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I was asked about advice for advice about undertaking Plastic Surgery training in Australia, so I thought I’d write it down.

The process goes Internship -> Residency (1-2 years) -> Unaccredited registrar (numerous) -> Accredited Registrar (5 years) -> fellowship (optional 1-2 years) -> Boss

Now the problem is that it is pretty competitive at all levels, very uncertain and often unsupported.

With the medical student tsunami well underway, competition for residency position is heating up, no longer can you expect to simply wander into a residency job of your choosing post internship. Further more if you want something as competitive as Plastics then you’ll need to score plastics rotations so you can meet the bosses. You also would benefit from an ICU, ED or anaesthetics term (my advice is to try and schedule this late in your residency career as you have to have done one of these terms within 5 years of applying to the SET program and you don’t want to break up your unaccredited registrar time with a residency ED/ICU/Anaes job if you can help it)

you need research, in plastics, published in certain journals.
You need a masters at least
you can now do your primary surgical exam before applying to the program (~$3000)

So you’ll want to start angling for unaccredited jobs. These are competitive (FYI there are 9 unaccredited jobs in NSW. people tend to stay in them till they get on or quit, and only 7 get onto the program per year IN THE COUNTRY).
Be prepared to suck up, hard. 1 guy i know spent every weekend and every morning pre round, hanging out at a different hospital to the one he was working at chatting up the bosses.

So while tootling around in unaccredited land, getting your masters and publishing like a mofo you will start thinking about applying for the SET program. The privilege of applying will cost you some $1200.
People are getting on somewhere around around 6 years post graduating uni, and it is not unheard of getting in at 10 years post.

Now, its probably true that if you really want to get on, you will eventually. The thing you have to ask yourself is how long you are willing to wait and how much you are willing to put up with.
As a registrar your time is not your own, you will have surprise shifts all the time, you will work 110hrs in a week +, we still do the Friday 11pm to Monday 8am (and expected to work all Monday as well) on call. (for those non surgeons, consider that on Monday your surgeon may not have slept since Thursday night). Almost everyone in the hospital will hate you, because while you’re operating you’re not in clinic, and ED has been waiting for hours, and that patient on the ward needs a review, and no they will not get someone to cover the other 2 registrars who are off. And certainly don’t expect love from the boss who has called the sole remaining registrar off to help them in the private.
As an unaccredited registrar you can’t even think about the light in the end of the tunnel because you aren’t even in the tunnel yet. Do consider what happens if you don’t get onto the training program – GP is increasingly competitive with the vast numbers of students coming through, CMO jobs are slowly being phased out as young consultants come out the other end. Surgical positions are tightening down from a high of 14 entries/year to 7 now.

That being said, your time actually operating is magical (provided that you were lucky enough that someone has taken the time to teach you, as an unaccredited the bosses are generally uninterested in teaching you, and you will have to settle for scraps of teaching. I was lucky in my first accredited year where I got superb training, but in my second year I can count on one hand how many times I operated with a consultant). (also as an unaccredited trainee you are NOT ALLOWED to go to any of the accredited teaching session) The extraordinary privilege of operating on someone and being able to restore function is unmatched, and while you are in theatre, its a bit like being on stage – its all about the operation, time loses meaning, everything else is forgotten, and you work.
And seeing people regain function in a hand, or saving someone’s sight is incredible. I got to see great things, I got to do great things and I certainly don’t regret doing it.

So it’s really up to your values. Surgery demands your everything, and it is rewarding. It is a noble cause (until you become a private cosmetic surgeon which I’ll rant about another time), and that might be for you.
And while I tell you all this, I was told all of this before. It will make not one iota of difference because you will need to experience it for yourself to see if its worth it for you.

Good luck, let me know how it goes.


Basel 2014


So I did my exams, and I passed. Yay!
<little jig of victory>

Wasn’t as bad as i thought’d they be and obviously my scotch habit hasn’t diminished my capacity too much.

