Becoming a Plastic Surgeon: Education, Training, and Career Path

For individuals considering a career in medicine, plastic surgery presents a fascinating and diverse specialty. This article provides an overview of the educational journey, training requirements, and career prospects for aspiring plastic surgeons in the United States and Canada. It is vital for readers to have a good understanding of the amount of time and effort required to complete training in Plastic surgery, obtain a license, and practice as a Plastic Surgeon in the US or Canada.

What Does a Plastic Surgeon Do?

A plastic surgeon is an Allopathic or Osteopathic Physician (MD or DO medical degrees) that has completed education including a Bachelor's degree, a medical degree from an Allopathic or Osteopathic med school and a plastic surgery residency training program lasting a minimum of six years in duration. Plastic surgery involves the reconstruction, repair, or replacement of physical abnormalities of function or form. It encompasses a wide range of procedures affecting the hand, trunk, skin, musculoskeletal system, breast, extremities, and external genitalia.

Plastic surgeons treat a wide variety of diseases and disorders, including congenital defects, cancers, traumas, degenerative or autoimmune illnesses, and everything in between. In general, Plastic surgery can be broken down into two major components, cosmetic and reconstructive surgery. When plastic surgeons see a new patient they will first perform a history and physical to better understand a patient's history. They may then order additional tests to learn more information about a patient's diagnosis. This will usually include imaging studies such as an X-ray, Cat scan/CT scan, MRI, and ultrasound. Other common tests they may perform include biopsy, wound culture and complete blood count.

Plastic surgery has been prominent in the development of innovative techniques such as microvascular and cranio-maxillofacial surgery, liposuction, and tissue transfer.

The Path to Becoming a Licensed Plastic Surgeon

The journey to becoming a licensed plastic surgeon is a long and demanding one, requiring a minimum of 14 years of dedicated education and training. Here's a breakdown of the essential steps:

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1. Undergraduate Education and Bachelor's Degree

After High School, the long and arduous path to becoming licensed in Plastic surgery begins with completing all the prerequisite college courses and obtaining a Bachelor's degree. The first step involves completing a bachelor's degree. While there is no specific major requirement, Biology, Chemistry, and Physics are common choices. Some colleges and universities offer "pre-med" majors or training programs that ensure med school requirements are met. During this time students will take many courses in Biology, Chemistry, Mathematics, and Physics.

2. Medical School (MD or DO)

Medical school must be completed after undergrad and usually takes four years to complete. The next step is completing a four-year medical school program. There are two routes to complete this part of the journey including obtaining an MD degree from one of the more common Allopathic schools or obtaining a DO degree from an Osteopathic med school. During medical school, students acquire foundational knowledge in basic sciences, clinical medicine, and surgical principles. It is during this period of time that students must pass their first two national board examinations, the USMLE Step 1 and Step 2 for Allopathic students and the Comlex Level 1 and Level 2 exams for Osteopathic students. All students need to pass these examinations to meet the requirements for State licensing.If you are a prospective med student interested in healthcare and becoming a Plastic Surgery specialist, it all starts with getting accepted into Med school.

3. Residency

To attend residencies, a license to practice medicine must be obtained. Residents need to obtain licensing in the State they are going to be residents in. There are two formal training pathways for plastic surgery.

Integrated Pathway: In this pathway a medical student will match directly into a plastic surgery residency program for six years (five years in a few accelerated programs). In this pathway the resident will have a primary focus on plastic surgery but will also have several ACGME required surgical rotations in general, vascular, surgical critical care and breast surgery to build a fundamental foundation. For the integrated pathway, aim for multiple letters from plastic surgery faculty who can attest to your strengths. Establishing early relationships with several faculty through mentorship or research is beneficial.
Independent Pathway: In this pathway residents complete an ACGME accredited surgical residency outside of plastic surgery and are eligible to take boards within that field. Most commonly, applicants complete a general surgery residency, however, graduates from otolaryngology, neurosurgery, orthopedic surgery, urology and oral and maxillofacial surgery (if an MD/DDS and with completion of at least two years of general surgery) may also apply. The Independent Pathway is three years in length.

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The curriculum for residency training in plastic surgery is two years. A minimum of three years of clinical training with progressive responsibility in the same program in general surgery. In the integrated model, residents complete five or six years of ACGME-accredited plastic surgery training following receipt of an MD or DO degree from an institution accredited by the Liaison Committee on Medical Education (LCME) or the American Osteopathic Association (AOA). Of these five or six years, no less than 24 months must be concentrated plastic surgery training with no less than 12 months of chief responsibility on the clinical service of plastic surgery.

4. Fellowship (Optional)

Attending a Fellowship training program in one of the many subspecialties of plastic surgery isn't necessary for licensing or finding a job, but may help greatly in defining the mode of practice for a plastic surgeon career and the type of patients they may see. It also may help in large metropolitan areas where competition may be highest.

