DOI: 10.1097/PRS.0b013e3181a2bccc
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PMID: 19342989
Issn Print: 0032-1052
Publication Date: 2009/07/01
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Excerpt
At the same time, general surgery training was different and included training in many, if not all, surgical subspecialties and often gynecology as well. The goal of the American Board of Surgery was to ensure that an individual certified in surgery had the capability to manage any sort of basic surgical pathology. It was not uncommon to examine candidates for surgery board certification with questions regarding hand, urological, or gynecological pathology. Because the training and practice of general surgeons and surgical specialists had much in common, it made sense for them to be grouped together in departments of surgery within medical schools. Though chairs of surgery were most commonly specialists in either general or cardiac surgery, they generally had some understanding and respect for the interests of plastic surgeons and could represent them within medical schools. Resources were also more available within most medical schools to support faculties and educational programs, and support for one specialty did not preclude support for another.
Things have changed radically since the middle years of the twentieth century. The specialized bodies of knowledge that define plastic surgery and the other surgical subspecialties have expanded exponentially. At the same time, the common elements in the training and practice of surgical specialists and general surgeons have contracted. Today, training program requirements in otolaryngology, urology, and neurosurgery do not include any general surgery years. The integrated model of training in plastic surgery requires that the trainee's curriculum is under the direction of his or her plastic surgery program director from the first day of residency. Though the degree of overlap between surgery and plastic surgery varies from institution to institution, the changing program requirements in plastic surgery will necessitate that plastic surgery training become increasingly unique.
The independent training model still maintains the possibility of training in plastic surgery after prerequisite training in surgery or other surgical subspecialties. Though this training path generally does include a training period in surgery, proposed changes in plastic surgery training requirements will require all programs to include 3 years of requisite training in plastic surgery after completion of the prerequisite requirements. This acknowledges that the specialized knowledge required of today's plastic surgeon is expanding and distinct from that of a general surgeon.
At the same time that subspecialty training is becoming more distinct, general surgery training is becoming more focused. For example, training in burns and surgical subspecialties is no longer required during general surgery training. Interestingly, the specialty wants to be referred to as “surgery,” not “general surgery.” This increased concentration on purely breast and intra-abdominal procedures creates a less generalized surgical perspective. This results in less empathy for subspecialty interests and a lesser understanding of issues of concern to plastic surgeons and other surgical subspecialists. In the resultant environment, it becomes difficult, if not impossible, for anyone other than a plastic surgeon to represent the interests of plastic surgery.
Meanwhile, strong representation has become increasingly critical in that the quantity of resources within medical institutions is diminishing. A serious commitment is required to get support from medical schools, hospitals, and third-party payers, and plastic surgery interests will obviously be best served by plastic surgeons.
