How to Become a Plastic Surgeon

Requirements

The road to becoming a fully independent and licensed plastic surgeon is a long one in the US. Beginning with an undergraduate degree like a BA or BSc, you will begin medical training proper in a 4-year medical school accredited by the AAMC, then a 6-year plastic surgery residency program accredited by the ACGME. Throughout all of this you’ll take qualifying and licensing examinations, from the MCAT before medical school, to the USMLE series through medical school and residency, and finally board certification exams at the end of residency.

It’s a truly massive investment of time and energy—approximately 14 years from the start of post-secondary education to full physicianship, and even longer with subspecialty training after residency. But the results speak for themselves: plastic surgeons enjoy tremendous career stability, moderate and varied workloads, and their compensation is among the very highest in all of medicine.  

Undergraduate Degree and Prerequisites

The first big task in your journey to plastic surgery is completing an undergraduate degree—either a Bachelor’s of Arts (BA) or Bachelor of Science (BS or BSc). This phase of work is commonly referred to as “premed,” meaning simply before medical school. A common misconception about premed work is that students who major in Biology or one of the other physical sciences most seemingly relevant to medicine stand a better chance of getting accepted to medical school. This isn’t true—according to most surveys, graduates in mathematics, social sciences, and the humanities do about as well as students with degrees in the physical sciences. Medicine is a field that requires many different skillsets, from dexterity to communication skills, and from in-depth organic chemistry knowledge to expertise in psychology. Although the term is more often used by DOs rather than MDs, traditional or “allopathic” medicine is still a field that demands a holistic approach by both students and practitioners.

Rather than looking at your undergraduate years in terms of what major to choose, think about more in terms of what courses you need for medical school and, most of all, how you can graduate with as high a GPA as possible. As with many things, you need to strike a balance between developing relevant knowledge and skills and boosting your “numbers” as best you can.

Many medical schools list required courses or prerequisites for admission, and so your first step in crafting your undergraduate plan should be to draft a list of medical schools you’d like to attend and their specific prerequisites. The AAMC’s Medical School Admissions Requirements (MSAR) database is a great resource for this information.

Generally speaking though, most prerequisite lists include the following:

Most medical schools will accept these prerequisites if taken at a community college or international school rather than a standard university, but typically not credits acquired through College Level Examination Program (CLEP) examinations. In general, medical schools value more traditional learning environments, so full-length in-person and online courses from accredited universities are the standard.

As you progress in your undergraduate courses, be sure to check in with yourself and examine how you feel about your proposed career path. Medicine in general and plastic surgery in particular are long and arduous career paths, and you want to ensure you feel confident and driven to continue on. This kind of self-reflection will be especially helpful later on, when you need to draft your medical school personal statement.

Taking the MCAT

As you approach the midway point of your undergraduate years you’ll need to start preparing to take the Medical College Admissions Test or MCAT. While there are some medical schools that don’t require the MCAT, the vast majority do, so this will be another mandatory step on your journey to becoming a plastic surgeon in most cases.

You’ll first want to make sure you have a grasp on your medical school application timeline. Most medical schools in the US have similar calendars for how and when to submit application materials through the American Medical College Application System (AMCAS) or TMDSAS, but it’s imperative to know exactly when you need to have your application materials submitted, and a crucial part of those materials is the MCAT.

Provided you’re not a non-traditional applicant on a non-standard timeline, you’ll begin planning your MCAT study schedule some time after your second year of undergrad, after all the major prerequisites have been completed. Although you’ll want to give yourself as much time to study as possible leading up to the exam, our general advice is to not start studying in earnest until 6 months prior to your exam. Your knowledge needs to be fresh and easily accessible, and the more time it sits in “long term storage,” so to speak, the harder it will be to deploy it on the exam.

Your prep will start by taking a full-length MCAT diagnostic test to assess your baseline strengths and weaknesses. Following this, you can plan out your study plan and make sure it lines up with your preferred MCAT test date. Your first phase of preparation will involve considerable review along with smaller blocks of practice questions. As you progress, you’ll eventually switch over into longer blocks of practice questions and limiting your review time to only what’s absolutely necessary. Active study—practice that includes taking the time to learn why you got a given question wrong, creating quizzes for yourself, and so on—is key to keeping yourself engaged in the process. Lastly, many students with heavy science backgrounds find the Critical Analysis and Reasoning Skills (CARS) section quite hard, so going over CARS strategy will help you implement strategies that can address the uniqueness of this section. 