5. Board Certification

Depending upon the State, board certification may or not be required for licensure. In every State though, Board certification does signify a higher level of testing and in some cases a higher level of training and may help a plastic surgeon's career. In addition, even if Board certification isn't required for full State licensure, almost all hospitals, clinics, and employers do require Board certification as a condition of employment. Become Board certified by either the American Board of Plastic Surgery or the American Osteopathic Board of Surgery for D.O. For more information, visit the American Board of Plastic Surgery.

Securing a Plastic Surgery Residency

Obtaining a residency in Plastic surgery is one of the most competitive programs to match into. Having top grades in med school and high USMLE scores are essential as residency slots are reserved for only top students.

Here are some helpful steps for students pursuing plastic surgery:

Students should start a research project or two so that it can be finished and published by the time they begin applying. This research doesn't necessarily have to be specialty specific, but it would help if it was at least related to surgery and would be best if it were relevant to some domain of plastic surgery.
Student pursuing plastic surgery, as indicated in their MSAS career preference, will be assigned to the surgery sub-I in R1-4 and will be placed on a plastics team.
Away rotations are strongly recommended for the integrated plastic surgery residency route, as this provides opportunities for students to work within other programs and obtain other letters of recommendation outside of their home institution.
If you have a research mentor, and if you plan to continue research in residency, then it's recommended to get a fourth letter from this person. There are a few residency programs that still require a chair letter.
In this specialty, research sets applicants apart in a competitive field and gives them something to talk about in their interviews.
Establishing early relationships with several faculty through mentorship or research is beneficial.
The most valuable resource for prospective plastic surgery applicants is to engage with current residents and fellows. Their insights into their experiences, specialties, and preferences can provide invaluable guidance. Additionally, exploring the research areas and focuses of plastic surgery attendings at IU School of Medicine or other institutions can offer insight into potential areas of interest. The Plastic Surgery Student Interest Group offers students the chance to engage with plastic surgery residents and faculty.

Subspecialties within Plastic Surgery

The field of plastic surgery is broad, that subspecialties exist within the specialty of plastic surgery, including cranio-maxillofacial surgery, microvascular surgery, hand surgery, and cosmetic surgery, just to name a few.

Cranio-maxillofacial surgeons treat conditions involving the bones of the face and skull, and their associated soft tissue abnormalities such as cleft lip and palate.
Microvascular surgeons move tissues from one area of the body to another and reestablish blood supply and innervation to this tissue using an operating microscope and sutures that are finer than human hair.
Hand surgeons treat congenital, acquired, and traumatic musculoskeletal problems of the hand and upper extremity, employing both plastic and orthopaedic surgical techniques.
Burn surgeons work as part of a large team that provides intensive care for burn-injured patients and treats both acute burn wounds and chronic scars.
The goal of the cosmetic surgeon is to make changes in body shape or rejuvenate areas that have been affected by aging.

The Cost of Becoming a Plastic Surgeon

The cost to become a plastic surgeon is on average $360,966, but this is not different than the cost of becoming any other type of Physician. This number includes the educational cost of getting a Bachelor's degree at an undergraduate school as well as the cost of getting an MD or DO degree at a Medical school. According to EducationData.org, the average cost of attending med school is $218,792. The average cost of undergraduate education is $35,551 per year for 4 years = $142,204.

Plastic Surgeon Compensation

There are several online sources that we feel are reliable at reporting salaries for Plastic surgeons. According to the Medscape Physician Compensation Report for 2022, the average annual salary for plastic surgeons is $576,000 per year. This places Plastic surgeons as the highest paid annual salary of the 29 specialties that they track. Another reliable source AAMC tracks annual pay for Plastic surgeons in academic medicine. According to the AAMC Faculty Salary Report the median pay for Assistant Professors in Academic Medicine for 2022 was $407,390.

Is Plastic Surgery Right for You?

Yes, the path to becoming a Plastic surgeon is very difficult. If you are seeking a life in surgery that is exciting, interesting, fulfilling, and diverse, plastic surgery would be an excellent career choice. It is commonly perceived that plastic surgeons do nothing but cosmetic surgery. One of plastic surgery's greatest attributes, however, is the breadth of conditions that fall into the area of treatment expertise of those in the field. These include congenital, acquired, and traumatic problems.

Although the field of plastic surgery is broad and challenging, it offers flexibility in lifestyle not found in other surgical specialties. A plastic surgeon can enjoy a thriving practice in either an academic or private-practice setting. The focus of the practice can be toward areas such as trauma, where the work can be exciting and unpredictable. Alternatively, it can be focused on elective surgery, such as breast reconstruction or cosmetic surgery, where the lifestyle can be more controlled.

Regardless of what type of practice a plastic surgeon pursues, those who choose plastic surgery as a career can rest assured that they will continue to encounter new challenges in a field that is always changing. They will be able to design a practice that fits in with their goals in life.

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