Training the Next Generation of Plastic Surgeons: A Lesson from Geese (2000)

If you watch Canadian geese as they journey southward, they form a V-formation that allows the flock’s range to increase significantly more than if each bird flew alone. As they go in a common direction, the geese get there quicker and more easily as they take advantage of each other’s thrust. Similarly, in plastic surgery the onus is on each of us to stay united in maintaining both reconstructive and cosmetic surgery within the core specialty of plastic surgery. Interestingly, when one part of plastic surgery, either cosmetic or reconstructive, slips somewhat out of formation, suddenly the whole specialty feels the drag and the resistance of trying to go it alone. But we must quickly get back in formation and take advantage of the lifting power of a unified plastic surgery. We must continue to cultivate and advance both the cosmetic and reconstructive aspects of our specialty, and thus allow all of us to stay in formation like the geese, so we not only get there more efficiently but remain intact as a specialty. As with the dramatic increase in interest, expertise, and experience in reconstructive plastic surgery in the late 1970s and 1980s, we are now seeing a surge in the popularity of cosmetic surgery. More plastic surgeons are now attending cosmetic surgery symposia or joining the American Society for Aesthetic Plastic Surgery as they make the transition to cosmetic surgery. As plastic surgeons, our heritage and roots are in problem-solving and the management of difficult wound problems with their inherent challenges. This aspect of our specialty is now struggling to maintain its presence in the marketplace, its status in plastic surgery, and its importance in our residency training programs. It has become increasingly more difficult to obtain insurance approval for many reconstructive procedures such as pediatric plastic surgery and reconstructive breast surgery. This is endangering an integral part of our specialty. As a clinical plastic surgeon and director of a plastic surgery residency program, it is of increasing concern to me that we continue to provide a balance as we train plastic surgeons in all aspects of reconstructive surgery as well as cosmetic surgery. The graduates of our plastic surgery residency training programs must continue to provide complete care in all the areas of plastic surgery, ranging from management of craniofacial problems to cosmetic surgery. As the years go by, it will become more difficult to do so. Who will be the future educators in this arena with more and more of our trainees directly marketing themselves as cosmetic surgeons as soon as they leave their residency? Numerous recently trained plastic surgeons no longer want to pursue the traditional route of taking emergency room call and establishing relationships with other physicians in the surgeons’ lounge as a method to facilitate growth within their practices. The current modality is to incorporate the Internet and personal Web sites along with practice marketing. As educators, we should incorporate changes into our residency programs so that we may continue to train the next generation of plastic surgeons in all aspects of our specialty. This has become a common goal for the major organizations and societies within our specialty as exemplified by the initial partnering talks that are proceeding between the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery. As our experienced, senior plastic surgeons who perform the art of reconstructive plastic surgery retire or phase their practice into cosmetic surgery, we are in danger of losing this unique aspect of our training program, jeopardizing not only our heritage but also the future of plastic surgery. Returning to our analogy, when the lead goose gets tired, he rotates back into formation and another goose takes the point. Likewise, it pays for all of us to take turns doing the tasks and to share leadership responsibilities. We as plastic surgeons, both reconstructive and cosmetic, are interdependent upon each other to reach our common goals. The geese in formation honk from behind to encourage those in front to keep up their speed. Cosmetic surgery must continue to work in concert with the rest of plastic surgery to keep the course. This is a difficult internal struggle we all have in striking a balance between cosmetic and reconstructive surgery; however, it is vital to reach our common goal—the future of our specialty. If a goose gets sick or wounded, one or two other geese will fall out of formation to protect their fallen comrade. They will stay with that goose until he flies again or dies. If he can fly again, they will launch their own formation to catch up with the flock. Plastic surgeons must maintain this same sense of brotherhood. During this critical time, we must stand together and support both cosmetic and reconstructive surgery in our residency training programs as well as in our everyday practice of plastic surgery. Furthermore, we must maintain our reconstructive educational symposia at the highest level, as we have done in the past, and encourage attendance by all plastic surgeons. Otherwise, we will fail as a specialty, and plastic surgery as we know it today will no longer exist. As I continue to train residents, I encourage them to remain broad-based initially in their own clinical practices and make it their goal to become an expert in at least one area of reconstructive and cosmetic surgery. This will serve them well and allow them to treat their patients more effectively. There is no better feeling than realizing that the smile you created in repairing a cleft lip for an infant helped transform that same patient into a functioning and fulfilled adult member of society. Similarly, the replantation of a finger or a hand can return a patient to society as a fully functioning contributor. Our mission, which we must not forget, is “to form, to make, and to restore to normal.” To reach our destination and continue in the tradition for the combined prospects of our specialty, we must fly together like the geese! A rational plan for plastic surgeons to learn from the innate characteristics of geese in flight is the following: The pursuit of a common goal with all plastic surgeons in formation would logically serve to preserve and enhance the specialty. If one aspect of our specialty temporarily falters, which it invariably does, the other, stronger aspects stand by it and lead it back into proper formation. Encourage our trainees to maintain the formation, to maintain reconstructive and cosmetic surgery in their clinical practice for both personal fulfillment and enhanced care of their patients.