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Session 165
Dr. Maryann Martinovic is a plastic surgeon working in the community. She joins me to discuss training and life as a plastic surgeon and what you should know!
If you are interested in learning more about plastic surgery, check out the American Society of Plastic Surgeons.
For more podcast resources to help you along your journey to medical school and beyond, check out Meded Media.
Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.
[01:44] Interest in Plastic Surgery
Maryann became interested in plastics, somewhere between her second and third year of med school. They had a student interest group for surgery where you could go shadow. And so she had shadowed a general surgeon doing mastectomies.
She quickly found herself being much more interested in what the plastic surgeons were doing to follow the mastectomy than the general surgery portion itself. Then in her third year, she was able to do a subspecialty rotation in two different fields. And she chose plastics to be one of them.
She liked how every day, they were doing a different surgery on a different part of the body. There was no routine element to it. You get to be creative and come up with these solutions to these problems that other people have not been able to fix or don’t know how to fix.
Maryann has an interesting background in the sense that prior to medical school, she actually spent a few years doing clinical research in cardiology. And that’s what she thought she was going to do with her life because she was familiar with it. And she found it interesting. And as time went on, where she had exposure through various clinical settings, she realized that she wanted to do something hands-on.
“Plastic surgery combines the best of being able to work with your hands but also being able to think on your feet and critically come up with a solution.”Click To Tweet[04:37] The Biggest Myths or Misconceptions Around Plastic Surgery
“Social media has made plastic surgery look glamorous.”Click To TweetInitially, she didn’t really appreciate how much a plastic surgeon was capable of doing. And they were trained to do hand surgery, facial fracture, and reconstruction. They work on kids and on adults. There’s really no inch of the body that they are not skilled to be able to handle in some capacity. And so most students aren’t really aware of that breadth of the field.
[05:38] Traits that Lead to Being a Good Plastic Surgeon
Attention to detail is critical. No matter how good you are in the operating room, behind the scenes, what the patient looks at, the end of the day is how their incision looks. What is the appearance or what is the contour?
So you have to be precise, and you have to be meticulous. You’ve got to be willing to spend that extra 10-20 minutes to put in that perfect suture. As opposed to having the philosophy that you just need to be done with surgery and get out of there.
“A good plastic surgeon is patient because you really have to assess what your patient's expectations are.”Click To TweetA lot of people come in hoping for or wanting something to look a particular way. And that may not be realistic. So you have to be able to convey what you know and what you’re capable of achieving.
Then there’s a big element of needing to have a creative side because you’re going to have to recreate something. And so you have to be able to think on your feet quickly and think about addressing various surgical wounds and problems.
[07:22] Types of Patients
They do a lot of breast reconstruction. Maryann takes care of women after mastectomies, and recreating a breast mound, as well as restoring their confidence and their appearance.
They also do a decent amount of skin cancer reconstruction. After a dermatologist or a general surgeon has resected a large area on their face, you then have to come up with ways to fix that.
Maryann also does a decent amount of breast reduction and a little bit of various wound reconstruction. These are sometimes paraplegics who have wounds from pressure injuries, other people who have wounds from traumas, or things like that.
“I do a fair share of removing implants or revising implants because women have concerns about them.”Click To Tweet[08:47] Typical Day
Operating days for Maryann would be Monday, Wednesday, Friday. Some of those cases are her own independent cases. Some of those are joint cases with other general surgeons, and then Tuesdays and Thursdays, she’s in the clinic all day.
“The joy of being a surgeon is you have to be flexible because you take a call and sometimes things come in and you have to add things on or adjust accordingly.”Click To TweetFor example, in patients with melanoma, a general surgeon could be resecting a skin cancer and doing a lymph node biopsy. Then Maryann comes in to close whatever hole or defect they create.
A lot of times, they work really closely together when women are having a lumpectomy, where part of the breast tissue is being removed. And then she gets to rearrange the remaining breast tissue to fill in that defect and make it look more normal and less deformed.
[10:45] Taking Calls
Maryann is fortunate she works in a community hospital setting. So she does take a week of call a month. And that’s usually for facial trauma. Most lacerations are things that are cosmetically sensitive that people want a plastic surgeon to repair. Her call is from home.
In an academic setting, calls can be quite different. For plastic surgeons, you’re either taking trauma calls for hand injuries or for facial injuries, and that’s the division of the two.
[12:32] Community vs. Academic Setting
Maryann chose a community setting based on her personal life. Her husband is also a physician, and he was in fellowship.
“The joys of a dual physician household is that you don't always get to predict and control where you train, how long you train, and all that stuff.”Click To TweetThey did long distance for two years while she was finishing her residency and he was still in fellowship. And at that point, she decided that her personal life mattered more than her professional. What was important to her was just being in the same city as him. And there happened to be an opportunity at a community hospital.
She admits that she had envisioned staying in academics, just because she liked the thrill of having a lot of variety and doing something different every day. But in her community practice, now she has a lot more autonomy over the things she does in terms of her relationships with patients. Ultimately, she believes that being in a community setting is what works for her considering the stage in her life with a young family.
[14:07] Life Outside of Medicine
Despite her friends and family telling her that she wasn’t going to have any life outside of medicine, everything worked out well for Maryann.
