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Some Thoughts About Cosmetic Surgery and Medical Education
I recently returned from our annual summer visit to friends and family in the Midwest. First, we visited Green Lake, WI for a reunion of our college friends. Then, my family and I visited Chicago, where my family has lived for six generations. This year, I even played in my high school's annual golf tournament where, interestingly, some of the best performances were by some of the graduates in their 70's or 80's! I guess that says a lot for practice makes perfect.
I also had an opportunity to visit my alma mater, Northwestern University Medical School. This year, I had the great pleasure of spending time with one of my most important and beloved teachers, who is still practicing and teaching half-time at Northwestern. He took me on a tour of the new Northwestern Memorial Hospital. We sadly looked at an excavation site which was formerly the home of the Lakeside Veterans Administration Hospital where my teacher taught and did research and where I had my junior year rotation in Internal Medicine under him. I also did extra work in the Pathology Department there and held a moonlighting job. I get a lot of good warm feeling when I return to the campus, although I could hardly recognize it. But, it was the seat of my medical education and I am very appreciative of the excellent education I had.
Earlier in the day, I visited the University of Illinois Chicago Medical Center. That medical center, when I was a student and resident, was the largest in the country with more hospitals and beds concentrated within one square mile than any location. The Cook County Hospital alone had over 3,000 beds. Today it has 500.
I thought a lot about the difference in education then and today. Recently, there have been a lot of constraints placed on medical education. Much of it is financial because hospitals are strapped for cash because of diminishing and poor payments from insurance companies, and the large load of either uninsured or welfare patients for whom the state and federal governments pay very little.
A tight economy and near-bankrupt governments makes it tougher to educate the students, interns, residents and fellows. During my residency, we had unlimited opportunity to perfect our cosmetic surgery skills. We were allowed to perform cosmetic procedures on patients for as little as $100. Granted, $100 then, would translate to $500 today, but still, that is a pretty reasonable price to have a nose job or eyelid surgery and for another few hundred dollars you could have a full face and neck lift. By offering patients such reasonable fees, our surgery schedule was full. And, a full schedule meant maximum learning.
Cosmetic surgery training requires experience and excellent teaching. Without patients who are willing to have their surgery at the university, where does the young trainee hone his skills? Today, there are few situations that match the wonderful opportunity we had as residents. For that reason, I see graduates of residency programs coming out with a lot less experience and skill than those of my generation. I have talked to some of the graduates who tell me they have only done five nose jobs for example. That is nowhere near a reasonable number. In a residency program, if one would do 25-50 cosmetic nasal surgeries under supervision, that would be a minimal, but adequate number. To come out with fewer cases under one's belt is inadequate to begin practicing.
In universal terms, as the United States medical care delivery system is sure to change, I am concerned that medical education will slip far down the line in priorities.
The consequences for all of us are not good.
- Robert Kotler, MD, FACS
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I also had an opportunity to visit my alma mater, Northwestern University Medical School. This year, I had the great pleasure of spending time with one of my most important and beloved teachers, who is still practicing and teaching half-time at Northwestern. He took me on a tour of the new Northwestern Memorial Hospital. We sadly looked at an excavation site which was formerly the home of the Lakeside Veterans Administration Hospital where my teacher taught and did research and where I had my junior year rotation in Internal Medicine under him. I also did extra work in the Pathology Department there and held a moonlighting job. I get a lot of good warm feeling when I return to the campus, although I could hardly recognize it. But, it was the seat of my medical education and I am very appreciative of the excellent education I had.
Earlier in the day, I visited the University of Illinois Chicago Medical Center. That medical center, when I was a student and resident, was the largest in the country with more hospitals and beds concentrated within one square mile than any location. The Cook County Hospital alone had over 3,000 beds. Today it has 500.
I thought a lot about the difference in education then and today. Recently, there have been a lot of constraints placed on medical education. Much of it is financial because hospitals are strapped for cash because of diminishing and poor payments from insurance companies, and the large load of either uninsured or welfare patients for whom the state and federal governments pay very little.
A tight economy and near-bankrupt governments makes it tougher to educate the students, interns, residents and fellows. During my residency, we had unlimited opportunity to perfect our cosmetic surgery skills. We were allowed to perform cosmetic procedures on patients for as little as $100. Granted, $100 then, would translate to $500 today, but still, that is a pretty reasonable price to have a nose job or eyelid surgery and for another few hundred dollars you could have a full face and neck lift. By offering patients such reasonable fees, our surgery schedule was full. And, a full schedule meant maximum learning.
Cosmetic surgery training requires experience and excellent teaching. Without patients who are willing to have their surgery at the university, where does the young trainee hone his skills? Today, there are few situations that match the wonderful opportunity we had as residents. For that reason, I see graduates of residency programs coming out with a lot less experience and skill than those of my generation. I have talked to some of the graduates who tell me they have only done five nose jobs for example. That is nowhere near a reasonable number. In a residency program, if one would do 25-50 cosmetic nasal surgeries under supervision, that would be a minimal, but adequate number. To come out with fewer cases under one's belt is inadequate to begin practicing.
In universal terms, as the United States medical care delivery system is sure to change, I am concerned that medical education will slip far down the line in priorities.
The consequences for all of us are not good.
- Robert Kotler, MD, FACS
Related Topics:
Labels: medical training
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