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Behind the mask - GO
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 What
does it take to become a plastic surgeon? It goes without saying
that you need a lot of aptitude. You can add to that the unflagging
dedication required to see you through years of studying and
apprenticing. Dr Norbert Kang MBBS MD FRCS (right) recounts his
own long voyage to the brink of qualifying as FRCS (Plas).
I wanted
to become a plastic surgeon as a child, probably because it had
a rather glamorous public image. I suppose I still had that
image in my mind when I entered medical school. It eventually became
clear that the public image of plastic surgery is at considerable
odds with the reality of what is done in most plastic surgery units
in the UK. Most operations are reconstructive rather than aesthetic
or cosmetic. Aesthetic surgery is probably the most demanding area,
because patients are essentially well and the purpose of surgery
is to improve or refine their existing features, which are usually "normal".
Nowadays, I would say I am driven by a strong desire to try to
put things back together and improve them when they have been damaged
or destroyed by trauma, cancer or time.
To enter plastic surgery
training in the UK you need to qualify first as a doctor. To do
this you have to gain entry to an accredited
medical school. In 1984 I went to medical school - the Charing Cross and Westminster
Medical School at the Charing Cross Hospital site on Fulham Palace Road, Hammersmith.
The school has since been renamed the Imperial College School of Medicine.
Different medical schools have different requirements.
In general, they require you to have A-levels in biology, chemistry and physics
or maths. Increasingly, many medical schools are recognising that a strong science
background is not a guarantee of success in training. Many are now looking for
candidates who have shown a strong desire to become a doctor in other ways, such
as spending a year between A-levels and university working in a refugee camp
to provide first-aid. Mature candidates are also considered, as they bring with
them experience of life that will help them to put their medical school training
into perspective. Too often, A-level students who are "good at sciences" will
be encouraged to pursue entry to medical school only to find they have little
aptitude for the reality of medicine or surgery.
 I
spent a year between A-levels and medical school travelling abroad
and doing odd jobs, mostly around London. Five years at medical school
studying for a medical degree was only the first qualification I needed
to gain entry into plastic surgery training in the UK. I graduated
in 1989 with MBBS and then spent a further 4 1/2 years as a senior
house officer, working up to my FRCS (Fellow of the Royal College of
Surgeons) diploma, gaining experience in different specialities such
as general surgery, intensive care, orthopaedics. Nowadays, it is recommended
that senior house officers spend only two to three years in basic surgical
training after graduation, working towards the diploma of MRCS (Membership
of the Royal College of Surgeons) before applying for higher surgical
training in a chosen specially, such as plastic surgery. The FRCS is
now only granted on completion of the specialist training. The FRCS
is then qualified by the addition of a suffix to indicate the speciality
in which it has been obtained, such as FRCS (Plas). Successful completion
of basic surgical training and obtaining the MRCS diploma are now sufficient
to be admitted to higher surgical training in plastic surgery.
When I entered the field it was normal to start
plastic surgery training as a senior house officer in plastic surgery for two
to three years before higher surgical training. In certain parts of the country,
competition for higher surgical training posts is particularly fierce and many
candidates need to have additional postgraduate degrees such as a PhD, MD (Doctor
of Medicine, to distinguish it from MBBS) or MS (Master of Surgery) before applying
for higher surgical training posts. I did two years of research after my plastic
surgery senior house officer posts working for an MD. I am now in year three
of my higher surgical training post. The higher surgical training for plastic
surgery lasts six years.
Trainees are referred to as specialist
registrars and after completing six years are expected to take
an exit exam leading
to the award of the diploma
of FRCS (Plas). This is followed by the award of the certificate of completion
of specialist training and admission to the specialist register of the General
Medical Council. In my case this should occur 19 years after I entered medical
school at age 18! My next goal after qualifying is to obtain a consultant post
in the NHS. I have not yet defined a specific area.
Many people perceive plastic surgeons as being
highly paid, but the true financial story is that it takes a long time to get
into that position. As a trainee I am paid to do a basic 40-hour week with 32
additional duty hours to cover time on call every week. This works out at about £8
(about US$12.75) an hour for my annual wage. I have no idea what it takes to
become a highly paid plastic surgeon, but my earnings fall far behind that of
many of my contemporaries at a comparable age who left school to pursue other
careers with less lengthy training. Ultimately, my remuneration as a fully fledged
plastic surgeon should just about compensate for their financial headstart.
Without question, plastic surgery is a dynamic
field and exciting to work in. The next big breakthroughs in aesthetic and reconstructive
surgery will come in:
1) The molecular biology of wound healing. We shall be able to accelerate the
healing process while controlling or abolishing scar formation.
2) The molecular biology of tumour or vascular growth. We shall be able to
selectively destroy tumours or vascular abnormalities, such as varicose veins,
avoiding the need for complex, painful reconstructive procedures.
3) The molecular biology and physiology of tissue engineering. This will allow
the production of prefabricated bone and/or soft tissue, for example, complete
ears or jaws for reconstruction without the need for transplant surgery.
4) The molecular biology of ageing. This will enable a reversal of the accumulated
effects of ultraviolet radiation damage and gravity. These breakthroughs will
occur as part of the tidal wave of data being generated from laboratories around
the world working in different areas of molecular biology.
The above text is reprinted from Body Language #2
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