Most surgical subspecialties have been very male-dominated. But there are more and more women paving the way. And as a result, people appreciate that they want a work-life balance and that’s becoming much more feasible. It doesn’t matter whether it’s plastics or any specialty.
[15:45] The Training Path
Historically, you do a five-year general surgery residency, and then follow that with a fellowship in plastics, which was three years at that time. Now, most programs are an integrated residency, which is six straight years. You do some general surgery training early on through different rotations just to get that experience. But you’re homed within the plastic surgery division.
Once you finish your residency, you have several options. You can either start practicing like what she did, or you can do a fellowship, most of which is a one-year fellowship.
The various pathways are either (1) hand surgery, (2) craniofacial surgery, which is usually dealing with pediatric congenital deformities, (3) microsurgery, which is learning how to essentially transfer free tissue from one part of the body to another, or (4) anesthetic fellowship.
If you don’t know initially that you want to do plastic surgery and you go do a general surgery residency, there is still a fellowship pathway option available. There’s just fewer of them in the country because a lot of schools have transferred them to integrated residency. But there is definitely one out there. You just have to look a little harder for it.
[17:24] How to Be Competitive for Matching
Obviously, you want good grades and good Step scores. But really, what’s also really important as plastics is a very small community. When she matched, there were 125 spots in the country for plastics. So you go on the interview trail and see the same people over and over again.
And so whatever your home institution is, just get to know the faculty. Because they probably know someone somewhere else that you might be interested in going for training. And they can make connections for you. And if you can get involved in doing research projects and things like that, it helps you stand out from the rest of the applicant pool.
“It really goes a long way to just start building that rapport.”Click To Tweet[18:25] Message to Osteopathic Students
There are several plastic surgeons out there with DO backgrounds. Nowadays, with Google and social media and people having Twitter handles, you can easily find a lot of these individuals. And they may have good recommendations about osteopathic plastic surgery residencies. That being said, there is now a single accreditation in place.
As of 2020. there are no longer DO-shielded specific residency programs. A lot of people call this the DO and ACGME merger. So there will be a new organization that will combine them. It’s all single accreditation. So the DO-specific programs have now opened up to MDs. And MDs have always been open to DOs. A lot of programs have made the switch before this year, but this year was the final year to finally make the switch. So we’ll see how students are doing as the data comes in.
[20:28] Message to Future Primary Care Providers
Plastic surgeons master in taking care of skin issues and reconstructing stuff so don’t be afraid to refer your patients to them if they see a patient with a defect or problems. Because they tend to be open to managing all sorts of different complicated issues.
[21:59] Specialties They Work the Closest With
Plastic surgeons work closely with breast surgery, dermatology, and general surgery.
[22:11] What She Wished She Knew Going into Plastics
What no one really prepares you for is when you’re in training, and you get this progressive responsibility. By your chief year, you feel on top of the world. There is nothing you can’t handle. You have no doubts about yourself and you’re just super confident. You’re ready to not have to run anything by anyone because you want to do it yourself. And then you get out into the real world and you just completely start doubting yourself. All of a sudden, you’re losing sleep wondering whether you’re made the right decision. It’s very nerve-racking.
'The impostor syndrome is real and people don't really talk about it very much. But it can be paralyzing.'Click To TweetMaryann remembers one attending who told her that the only surgeons who don’t have complications are the ones who don’t operate enough. And it’s so true. But at the same time, when you have something that doesn’t go how you planned, and it’s devastating. But you have to find it within yourself to evaluate the situation and keep moving forward. Don’t be afraid to ask for help. You’re not just on an island by yourself where no one’s there to help you.
[24:53] The Most and Least Liked Things
Maryann works with a lot of cancer patients. You see them at the beginning of their journey when they’re grieving the loss of a body part or coping with this horrible diagnosis. And then she gets to follow them along and offer them this really happy, exciting experience that brings them back to feeling like who they are again. So watching people go through this evolution is something she finds very fulfilling.
On the flip side, what she likes the least is that you never stop thinking about your patients. In many ways, that’s what makes you a good physician. But it can be exhausting because it’s hard. Sometimes it feels like you can just never shut it off.
[26:37] Major Changes Coming Into the Field
Insurance is always an issue. So in the early 90s, Congress mandated that breast reconstruction was a covered service once a woman had a mastectomy. This is phenomenal because no one chooses to have cancer. No one chooses to voluntarily have their breasts removed. So they should be able to restore that.
But there are decisions that get made. There was one instance that her patient’s insurance company denied a procedure that was needed to fix a defect. So she had to write a letter, and she had to support it through various manuscripts and literature. She had to present the indications and it finally got appealed. But it was such a headache and so much extra work for Maryann. It was also so upsetting to the patient because she thought she wasn’t going to be able to have the procedure she wanted.
[28:52] Final Words of Wisdom
If she had to do it all over again, Maryann would still be a plastic surgeon 100% because she says she loves her job.
Finally, she wishes to tell students who might be thinking of doing a subspecialty is to know what feels right in your heart and just keep pushing forward. Don’t let people tell you that you can’t do something because of some type of misconception or societal role.
'Don't let people put you down or tell you you can't make it happen.'Click To TweetLinks:
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