Check out our video for a failproof MCAT CARS strategy:

Applying to Medical School

The first step in applying to medical schools is to research your chosen schools’ admissions data using their specific websites and the aforementioned MSAR database. Make sure to check out the best medical schools for surgery. Get a sense of how competitive your GPA and MCAT scores will be and find out what qualities they value in applicants to help steer your personal statement and, to a limited extent, your letters of recommendation.

You’ll start drafting and assembling your AMCAS materials during your third year as an undergraduate with the aim of submitting your application before the start of your fourth/senior year. A standard AMCAS timeline looks something like this:

Before we celebrate moving on to medical school, let’s briefly go over the main elements in your AMCAS application 

Primary Application & Background Information

This covers your identifying information, schools attended, and basic biographical information like name, date of birth, citizenship, and so on. 

Coursework & Transcripts

While your official transcript will be sent to AMCAS following your request, you’ll also have to input its contents into the AMCAS application’s Coursework section before submitting. This covers the basics like dates of attendance, courses taken, and grades, including overall GPA.

Letters of Evaluation

More commonly referred to as Letters of Recommendation, these are confidential letters submitted by either individual faculty/writers or a committee of writers to support your candidacy. Each school has slightly different guidelines for these—some schools prefer a specific mix of individually-written letters, and others prefer a committee letter written collective by a group of faculty. As always, check your school’s specific medical school requirements before making these requests.

Work and Activities Section

The AMCAS Work and Activities section is sort of like a CV. It covers the relevant information not included on your transcript, including research projects, publications, extracurricular activities, clinical experience, shadowing, volunteering, and much more. The AMCAS application includes room for up to 15 entries in this section, and you can identify 3 of these as the most meaningful. 

Personal Statement

The AMCAS personal statement is your opportunity to share your story up to this point. While it isn’t as initially make-or-break as your GPA and MCAT score, it’s the element that allows you to speak directly to admissions committees and, in this case, discuss your desire to pursue a future career in medicine. The most important aspect of your personal statement is to be honest and not lapse into marketing yourself or your skills. Your other application materials can attest to your academic performance and skills, but the personal statement is where you provide the context and narrative that fleshes out those details.

Secondary Applications and Essays

Most medical schools function on a two-application system, meaning they will assess your AMCAS materials and then, pending a positive assessment, send you a secondary application which includes prompts for a secondary essay. These are where you’ll be able to dig into the details of your desired specialty a bit more, although each school’s secondary questions are different and so the scope of your responses will necessarily vary as well. Consulting medical school secondary essay examples can be especially helpful for this, as these prompts usually come with specific word/character limits. You may be extremely comfortable answering the question “where do you see yourself in ten years?” in 1500 words, but if your limit is 400 it will greatly benefit you to see how others have handled similar constraints.

While in Medical School

The second of your three big educational phases begins with matriculating to medical school. Most medical schools are structured around a 4-year curriculum that gradually shifts from coursework into full-time clinical work.

The first year in most programs is almost entirely classroom-oriented, while the second year is a varying mix of coursework and “core” clerkships in specialties like internal medicine, emergency medicine, neurology, pediatrics, psychiatry and—most relevant for you—surgery. These core clerkships vary from school to school, but their focus is on developing clinical knowledge and skills through limited patient interactions under detailed supervision. Clerkships are somewhat similar to shadowing, but a step up in terms of activity and responsibility. Once you’ve completed the phase of core clerkships, usually by midway through year 3, you’ll begin advanced clerkships and electives, as well as dedicating more time to research projects depending on your program.

Coursework in medical school will cover a great deal of science, but geared toward its use in medical practice to a greater extent. Expect coursework in anatomy, biochemistry, radiology, microbiology, and pharmacology among much else. During the first year especially, medical schools often utilize some form of “Basic Doctoring” or introductory course specific to developing understanding of clinical practice and knowledge. In especially renowned schools, these year-long courses are often tailored to the specific aims or values of the school, such as the “Genes to Society” course at Johns Hopkins.

