Two Ways to Become a Plastic Surgeon: Why I Did General Surgery

Someone asked me whether doing general surgery first made me a better plastic surgeon, and I want to be careful here, because this is always a bit of a loaded question inside my field.

So, full disclosure up front: all the ways to become a plastic surgeon produce fantastic plastic surgeons. I'm not here to tell you one pathway makes better doctors than the other. I'm going to tell you why I valued my general surgery training and what I think it gave me.

For those who don't know, there are two routes into plastic surgery.

The traditional route is the one I took. You complete a full surgical residency first, finish it, and then do a plastic surgery fellowship afterward.

The integrated or combined route is the newer one, and it's what most programs have transitioned to. You match directly into plastic surgery and you're in plastic surgery the entire time.

The trade-off is real in both directions. In the integrated model, you spend more total time in plastic surgery, which is obviously valuable. But you're also starting as a younger resident.

Here's the part I think gets underappreciated.

When you arrive at plastic surgery as an older resident who has already been a chief in a surgical specialty, you learn faster. Not because you're smarter, but because you already have a surgical skill set to hang new information on. The fundamentals aren't consuming your attention anymore, so you can spend that attention on what's actually new.

Both ways are great. That's just the specific advantage of mine.

I loved my general surgery training. All of it. My favorite subspecialties were trauma, transplant, and vascular — and I'd happily go back and do any of those rotations again.

But the thing I'd point to as most valuable isn't a particular operation. It's this: general surgery is a field where you learn how to care for extremely ill patients.

I did 11 dedicated months in a surgical ICU, and I had ICU patients on my service the entire time I was a resident. That does something to you as a physician. It makes you a really good doctor.

Now, the honest reality: as a plastic surgeon, I rarely have critically ill patients where I'm the only physician managing them. That's not the day-to-day of my practice. But I could be. And I love that I have that skill set sitting there, whether or not I reach for it often. It's part of why I believe your surgeon should be the one managing your complications rather than handing you off.

There's a second thing, and it's about responsibility rather than medicine.

As a junior resident, you're part of the team. As a chief resident, you're running the team. Those are genuinely different jobs, and learning to run a team in a general surgery environment was very valuable to me.

Again, I think it just makes you a great doctor.

Here's the broader context, and it cuts against my own preference.

Medicine is moving toward specialization across the board. There's not a lot of "general" anything anymore, and that's true even within plastic surgery — most of us specialize after training, even though we're trained across an enormous range.

Plenty of other surgical subspecialties are doing exactly what plastic surgery did: reducing the total years and cutting off the general surgery portion at the end. Vascular surgery has done it. Cardiac surgery has done it.

And with the changing medical environment and the complexity of these fields, I think that's probably for the better. You can only fit so much into a training pathway, and the depth these specialties now require has to come from somewhere.

I can hold both of those thoughts at once. The trend makes sense, and I still wouldn't trade what I got.

I want to be clear about what this post is and isn't.

This is not a checklist item for picking a surgeon. Integrated-pathway plastic surgeons are excellent, and a surgeon's route through training is not where you should be spending your evaluation energy. The things that actually matter are whether they're board certified by the right board, whether they hold hospital privileges, and whether they're a plastic surgeon at all rather than a "cosmetic surgeon". Those distinctions are enormous. This one isn't.

There are two roads into plastic surgery, and both produce excellent surgeons. The traditional path means a full surgical residency followed by a plastic surgery fellowship; the integrated path means matching directly in and spending more total time in the specialty.

I took the long way. What it gave me was comfort managing critically ill patients, nearly a year in a surgical ICU, and the experience of running a surgical team as a chief — none of which I use every day, and all of which I'm glad to have. The field is moving away from that model for defensible reasons, and I think the trend is probably right.