In a plastic surgery residency, you’ll learn the skills of a surgeon and the artistry of a sculptor needed to fulfill the needs of your patients, from babies to the elderly. The discipline requires as much training and skill as you would learn in a , as all plastic surgery residency programs usually last for five or six years. There are two pathways in the US, at least, that you can take to becoming a plastic surgeon that we’ll talk about. In Canada, you’ll spend the same amount of time – five years – and have a similar structure as a . You will have to do off-service rotations before getting into the core plastic surgery courses such as reconstructive and aesthetic surgery. This blog will take you through the pathways in both countries, and give you insider information on what plastic surgery residency directors are looking for in your application.
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A plastic surgery residency is where you learn how to restore and repair, build and deconstruct, create and reimagine all aspects of the human body. As a plastic surgeon, you’ll help people regain a sense of normalcy after traumatic and life-changing injuries. WWI veterans needed plastic surgeons. Burn victims need them as well. However, your patients will not always have these issues and it is the variety of problems that a patient can present with that graduates enjoy about the profession.
Many programs in the US are designed to be either integrated or independent residences, which are the same as categorial and preliminary. There are a lot of schools that offer only one path, and you can choose whichever path suits you, but the breadth of knowledge you’ll need to internalize and learn will be substantial. You’ll deal with the skin and blood vessels; the jaw and mouth; face and hands; and learn how to use the entire body as a tool to repair itself.
To give you an idea of the variety of plastic surgery, here’s a list of common plastic surgery subspecialties:
Advanced Complex Tissue Injury
- Cleft Lip and Palate
- Hand and Upper Extremity
- Peripheral Nerve Network
- Post-Bariatric Body Contouring
- Skin Cancer
- Ear Reconstruction
And there a few more, basically, for every part of the external body. Categorical plastic surgery residencies in the US often start with the basics of the field regarding knowledge of surgery and teaching standard surgery skills. You’ll also do a few rounds in medical specialties that are related to plastic surgery such as an or .
As we talked about earlier, if you want to become a plastic surgeon in the US there are two pathways:
- Integrated Plastic Surgery Residency
- Independent Plastic Surgery Residency
There are not that many differences between “integrated” and “categorical” in this context and integrated means the same thing as categorial – a residency for PGY-1 residents who will learn first about other medical specialties and then enter plastic surgery residency rotations. An “independent” plastic surgery residency is for residents who have completed at least two or three years in another surgery residency program and have decided to specialize in plastic surgery.
There are over 90 integrated plastic surgery residencies in the US with 207 positions and they had over 250 applicants last year so it is not a particularly competitive field. The first years of a plastic surgery residency involve a lot of didactics but in various formats, including textbooks and lectures as well as rotations through various departments.
Depending on the program, you’ll either first rotate through various wards and departments in a general surgery capacity or start directly into plastic surgery wards such as burn units, breast reconstruction, and pediatrics.
If you take the independent route, you’ll probably end up doing the latter, as some programs require completion of another residency related to plastic surgery before applying. But one way to make an easier transition into an independent plastic surgery residency is by completing your surgery residency at the same program/school/hospital.
You will still have to apply and be accepted, but graduating into the plastic surgery residency program after you’ve completed something else at the same institution will look good on your application, and is actually recommended by some programs.
Many schools offer both pathways (integrated and independent) and you can also continue with a to further your training. You will have to be board-certified by the American Board of Plastic Surgeons (ABPS) to start practicing and that can take a long time. According to the ABPS, many plastic surgeons train for between 14 to 16 years and have passed various boards and certifications so it can be a long time before you start practicing.
The almost 250 integrated plastic surgery residency positions available were all filled last year, for a 100% match for all applicants with a majority of those positions (92%) going to US medical graduates. Despite its prestige, variety and the amount of job opportunities a plastic surgery is not as popular as other surgery subspecialities such as general surgery, which had over 3000 applicants. The length of training involved could account for the low numbers, but PGY-1 applicants still have to submit the typical application materials through to apply, such as:
But independent plastic surgery residencies do not typically participate in the ERAS, as they have a variety of different they use to accept and review applications to their programs, such as the San Francisco match service or the Only Plastic Surgery Common Application (PSCA). They also have different admission requirements since you have already completed a residency.