Throughout medical school you’ll also be required to take the various United States Medical Licensing Exams (USMLE). The USMLE is organized into 3 individual exams or “Steps.” They are:

As noted, only the Step-1 and Step-2 exams are taken during medical school, whereas the Step-3 is taken either after graduating and entering into general practice or into the first year of residency. Since you’re headed for Plastic Surgery, you’ll be in the latter group, and in fact most, if not nearly all, graduates of medical schools go on to residency in order to become licensed in a medical specialty. This is precisely your next step on the road to becoming a Plastic Surgeon.

Applying to Residency Programs

By the beginning of your third year in medical school you’ll begin crafting your application materials for residency program applications. These are submitted through the Electronic Residency Application Service or ERAS. Your ERAS materials are then utilized by the National Resident Matching Program or NRMP. Your ERAS application for residency will be similar to that of your AMCAS application for medical school, with some notable differences.

In addition to your medical school transcripts and residency personal statement, your ERAS application will also require:

For plastic surgery residencies, you’ll of course want to discuss your experiences in surgical rotations, as well as any plastic surgery-specific experiences you had during medical school. You can do this in the personal statement, but a record of strong performance in surgery should be apparent in your MSPE as well. During medical school you’ll want to have undertaken as many surgery-related elective rotations as possible, including those in general surgery, plastic surgery, and orthopedic surgery. While your application materials for medical school won’t need to show much specialty-specific experience, your application for residency should indicate work toward your chosen path of plastic surgery. This can also include shadowing experiences as well, which may be easier to arrange than formal clinical clerkships.

Your ERAS timeline will have you submitting your application materials sometime in September of your fourth year in medical school, and you should register into the NRMP Match program in this same month after submitting. You’ll begin interviews with programs shortly after this in October, during which time you’ll rank the programs you interview with according to preference. From this list, and similar data provided by residency programs, students are “Matched” to residency programs to which they’re the best fit in March. After this, you’ll finish your final few weeks of rotations and elective work, and then set off for residency.

Check out the top residency interview questions you must know:

Residency and Licensing

You’re almost there! How long is residency? Plastic surgery residency programs are approximately 6 years in length, and are broken into 3 years of General Surgery training to further develop your surgical skills, and then 3 years of specialized plastic surgery work. In essence, plastic surgery residency doesn’t start until the fourth year. While there are integrated residency programs—plastic surgery residencies available to recent medical school graduates that include 3 years of preparatory work and then 3 years of specialized work—most are limited to a 3-year independent residency in plastic surgery following a full residency in either general or another specialized surgery. In essence, you’ll be applying for residency in one of these non-plastic surgical residencies and then moving into a plastic surgery-specific residency thereafter.

There are 54 accredited plastic surgery residency programs in the US, and a total of 205 active residents and fellows. On that last point, many residents continue into subspecialty fellowship training following their initial plastic surgery residency, which may include work in:

If you opt into subspecialty fellowship training, you can expect at least another 2 years of residency before moving on into fully unsupervised practice, but can also count on an even greater level of job security and compensation. 

Licensing

Final licensing for independent practice in plastic surgery is attained through examination by the American Board of Plastic Surgery. These board exams are divided into two halves: a written examination and an oral examination. 

Written Exam — Comprised of 3 blocks of 100 questions and 1 block of 50 unscored questions. Crucially, the unscored questions are scattered randomly throughout and are not indicated as such. They’re included to assist in analyzing “the statistical properties prior to those items being placed on an examination.” Total testing time is about 7 hours. 

Oral Exam — After passing the Written Exam, candidates are required to submit a 9-month case list to be assessed by the Board. This list is assessed to establish diversity, complexity, and volume of plastic surgery procedures undertaken by the candidate, and from this list the Board chooses 5 of these cases to be used as the foci of the 2.5-day oral examination. This is, unsurprisingly, the most demanding and intimate examination in the career of a plastic surgeon, as it consists of direct discussion and analysis of the plastic surgeon’s case reports with a committee of 5 people. It’s intense!