OH yes, my blog traffic was very exciting for a while, I thought that my little corner of the web was somehow super interesting but it turns out that simply having the worlds ‘bill henson’ was enough to make this a superstar blog.  I need to preemt the next controversy….

anyways, i ought to go do some busywork – make some more inappropriately reactive software. bah.
Thought puddle was looking a bit empty. And i do apologise that it hasn’t really been a joyful trundle of late – it was supposed to be an entertaining record of adventures.  Hopefully fun times are ahead


They swing the wrong way. Clearly they should be pull to enter, and push to leave so that after one has theoretically washed one’s hands one doesn’t need to grip a festering door handle coated with the flora left by those less hygenic.
Its not even going to cost extra money, just put the stupid hinges the other freaking way

Ok, time for a rant.
I went to a meeting. It was a meeting and discussion on Close the Gap Day. We had a great speaker who was very down to earth and gave simple, practical things we could do to when we dealt with indigenous patients.  She had a sense of purpose, of hope that it could be done better through co-operation.

So then we went onto discuss how come there were, out of nearly 300 students, less than 20 showed up, and how we could try to improve the teaching of cultural awareness.  And this is where it gets annoying. As in almost all semi politcal ideological groups I’ve found myself in, most everyone there was more concerned with slapping each other on the back for being enlightened and slamming the establishment, and the others for not.
What annoyed the bollocks out of me was that a friend of mine and I proposed some changes to how it could be taught – simple things like a more positive, co-operative tone; as opposed to the ‘us-them’ dichotomy that we were hit with and the very confrontational ‘blaming’.  and about half the group pounced as if we were anti-aboriginals.  They threw up totally spurious straw man arguements like – well I was all inspired so you obviously must be wrong.  But what they in their blinkered chuckleheadedness fail to realise is that I’m not saying that no-one got something out of it, just that many did not and perhaps that we could reshape it so that more people were eager to do something.  I mean come on, I came in, on my holidays to attend a meeting on close the gap day, as if I’m anti.  Face it, those who got something out of it as it was, probably would have gotten something out of it regardless.

Not everyone is going to be a cardcarrying idealogue, not everyone will be inspired to be a champion of  these issues.  Some of the people at the meeting will be and great for them.  But what I’m eager to see is that people, us as potential future doctors, are sensitive to the issues and know how to access  help to ease the process of getting healthcare to indigenous Australians.  It’s progress if, in the future, we have an indigenous patient and we have the thought to contact the liason officers to help ease the process a bit, if we take a bit more time to listen and explain.

If we could stop congratulating ourselves on being teh awesome and actually think about what we can do to make a difference that would be great.

‘I’ve nothing against people (to use a vogue phrase) having ’emotional intelligence’ as long as it is allied with ‘intelligent intelligence’. What I am less anamoured of is people diving into emotionalism and abandoning anything else at all’

-‘How Mumbo Jumbo conquered the world’ Francis Wheen

Very funny, do read it if you have half a chance

To nick a phrase found on Orac’s blog, ‘the stupid, it burns’.
I happen to be a forum and blog junkie and recently on one of the many I visit, an argument appeared as to what a ‘dancer’ is.

Dancers are one of the few groups of people who are so insanely ego-centric that they would get uppity over the correct usage of the designation of dancer. They have elevated it into a hallowed title, conveying an aura of ‘dancerness’, of ability, passion blah blah blah.
So some argue the strictest dictionary application – that dancer is one who dances in public for pay.
Which is patently stupid when considering the rich heritage of other cultures where dance is simply a way of life. The advent of ‘dance’ and indeed ‘art’ as a profession is very recent, these activities have been a part of all human cultures for thousands of years, pretty much as soon as culture developed – from caveman days of rockpainting and jewelry making.
But no, bobbleheads still insist that a professional arts corps is necessary because without it There would be no jane austen, no bach, andy warhol, no great musicians, building would only be functional, walls would all be one colour’ I mean, jeebus, if we didn’t have professional artists, holy jeepers batman, colour would never have been invented!!!!
also highly amusing because one of Warhols ideas was that art is potentially anything one considers to be art. And that art and not art is a blurred distinction

Other knuckleheads content that to be worthy of the term dancer one must have ‘passion’ for it, as if that is a useful definition. You might as well make ‘dancerness’ a criteria.