But what kinds of things do program directors look for?
Surgical residencies stress more accomplishments than other skills such as USMLE scores and grades, although those are important too. But they also want to see things such as you shadowing a plastic surgeon, or beyond that having been mentored over time by a plastic surgeon. You could also do an elective in surgery or a related field, and having published research into the subject, which are general things, but they apply more to surgical residencies than non-surgical ones.
The number of integrated programs is higher than independent programs, so we’ll look more at how they are structured over independent programs, as integrated programs are more profligate. Integrated programs take you through the basics of any surgical resident including a general surgery resident, such as taking patient histories and assessing their condition. Plastic surgery, as any surgery subspecialty, is especially patient-facing so knowing how to properly build rapport with patients is important.
You’ll take instruction through a variety of sources and formats and rotate through various clinical locations that are particular to your program or school. Some programs use conferences – academic conferences – as a learning model where you can learn from expert faculty or discuss specific cases with a large group of residents headed by an experienced surgeon. You will have some specific plastic surgery rotations ranging from cosmetic surgery and trauma to transplant and hand surgery.
In the final three years, which is where independent plastic surgery programs begin, you’ll advance to exclusively plastic surgery rotations in aesthetic or reconstructive surgery, pediatrics, skin or breast cancers, and oral and maxillofacial surgery. These rotations can take between two or four weeks, depending on the program, and it is only in your final year, usually, that you have the freedom to choose electives or a research project. Once you have completed the final year you are ready to obtain a board-license from the ABPS.
In Canada, you will have to spend at least five years in a program, as there are no distinctions between integrated and independent; categorical and preliminary. You will enter directly from medical school and attend what a lot of programs call a “surgical boot camp” where you will go intensive, four-week training in surgery basics. Then you will proceed to rotations in other medical specialties and then, in the later years, move to strictly plastic surgery specialties and subspecialties such as aesthetic and extremity surgery.
Since all Canadian residency programs are switching to the Competence by Design model, you’ll only progress to the proceeding years of your residency by completing Entrustable Professional Activities to prove your competency in a simulated real-world environment, rather than having you write typical in-training exams. This is something we’ve already talked about, but as it is a universal program then we’ll mention it mostly in relation to the plastic surgery residency programs available in Canada, and how some curricula might change in the near future.
You’re also encouraged to do research during your residency, as in the US, but very few programs have a research module integrated into the curriculum and you will have to take time off to do it. Plastic surgery is big on research, even though it may not seem like it from both the US and Canadian pathways, but being involved in research even before you apply is a good way to stand out from other applications, which we’ll talk about more in the following section.
There are only 24 plastic residency positions in Canada. But they have a perfect 100% match rate, and there were almost 90 applicants last cycle so getting into these positions is incredibly competitive. The number of positions has risen and fallen over the years suggesting that some programs increase the number for reasons as varied as not enough applicants or more resources being diverted to the plastic surgery residency program.
But the application requirements are typical for any residency program in Canada, as you must submit:
have to provide more application materials, including their proof residency or Canadian citizenship, as well as a USMLE or scores. Some residency programs also ask for MCCQE Part 1 scores from Canadian medical graduates, although it is not a universal requirement. Many programs also forego the sometimes-used , which consists of the CASPer exam that many medical school and residency programs use to assess your non-cognitive abilities.
But as to what Canadian plastic surgery residency program directors are looking for in an application; since the world of Canadian plastic surgery residency programs is small (only 13 programs) many residency directors, current residents and other faculty know each other well, meaning a collection of outstanding letters of reference are viewed more favorably than other applications elements, such as a personal letter.
In keeping with the theme of familiarity, another important factor in getting an interview invitation is if you have completed an elective at the program you are applying to, so your interviewers know you on some level and can remember you. Even if you graduated from another medical school, taking an away rotation at your dream program will give you an early introduction to the faculty, as well as demonstrate your desire to join the program.
Many plastic surgery residency programs in Canada, such as at McGill and the University of Toronto, have already made the transition to the Competence by Design model, so the structure of your residency program will almost look the same no matter where you study. Of course, every program has different pathways to pass through the four stages of the CBD model:
- Transition to Discipline
- Foundations of Discipline
- Core of Discipline
- Transition to Practice
But, as a plastic surgery resident, you will have to demonstrate your ease and competency in performing vital procedures unique to your discipline. We already talked about the “boot camp” that many programs favor as an introduction for you to grasp the medical science behind plastic surgery, so once you have acceded to the later years of your residency you will focus more on plastic surgery specific rotations.
