Temporary Injectable Fillers M Alam, JS Dover Plastic & Reconstructive Surgery NOV EMBER 2007; 120(6S)
Frequently Used Grafts in Rhinoplasty: Nomenclature and Analysis J Gunter, A Landecker, CS Cochran Plastic & Reconstructive Surgery J ULY 2006; 118(1)
JA NUARY 2006; 117(1) Plastic Surgery Resident | Fall 2015
33
External Approach for Secondary Rhinoplasty J Gunter, R Rohrich Plastic & Reconstructive Surgery AUGUST 1987; 80(2)
BODY / AESTHETIC Evidence-Based Medicine: Liposuction A Matarasso, SM Levine Plastic & Reconstructive Surgery DECEMBER 2013; 132(6)
Body Contouring MA Shermak Plastic & Reconstructive Surgery J U NE 2012; 129(6)
he Zones of Adherence RJ Rohrich, P Smith, D Marcantonio, et al. Plastic & Reconstructive Surgery M AY 2001; 107(6)
Liposuction as an Adjunct to a Full Abdominoplasty Revisited A Matarasso Plastic & Reconstructive Surgery OCTOBER 2000; 107(6)
RECONSTRUCTIVE / HEAD AND NECK Primary Intranasal Lining Injury Cause, Deformities and Treatment Plan FJ Menick, A Salibian Plastic & Reconstructive Surgery NOV EMBER 2014; 134(5)
Head and Neck Reconstruction P Neligan Plastic & Reconstructive Surgery FEBRUARY 2013; 131(2)
An Approach to the Late Revision of a Failed Nasal Reconstruction FJ Menick Plastic & Reconstructive Surgery JA NUARY 2012; 129(1)
34
Plastic Surgery Resident | Fall 2015
Microvascular Repair of Heminasal, Subtotal and Total Nasal Defects with a Folded Radial Forearm Flap and a Full-hickness Forehead Flap
he Respective Roles of Plastic and Orthopaedic Surgery in Limb Salvage
FJ Menick, A Salibian Plastic & Reconstructive Surgery
JA NUARY 2011; 127(1)
FEBRUARY 2011; 127(2)
OZ Lerman, SJ Kovach, LS Levin Plastic & Reconstructive Surgery
An Evidence-Based Approach to Lower Extremity Acute Trauma
Twenty-Six-Year Experience Treating Frontal Sinus Fractures: A Novel Algorithm Based on Anatomical Fracture Pattern and Failure of Conventional Techniques
ND Medina, SJ Kovach III, LS Levin Plastic & Reconstructive Surgery
E Rodriguez, M Stanwix, A Nam, et al. Plastic & Reconstructive Surgery
ST Hollenbeck, JD Toranto, BF Taylor, et al. Plastic & Reconstructive Surgery
FEBRUARY 2011; 127(2)
Perineal and Lower Extremity Reconstruction
DECEMBER 2008; 122(6)
NOV EMBER 2011; 128(5)
A 10-Year Experience in Nasal Reconstruction with the hreeStage Forehead Flap
Supericial Fascial System (SFS) of the Trunk and Extremities: A New Concept
FJ Menick Plastic & Reconstructive Surgery
TE Lockwood Plastic & Reconstructive Surgery
M AY 2002; 109(6)
BODY / RECONSTRUCTIVE Evidence to Support Controversy in Microsurgery KL Fan, KM Patel, S Mardini, et al. Plastic & Reconstructive Surgery M ARCH 2015; 135(3)
Abdominal Wall and Chest Wall Reconstruction G Althubaiti, CE Butler Plastic & Reconstructive Surgery M AY 2014, 133(5)
Vascular Bone Transfer Options in the Foot and Ankle: A Retrospective Review and Update on Strategies NT Haddock, K Wapner, LS Levin Plastic & Reconstructive Surgery SEP TEMBER 2013; 132(3)
J U NE 1991; 87(6)
BREAST / RECONSTRUCTION A Paradigm Shift in U.S. Breast Reconstruction: Increasing Implant Rates C Albornoz, P Bach, B Mehrara, et al. Plastic & Reconstructive Surgery JA NUARY 2013; 131(1)
