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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.

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Basel 2014

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