Last, there will be some action required to obtain a state medical license, but in some cases examinations can be waved if a doctor has already passed the USMLE Step-3 and completed a post-graduate residency program.

Practice and Compensation

There are slews of videos on YouTube that follow a day in the life of a plastic surgeon, and common to each is the sense that they work not as loners but as important parts of incredibly talented teams. Between administrative workers, PAs, nurses, and fellow surgeons, most practicing plastic surgeons are like a lead instrumentalist in an orchestra than standalone soloists. A day may involve a single surgery or a series of surgeries, and may last a very comfortably 6 hours or nearly 16. As highly specialized physicians, plastic surgeons are able to choose, to a great extent, their workload and location. 

With regard to compensation, it’s somewhat entertaining to think in terms of the entire process outlined above. In your premed years, you’ll likely live quite minimally, perhaps maintaining a part-time job but likely relying on students loans and medical school scholarships to pay your medical school tuition and cover the remainder of your living expenses. In medical school, this shifts fully into debt-growth, as you will likely be unable to maintain any kind of paid work outside of your program. Most students graduate from medical school with nearly $200k in student debt, which in most situations would be cause for absolute despair.

However, the tide begins to turn in residency. Average resident pay for plastic surgery residents is slightly higher than average, but begins as most do around the $60k mark. Still, it’s pay! You won’t really start paying off your student debt with this, but it can keep you afloat and prevent or at least minimize accruing further debt. However, upon leaving residency and beginning your unsupervised practice, you can expect to make upwards of $443k per year. The long hours, the gargantuan level of debt, all your hard work—all of this will have gotten you into your dream career and a lifetime of financial security. 

Becoming a Plastic Surgeon in Canada

Most of the outline above applies to students in Canada as well, but it’s worth noting the differences here before concluding. Overall, Canadian medical schools are in fact more competitive than many in the US, with lower acceptance rates on average. There are also slight differences in the application processes for both medical school and residency matching, assessments throughout medical school, and the structure of residency programs. Let’s go over these differences now. 

Applying to Medical School in Canada

Most Canadian schools require the MCAT, although the University of Ottawa does not. Individual schools will additionally vary by how they weigh individual sections—for instance, McMaster only considers your score on the CARS section, while Toronto has a section-specific cutoff of 125. With regard to MCAT policies and your study strategy, then, always consult the sites of specific schools to which you’re applying before committing to a plan. 

While the US utilizes the AMCAS system for medical school applications, medical schools in Canada are more individualized. While Ontario’s six medical schools utilize the centralized Ontario Medical School Application Service (OMSAS), other schools use their own independent online application systems. There is no central, national application service like AMCAS in the US. We’ll discuss things mostly in terms of OMSAS, but many of these guidelines and application elements are common to each school’s application system, whether in Ontario or elsewhere. 

Like AMCAS, OMSAS includes fields for basic information, MCAT, and GPA information, including your transcripts. OMSAS also includes a few unique fields, including the sketch. The autobiographical OMSAS sketch takes the place of the personal statement and AMCAS Work and Activities section, and includes space for 32 items in 7 categories, including: employment, formal education, volunteering, extracurriculars, awards/accomplishments, research, and “other.” This will take you quite a bit of time, and additionally requires “verifiers” to be added to each item. These verifiers will be different than the individuals—termed “referees” in OMSAS—who have provided your confidential assessments or letters of recommendation. 

Lastly, just like in the US, Canadian medical schools often have school-specific short essay questions to be answered as part of the application. For schools outside Ontario you’ll simply answer these as part of the online application, but in OMSAS you’ll select which schools you’re applying to and be prompted with each school’s questions from there. 

While in Medical School in Canada

Although Canadian medical schools utilize a similar 2+2 curriculum model that divides the program into a coursework-heavy phase and a preclinical rotation phase. However, a big difference between the two countries is grading for each of these phases—while US medical schools largely use Pass/Fail grading during only the first two years, Canadian schools utilize P/F throughout. 

Of additional note is the lack of the USMLE exam series in Canada. Instead, Canadian medical students take the MCCQE Part 1 and Part 2 exams after matching into a residency programs. Of course, if you plan on applying for residency in the US you’ll still need to take the USMLE exams as well, but for students staying in Canada after graduating from their MD program, they’ll be spared having to take both.