Breast Reconstruction Following Nipple-Sparing Mastectomy: A Systematic Review of the Literature with Pooled Analysis M Endara, D Chen, K Verma, et al. Plastic & Reconstructive Surgery NOV EMBER 2013; 132(5)
Abdominal Wall Following Free TRAM or DIEP Flap Reconstruction: A Meta-Analysis and Critical Review LX Man, JC Selber, JM Serletti Plastic & Reconstructive Surgery SEP TEMBER 2009; 124(3)
Breast Reconstruction with a Transverse Abdominal Island Flap CR Hartrampf, M Schelan, PW Black Plastic & Reconstructive Surgery FEBRUARY 1982; 69(2)
HAND
Hemangiomas and Vascular Malformations in Infants and Children: A Classiication Based on Endothelial Characteristics J Mulliken, J Glowacki Plastic & Reconstructive Surgery
CJ Pannucci, SH Bailey, G Dreszer, et al. Journal of the American College of Surgeons
M ARCH 1982; 69(3)
JA NUARY 2011; 212(1)
Tendon Disorders of the Hand D Lalonde, S Kozin Plastic & Reconstructive Surgery J ULY 2011; 128(1)
Microsurgical humb Reconstruction with Toe Transfer: Selection of Various Techniques FC Wei, HC Chen, CC Chuang, SH Chen Plastic & Reconstructive Surgery FEBRUARY 1994; 93(2)
Why I Hate the Index Finger WL White Orthopaedic Review J U NE 1980; 9(6)
Reprinted in Hand (NY) DECEMBER 2010; 5(4)
CRANIOFACIAL Primary Repair of Cleft Lip and Nasal Deformity L Monson, R Kirschner, J Losee Plastic & Reconstructive Surgery DECEMBER 2013; 132(6)
A Novel Algorithm for Autologous Ear Reconstruction F Firmin, A Marchac Seminars in Plastic Surgery NOV EMBER 2011; 25(4)
A Craniofacial Glossary J Mulliken, N Le Journal of Craniofacial Surgery M AY 2008; 19(3)
Validation of the Caprini Risk Assessment Model in Plastic and Reconstructive Surgery Patients
BURN Surgical Treatment of Facial Soft-Tissue Deformities in Postburn Patients: A Proposed Classiication Based on a Retrospective Study T Zan, H Li, B Gu, et al. Plastic & Reconstructive Surgery DECEMBER 2013; 132(6)
Acute Burns T Grunwald, W Garner Plastic & Reconstructive Surgery M AY 2008; 121(5)
BONUS READING: SPECIAL TOPICS Classic Citations in Main Plastic and Reconstructive Surgery Journals WJ Zhang, YF Li, JL Zhang, et al. Annals of Plastic Surgery J ULY 2013; 71(1)
Minimizing the Pain of Local Anesthesia Injection AR Strazar, PG Leynes, DH Lalonde Plastic & Reconstructive Surgery SEP TEMBER 2013; 132(3)
he Role of Bacterial Bioilms in Device-Associated Infection AK Deva, WP Adams, K Vickery Plastic & Reconstructive Surgery NOV EMBER 2013; 132(5)
Patient-Reported Outcome Measures in Plastic Surgery: Use and Interpretation in Evidence-Based Medicine AL Pusic, V Lemaine, AF Klassen, et al. Plastic & Reconstructive Surgery March 2011; 127(3)
he Science Behind Qualityof-Life Measurement: A Primer for Plastic Surgeons SJ Cano, AF Klassen, AL Pusic Plastic & Reconstructive Surgery M ARCH 2009; 123(3)
Marking and Operative Techniques Plastic & Reconstructive Surgery JA N UARY 2006; 117(1)
International Clinical Recommendations on Scar Management TA Mustoe, RD Cooter, MH Gold, et al. Plastic & Reconstructive Surgery AUGUST 2002; 110(2) u
Let the debate begin: What articles that every resident should read have been left of this list? Send your suggestions to PSN@plasticsurgery.org and we’ll publish your responses in the next issue of Plastic Surgery Resident.