Interestingly it was only students and non-professional dancers who were all up in arms. My pet theory is that dancers as a whole are so mindboggling insecure that they need a shibboleth to feel secure in themselves and their art. They need a way to differentiate themselves from the mass of the ‘other’.
Or perhaps, as some of them will not assign the title of ‘dancer’ to themselves, feeling themselves unworthy of the title, it is because of the deification of dancers and artists generally – something that John Carey talks about in ‘What good are the Arts?’.
“talk of the immortality of art, in the absence of a belief in God, is childish and self- deceiving”

I was recently at a shindig for dancers and dance artists and had to exert considerable self control not to explode in an indignant mess.
I love the arts, despite being a grouchy bastard, I really believe and enjoy them, but recently I am seeing that we, as artists, could possibly be the worst thing that ever happened to art.

On several occasions I’ve been to talks and showings about ‘research’, movement ‘research’ and the like.  As a budding scientist and also just because I have a brain, its pissing me off – I am more than willing to accept the need to discover new things in art practice and that it requires investigation. But what I’ve seen is absolute rubbish which is indulgent, stupid and justifies why people hate contemporary art.

Case A.
A  choreographer and dancer have been given 4 weeks of rehearsal space time to research her project, which was vaguely looking at Communication Technologies, pas and present.  So I dutifully trundled out, as my practice is technologically mediated and I do love a good stickybeak.   I then spent the next hour physically holding myelf in so I didn’t launch myself onto stage and hurt someone – either that or holding in bales of laughter at the sheer idiocy of it.  It was actually offensive how insanely stupid the showing was.   It consisted of 2 dancers in various scenarios looking at communication technologies
*Idea one.  Stand on one leg, balance while wriggling fingers like they do in bad hacker movie. This was supposed to represent SMS-technology.
*Idea two. Hold hand to ear like you had a phone and rush around.
*idea three. Do the same as above but run from the back of the stage to the front of the stage, stopping suddenly and running back
*idea four.  Walk in circles rapidly. Apparently this was to convey the idea of radio wave propagation.
*sitting down while flapping hands – smoke signals

Case B.
this time a 2 week research grant.
Which developed a ‘call and response’ technique using sensors.
I mean WTF? A cellist plays a phrase. the dancer moves a limb hooked up with a bend sensor which triggers a pre-recorded track. Woop. Who the hell cares? Its old, and uninteresting to boot.

Case C.
I overheard two choreographers passionately talking about this ‘research’ they were going to do on tango  dancing.  I like tango dancing. I can’t do it, but it sure is awesome to watch.  However the premise for their research was ‘what if i put my leg here, instead of here’.  I mean, what if? Its exactly the same as tango, except every so often my leg goes on the outside instead of the inside – amazing.

While these may all be necessary stages in their arts practice to develop as artists, I really have to question, does the public purse have a duty to fund them? Perhaps I’m just grouchy, but for me, these projects, answer and deliver nothing of use.  It seems that this sot of thing is better left to dicking about in loungerooms.
A problem is the funding structure that I am talking about in particular – which is specifically for ‘research’ and not to be outcome oriented. But perhaps it should be – maybe it will filter out stupid, if people know they are supposed to put something on.  One thing to say about free market capitalism is that it forces some sort of applicability due to the need for public consumption – it does limit innovation as it means work has to ‘populist’ (not always a bad thing), but the state supported model goes the other way, and lets artists get all carried away with their own importance and encourages them to waffle about directionlessly.