Applying to Residency Programs in Canada

Residency matching in Canada is handled by the Canadian Residency Matching Service (CaRMS). Because Canadian students don’t take the USMLE, which is a big factor in US residency application evaluation, the Letters of Recommendation, Personal Statement, and CV are much more influential in matching. Additionally, CaRMS utilizes an MSPR rather than MSPE, which is in most ways the same thing except it does not feature the “Noteworthy Characteristics” section. Because of this difference, the MSPR is prepared and sent automatically by your school to CaRMS, eliminating the need for a separate meeting and editing process with a committee at your medical school.

You’ll also want to do some CaRMS interview prep before your interviews begin following your application submissions as well. The structure of residency interviews in Canada is quite similar to that of US programs, but you’ll want to make sure to review common CaRMS interview questions beforehand to boost your confidence and ease for the big day. 

Lastly, since you’re aimed at plastic surgery you’ll also want to ensure that you’ve taken as many surgery electives as possible during medical school, in both general and specialized surgeries. You’ll also want to ensure one of your letters of recommendation comes from one of the attending surgeons with whom you worked during these rotations. Lastly, ensure that you have some surgery-specific shadowing experience early on in medical school to indicate the longstanding nature of your interest in the specialty.

Residency and Licensing in Canada

Residency programs in Canada are also quite similar, although there are sometimes small differences in duration. For instance, family medicine residencies in Canada run 2 years rather than 3 years in the US, while neurology residencies are 5 years long in Canada and 4 in the US. These differences are largely the result of slightly different guidelines set by the Royal College of Physicians and Surgeons of Canada, but for the most part the major points of these guidelines—types of proficiencies required for accreditation, etc.—are very similar. 

As noted above, the big difference comes in the form of assessments. While US residents need to take the USMLE Step-2 and Step-3 in residency, Canadian residents take both parts of the MCCQE. These exams serve effectively the same purpose despite their minor differences though—both series are designed to ensure that residents are prepared to function as independent/unsupervised physicians following completion of their programs. 

A big structural difference of the MCCQE is its use of Objective Structured Clinical Examination (OSCE) stations for the Part-2 exam. Reminiscent of the COMLEX Level 2-PE, the MCCQE Part-2’s OSCE stations are simulated patient encounters in which the candidate is required to perform a number of basic clinical functions like eliciting a history, answering questions, assess an urgent situation, and so on. These take some preparation to master, but by the time you take the Part-2—likely in your second or third year of residency—you’ll already have a fairly extensive history of clinical work and rotations informing your navigation of these simulated encounters. 

Lastly, Canadian residents will need to pass the Royal College’s comprehensive plastic surgery exam. This is a big, three-part exam that includes: 

1. Surgical Foundations exam
2. Written component, comprised of two 3-hour papers of short answer questions relating to plastic surgery specifically
3. Oral examination, comprised of stations testing various competencies in which the candidate answers questions posed by examiners centered on clinical vignettes

This is not unlike the American Board of Plastic Surgery exam, but differs in its use of an additional general Surgical Foundations exam. Following this last series of exams, though, Canadian residents move into fully licensed, independent practice.  

Lastly, compensation for plastic surgeons in Canada is about on par with those in the US—approximately $450k per year. 

Conclusion

While the financial advantage of becoming a plastic surgeon is indeed impressive, there’s almost no way to maintain focus and discipline throughout this 14+ year process for the sake of money alone. If that were the case, your time would likely be better spent training into finance or business administration. Rather, the real beauty in pursuing a career in plastic surgery is literally making the world a healthier and more…well, beautiful place. Medicine is a calling, and to be called to plastic surgery is to desire to improve the material world in a more visible way than that of many medical specialties. You’ll be directly impacting people’s sense of self and their happiness with their own bodies, and this kind of impact is a truly rare thing for anyone to accomplish, let alone on a daily basis. It will be a long and arduous path, but with careful planning and unparalleled hard work you can enjoy the artistry and meaningfulness of life as a Plastic Surgeon.

FAQ

To your success, 

Your friends at BeMo 

BeMo Academic Consulting

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