Plastic Surgery Resident | Fall 2015
35
From Residency to Retirement ASPS Residents and Fellows Forum – the best educational value for future plastic surgeons y employing the core values of the American Society of Plastic Surgeons (ASPS) as an anchor, the goal of excellence in plastic surgery will be achieved – through education, research, intellectual exchanges and promoting unity in the specialty.
B
education is at the core of the ASPS mission. he Society supports its members from residency through retirement, with a special focus on providing its future members (today’s residents, fellows and senior residents) with a unique set of educational and training tools. to address the speciic educational needs of plastic surgeons in training, ASPS ofers the residents and fellows forum (rff), in which 106 of America’s top plastic surgery residency programs have enrolled their residents, fellows and senior residents. Why? he answer is simple: rff provides a robust set of tools forged for education and training purposes, to give future plastic surgeons access to the wide range of experience they need to be successful. hese tools include:
ASPS provides online information speciically designed to help guide residents and fellows throughout their training.
Plastic Surgery The Meeting rff members receive free admission to Plastic Surgery he meeting, the annual and largest (by instructional course and attendance) scientiic plastic surgery meeting in the world. Advanced registration is required.
Job Opportunity Board (JOB) he ASPS Job opportunity Board (JoB) lists available fellowships and employment opportunities for plastic surgeons. View open positions, post a resume/cV at no charge – and even ind a list of recruiters to help plan your next career move.
...And much more in addition to educational beneits, rff members receive discounts on ASPS products and meetings.
Plastic and Reconstructive Surgery (PRS)
To enroll in the RFF
he world’s top-rated plastic surgery journal, PRS is the premier journal for every specialist who employs plastic surgery techniques or works in conjunction with a plastic surgeon. rff subscribers receive a complimentary print, app and online subscription to PRS.
residents and fellows from plastic surgery training programs in the united States and canada can join the rff, and ASPS is reviewing options to provide rff to training programs worldwide. Some training programs pay the $100 rff subscription fee directly, while others ask the resident or fellow to cover the cost. residents and fellows may call the ASPS member Services center at 800-766-4955 to join the rff or to obtain further information.
Plastic Surgery News (PSN) he Society’s award-winning news publication, PSN is read by more than 7,000 practicing plastic surgeons and industry professionals. rff subscribers receive a free subscription.
Plastic Surgery Educational Network (PSEN) PSen is an online learning portal that serves all of the subspecialties of plastic surgery. members can access more than 100 surgical procedure videos, including the original monthly Hd Surgery Spotlight program, as well as hundreds of recorded lectures, case reports, journal articles, literature reviews, self-study tests and cme courses. For residents only: Within PSen is the resident education center, which was developed by ASPS in concert with the American council of Academic Plastic Surgeons (AcAPS) to provide a uniied, online plastic surgery curriculum. hese materials are reviewed and updated annually by the ASPS/ AcAPS curriculum development committee and contains more than 85 learning modules among eight broad curriculum sections. each module contains a pre-test, journal articles, audio slide lecture, a typical oral board case, additional resources and a post-test. PSen’s resident education center is used as part of the curriculum by program directors in more than 90 percent of u.S. residency programs.
