The ACGME reports multiple paths to plastic surgery specialization including 6-year integrated plastics programs as well as specialized 2-year plastics training programs following completion of residencies in neurological surgery, orthopedic surgery, otolaryngology, or urology. Plastics subspecialties also include craniofacial and hand surgery. For this spotlight we interviewed Daniel Cho, newly minted MD PhD, and a first-year resident in the University of Washington Plastic Surgery program, training at four University-affiliated hospitals: UW Medical Center, Harborview Medical Center, the Seattle VA, and Seattle Children’s Hospital. As with many 6-year integrated programs in Plastics, the UW program curriculum’s first 3 years of training are the same as General Surgery residencies, and the last 3 years are focused on Plastic Surgery.

1. Why plastics?

I think plastic surgery has evolved to become truly general surgery while the scope of general surgery has significantly narrowed over the past few decades. Plastic surgeons operate all over the body and do a wide variety of procedures. While many people associate plastic surgery with cosmetic surgery, the field really encompasses so many areas including pediatric/craniofacial surgery, hand surgery, microsurgery, breast surgery, peripheral nerve surgery, and reconstructive surgery. When I was trying to decide on a specialty, I wanted to find a field that would allow me to take care of all different kinds of patients, be challenged in the operating room, and also develop long-term relationships with patients. Additionally, I wanted a field that would allow me to continue to be involved in research while still being a clinician. As a fourth year, I liked all my core clerkships but I fell in love with plastic surgery after I saw my first cleft palate repair and knew this was the right specialty for me. I think that it is an exciting and dynamic field that is continuing to evolve.

2. How do you plan to integrate your PhD?

here are a lot of areas to pursue research in plastic surgery, including composite tissue allotransplantation (face/hand transplantation and the immunobiology that allows these procedures to be successful), wound healing, and tissue engineering. My PhD was in Biotechnology and I focused on the use of polymers as biomaterials for drug delivery and tissue engineering. While my PhD research was focused on developing oral drug delivery systems for therapeutic proteins and peptides, I was exposed to all areas of bioengineering. A lot of the academic plastic surgery programs have labs that are affiliated with the department. I am particularly interested in pediatric/craniofacial surgery and plan to continue research in bone tissue engineering. I’d love to develop a way to 3-D print autologous tissue engineered bone in real-time in the operating room for craniofacial defects.

3. What is something you learned during your MD/PhD that you didn’t expect?

I am incredibly grateful that I had the opportunity to go through the MD/PhD training. The time I had off after the first two years of medical school for my graduate studies gave me a chance to really figure out what I want out of my career. It helped to gain perspective about what is important in my life and helped me to find the right specialty for myself, one that will not only engage me in clinical practice but also offers me research questions that I am excited to tackle. Additionally, the PhD training gave me a chance to mature as a person and as a scientist. The way I approached patients and clinical problems after I returned to medical school was different than before I left. Everything made so much more sense and I felt as though I had much more balance in my life.

4. Advice for MD PhD students considering plastics?

Do it! It’s an incredible field that most medical students (and MD/PhDs) have very limited exposure to. If you are considering a career in surgery, definitely spend some time learning more about plastic surgery. The work that plastic surgeons do is truly incredible and often seems like science fiction – free tissue transfer, face/hand transplants, cranial vault remodeling. There are so many research opportunities that would benefit from MD/PhDs and the field is constantly evolving. Plastic surgeons are a very forward-thinking group of people who truly love what they do.

5. What is your favorite part of medicine?

I love working with children and their families. As a surgical resident, I obviously enjoy being in the operating room but I also value spending time with patients in the clinic. I find the longitudinal experience of meeting a patient in the clinic, counseling them, going to the OR, taking care of them post-operatively, then following up in the again in the clinic is the most fulfilling part of medicine. Each surgical patient is like a research project in graduate school, you identify the problem, develop a plan, execute your plan, then evaluate the results and use the knowledge you gained to do even better the next time. I am interested in pediatric/craniofacial surgery because you get to follow your patients throughout their childhood, often operating on them multiple times and helping to coordinate the multidisciplinary care that patients with craniofacial problems require.

Plastic Surgery By the Numbers

Overall job satisfaction: 41%

Would choose same speciality again: 49%

Typical work week: 52 hours

Clinical median salary: $425,668

Academic Medicine (associate/full professor): $443,000

(Data from: Archives of Internal Medicine July 2011, Medscape Physician Compensation Report 2012, MGMA Physician Compensation Report 2013, AAMC Report on Medical School Faculty Salaries 2009-2010)

Entering first-year residents: 2013-2014 AAMC Match Data

Mean USMLE Step 1/ Step 2 scores: 245/ 252

37% AOA

10.7 average publications/presentations/abstracts

4.2 research experiences

3.5 work experiences

7.9 volunteer experiences