A lot of programs have a specific preference for residents who are interested in becoming faculty or academic doctors, so you may have a chance to teach or do a research project during your later years as well. So much of your residency goes into learning and seeing patients because you will always be presented with a unique problem, which requires a unique solution. Plastic surgeons are known for solving problems with out-of-the-box solutions, such as skin grafting, leaving flaps of skin or using microsurgery.
Get Great USMLE Scores
This tip applies more to American residents than Canadians, as board exams do not often figure into the application process in Canada. But, generally, having high USMLE scores (some independent plastic surgery residency programs in the US even have a minimum to be interviewed) is a good indicator that you have the cognitive knowledge to be a competent plastic surgeon. They are also a good indicator of whether you will pass your board certification so program directors are keen to see how you’ve fared at the main licensing exam.
Strategize your Interview Answers
It’s no secret that residency program directors place a lot of value on your interview performance. It’s not only your answers they judge, but how you carry yourself, how you answer your questions and what kind of questions you ask them, so there is a lot of you need to prepare before going in for your interview. Mock interviews are one of the best ways you can prepare, since they allow you to formulate and refine answers to the most common Some programs in Canada use , so, you’ll have to prepare by reading over , but also, by reading up on the latest developments in plastic surgery to keep in mind when you are in the interview.
Choose the Right Clinical Electives
This tip applies more to Canadian applicants as most program directors in Canada want to see that you have prepared specifically for surgery during medical school. As we mentioned, if you are able and have the resources to take an away rotation or visiting student rotation at another program, specifically, the one you want to attend, you should do it. Not only will you get an introduction to the department before anyone else, but you’ll also be able to form relationships with the faculty so they will remember you when you application comes up.
Get Great Letters of Recommendation
We talked about this already, but the importance of letters of recommendation to getting into a plastic surgery residency cannot be overstated. This is important in the US, but more so in Canada, as residency directors there have less to rely on to determine your skill level, work ethic, and professionalism. And since many of these program directors are familiar with one another, hearing from one of them that you are an excellent student with significant potential can make your application stand out.
1. Is a plastic surgery residency competitive?
Plastic surgery is not among the in North America as the number of positions available in both the US and Canada are level (more or less) with the number of applicants all these programs receive every year.
2. How can I get into a plastic surgery residency?
Plastic surgery is a surgery subspecialty so you’ll need to take a lot surgery electives, and have a lot of extracurricular experiences in clinics that treat people with a range of ailments.
3. What are the requirements to get into a plastic surgery residency?
In the US, you can choose between doing an integrated or independent residency, which we already explained that you’ll need different requirements for each program. But generally, you’ll need to have completed medical school; taken and passed the USMLE; letters of recommendation; research or surgical experience.
4. How much are the starting salaries for plastic surgery residents?
In the US, salaries can vary depending on the program, but one program’s starting salary is $58,965, which can go up to $70,000 in your final years. In Canada, you can expect to earn $61,635 in your first year and $83,860 in your final year.
5. How long does a plastic surgery residency last?
In the US, a plastic surgery residency can last between three years for independent residencies, or five years for integrated ones. In Canada, a plastic surgery residency program is categorical so you’ll spend five years in the program.
6. Is there a good work-life balance for plastic surgeons?
A majority of plastic surgeons say they are quite satisfied with their work-life balance. As with some medical specialties, plastic surgery is highly specialized, so they only work when they are needed. Since a lot of plastic surgeons go into private practice, they can also determine their own schedules.
7. How can I match to plastic surgery residency?
The things that’ll help you get into a plastic surgery residency are outstanding board scores, taking surgery electives, and demonstrating a sense of service through volunteer work or a global elective to demonstrate how you’ve tried to address disparities in health care, especially in plastic surgery.
8. Which plastic surgery residency program is the best?
We listed the top programs above, but the UCLA system (including all the other medical schools) are typically ranked highest, while the University of Ottawa in Canada has a well-regarded program.