36
Residents section of plasticsurgery.org
Plastic Surgery Resident | Fall 2015
By working directly with their training program, each resident and fellow beginning July 1 had access to the educational beneits of rff – the start of the resident academic year. his rff subscription will continue through June 30, 2016, when it may be renewed by the training program or by the resident/fellow. How to subscribe: if a plastic surgery training program is not participating in the rff, individual subscriptions can be obtained by any plastic surgery resident or fellow. online rff registration is available at plasticsurgery.org/Residents. rff subscriptions begin each July 1 and end the following June 30. Plastic surgeons who have completed their residency may continue to receive the rff educational beneits (as well as many other beneits) by joining the ASPS as a candidate for membership. residents who become fellows may opt to continue in rff until their fellowship is completed. Should you join the rff? ASPS strives to provide residents and fellows the tools needed to be successful throughout residency and training, through passing the board exam, and into (and beyond) the transition to a plastic surgery practice. !
early involvement in organized Plastic Surgery ofers Long-term Beneits by Henry C. Hsia, MD f you were to ask newly minted plastic surgeons why they aren’t involved in organized plastic surgery, you would likely hear some very good reasons. Perhaps it’s too soon – they’ve just inished residency and need to focus on building a career; they don’t have the bandwidth to spend time on activities that don’t pay the bills or don’t seem relevant to running a successful practice.
I
maybe they’ll get involved “later,” once things are more “settled” in their careers and they have the experience to contribute in more meaningful and productive ways. or perhaps they feel that getting involved with professional organizations is simply a waste of time. After all, in an era when work-life balance has become a top priority, who can spend time and energy on eforts that threaten this balance, with no guarantee of any beneits in return? each of these reasons can make sense – in the short run. But whatever short-term downsides may exist, they are more than outweighed by the long-term upside of getting involved.
Hi-Rez MD transitioning from residency to practice is one of the most exciting and turbulent periods of your life. it is illed with opportunities and challenges that bring a sense of anticipation and anxiety as you grapple with decisions that can deine the rest of your career. young plastic surgeons today may ind building a successful practice to be very challenging. most of us can fall back on mentors and colleagues from residency for support and advice, but it also helps to have the clearest picture possible of how the health-care landscape is changing – and the impact those changes can exert on you and your practice. he resolution and quality of that picture will only improve as you become more involved with plastic surgery societies, such as ASPS. you’ll learn more about what’s going on in the specialty – regulations and challenges, for instance – and what’s being done about them. you’ll be exposed to other surgeons with perspectives and backgrounds that complement your own, allowing you to ind answers and solutions that you might not have otherwise developed. Becoming an active member in our community of plastic surgeons should be treated as a critical component in the career development plan for every young plastic surgeon. it also makes it easier to build your own professional network, and while you may already know plastic surgeons in your area – which can lead to referrals in the event your skills or strengths difer – specialty organizations also allow you to engage with plastic surgeons who face problems and challenges in their
lives – both professional and personal – similar to your own. Hearing how other plastic surgeons have dealt with their challenges can help you better cope with your own, which may actually help you achieve a greater work-life balance.
Education, advocacy Being actively engaged in an organization such as ASPS can also complement surgical training. residency and ABPS certiication requires proof (therefore, study) of knowledge and competency as a plastic surgeon. membership in ASPS makes continuing medical education easily accessible – one look at any Plastic Surgery he meeting brochure is proof that most of the educational needs that young plastic surgeons require can be found under one roof. Whether the focus of your career will be aesthetic surgery or microsurgical reconstruction, you will face challenges ranging from scope-of-practice issues to payer reimbursement, which will be diicult to tackle on your own. And while you may have ideas on how to deal with these challenges, being involved in organized plastic surgery gives you a voice in the debate and access to mechanisms that can help shape its outcome. Keep in mind that being a young plastic surgeon doesn’t mean you don’t have the experience to make a diference. you are now part of the plastic surgery establishment. he mentors and attendings who once were your supervisors are now your peers, and given the changes going on in the world, fresh perspectives like yours become even more critical to developing new solutions and ideas.
Low-cost participation you won’t have to give up a lot to participate. As a young plastic surgeon, you control exactly where and how you want to get involved. So try to make wise choices and choose a group or committee in ASPS that aligns with your interests and its your available time. Assess and reassess on a regular basis your own level of satisfaction – and if things are not working out, then you have the ability to change how you participate. Becoming more involved with ASPS and other professional groups does require time and efort, but like many things in life, you’ll generally get back what you put into it. And the return on investment from participating in your Society may turn out to be much richer and more profound than you ever expected. ! Henry Hsia, MD, is an assistant professor of Surgery (Plastic) at Yale University School of Medicine in New Haven, Conn., and founding director of the Yale Regenerative Wound Healing Center. his is an edited version of an article originally published in “YPS Perspective” in the January/February 2013 issue of Plastic Surgery news. Plastic Surgery Resident | Fall 2015
37
TOP 7 questions asked by residents at Q: What’s the deal with all those ribbons on name badges?
Q: What is “Session Practice Innovation”?
A: Ribbons are conferred to identify
A: Session Practice Innovation is a new track that will focus on how to successfully manage and operate a proitable practice, which includes the requirements and integration of ICD-10-CM.
attendees who contribute through certain roles during the annual meeting, or who’ve donated to he Plastic Surgery Foundation or to PlastyPAC, the political action organization that works on behalf of the Society. Ribbons also can serve as special recognition of leadership, as well as of honorary members. All residents should receive a “Resident” ribbon when they exchange their ribbon voucher at the ribbon desk, located in the Registration area.
Q: What do I wear to Plastic Surgery he Meeting? A: “Business casual” attire is appropriate for the annual meeting. Please keep in mind that temperature luctuations in convention centers are common, so please dress in layered clothing that can be easily added or removed throughout sessions and instructional courses. Q: Is registration required for scientiic sessions? A: No, registration is not required for scientiic sessions. All registrants of Plastic Surgery he Meeting have open access to these panel presentations. hese are often referred to as General Sessions. General Sessions for 2015 include: Session A – Ballroom East; Session B – Room 210-C; Session C – Ballroom West; Session Practice Innovation – Room 210 A-B
38
Plastic Surgery Resident | Fall 2015
Q: Where can I ind a cup of cofee? A: Breakfast and lunch are included with the registration for the SRC on hursday, Oct. 15, and the Residents Day Program on Friday, Oct. 16. Cofee and snacks will be available for purchase in the BCEC at “Outtakes,” located on Level 1 in the North Lobby, near the Registration area.
Q: How do residents gain access to instructional courses? A: Residents registered for Plastic Surgery he Meeting may add courses and events to their registration online prior to the start of the meeting, or onsite at the Registration desk located on Level 1 – or at the course Registration Kiosk, located on Level 2 between Rooms 207-208. One hour prior to the start of any instructional course, residents can check with representatives at the onsite Registration desk or at the kiosk, to see if space is available at the
instructional course. If the course is not sold out, residents will be able to register one hour before the course starts – and get in for free!
Q: Who can attend Residents Day? A: Residents Day is free to all residents and Fellows; advance registration is required. he program runs from 7:30 a.m.-4:30 p.m. Friday, Oct. 16, in Room 201 A-B of the BCEC, with complimentary breakfast served from 7-7:30 a.m. Lunch is also included with registration. u
coming to
LOS ANGELES SEPTEMBER 23-27, 2016 6410
x vLNJ[M@ LU sodcbc
FE
5
RM ESW ac EL LUUWG{
tAYODFRCRE@ EL gO[FERY cDGTWLMF cS[JWX oNJO[MEF EL k[GPWE kLFE vLSWFRCW dLDMX oNJO[MEF sDOO JLGEULORL LU "ES TWMWG[ERLM FRORYLMW ZGW[FE RNJO[MEF
kuv;95.* d5
v[JvLM v[GW gGLTG[N
Plastic Surgery Resident | Fall 2015
9