Is it safe to get a rhinoplasty at a teaching hospital/ university resident clinic?

Question

Are the doctors that perform the surgery on you new and fresh doctors or will they have a decent amount experience?

Brock Ridenour, MD · Answer

It would depend on the level of supervision in the clinic.  Rhinoplasty is perhaps the most challenging operation in cosmetic surgery. It is hard to achieve naturally beautiful results that stand the test of time. The surgeons training and years of experience are important variables in the ultimate outcome. When I was an attending surgeon at a University clinic, I was very "hands on" in my approach - perhaps too much so in the opinion of some residents and fellows. I saw the patients in consultation and helped the resident physicians develop a surgical plan. I was present during the operation and made certain the patient had a quality outcome. I was also involved in the aftercare of the patient. I felt this was my obligation to both the physician-in-training as well as the patient that was placing their trust in the institution.   Resident physicians and Fellows need the opportunity to perform cosmetic procedures so they are prepared to treat patients on their own at the conclusion of their training. Resident Clinics serve an important function because they allow doctors to gain much needed experience while providing services at a reduced cost to the community. But not all clinics operate equally. I would want to know who will be supervising my operation, whether they will be physically present during the procedure and what remedies are available if their are any complications.I hope this helps. Best of luck to you.

Anna Petropoulos, MD, FRCS · Answer

Dear Jonathan, Your question is a very valid one. I agree with the answers below. It seems that you are in or near Boston, so you have the advantage of having some of the best teaching hospitals in the world, which only accept the top applicants. Nevertheless, surgical experience is surgical experience. Having trained at Massachussets Eye and Ear Infrimary myself, I can report that the professors only let a resident operate if he or she has demonstrated competence and skill at a given level and then increase the level of difficulty for them accordingly. Typically, in general a resident will not be performing a rhinoplasty and that procedure is left for the Fellows who have 5 prior years of similar specialty training.  (You can delay an elective procedure towards the end of the academic year e.g. April May June when the residents /fellows have gained more surgical experience rather than in July where they are fresh on the team.) A Rhinoplsty is not only a surgery, it is also an ART and it needs a lot of attention to detail and experience to know what maneuvers will produce what results. It is also important for the new nose to match the person's persona - their face, their body build, their ethnicity, their character. An excellent communication tool that we use in our office pre-op to ascertain these details together with our patient, is computer imaging where you could try different aspects of noses on the face in multiple views to determine together which is the best one and also delineate which is a surgically feasible one. If you are not feeling the trust and comfort level you would like to feel (regarding who will do the surgery) at your teaching hospital another option is that you seek a Facial Plastic surgeon in private practice based on his/her results and reputation and there you are guaranteed that they will do the surgery !Best of luck in your endeavors !Kind Regards, Dr. Anna Petropoulos

Waleed Ezzat, MD, FACS · Answer

Dear JonathanBravo:This is a good question that is asked frequently in my practice.  As a whole, getting your rhinoplasty done at a teaching hospital does not necessarily mean that your rhinoplasty will be done by a lesser trained surgeon.  Some of the best surgeons work at teaching hospitals and their skill is necessary to properly train the next generation of surgeons.  So this does not imply that you will be getting "discount" surgery.Ask specific questions to your surgeon.  If you have reservations about having residents in your procedure, talk about this with your surgeon.  Often, you will find that the he or she is not just supervising the residents, but taking an active role in the procedure.  I wouldn't be surprised if you find that the attending surgeon is being assisted by chief/senior level residents that already have years of surgical training behind them and will be working as a team on your case.As faculty, I value having my residents in these cases assisting me.  It never hurts to have an extra set of eyes and hands that are highly trained assisting you!Overall, keep in mind that any plastic/reconstructive procedure is a team effort and you are a critical part of the team.  Communication is key - so don't hesitate to ask direct and specific questions.Good Luck!Dr. E

Afshin Parhiscar, MD · Answer

Dear JonathanIn general, it is safe to have surgery at teaching hospitals. The doctors that are less experienced are working under the supervision of more experienced surgeons. One major difference with a private practice is that you wont be able to see what type of results and what style of look your surgeon likes. I feel it is safe but chances are, you are taking on a little more risk of not getting the exact results that you want.

Mark D. Wigod, MD · Answer

When you go to a University Resident Clinic, you are making a trade off.  You are hoping to pay less, but you have to accept a less experienced surgeon.  Some clinics have good supervision and some do not.  Residents are more experienced later in the training year cycle (July to July).  I had the benefit of operating in a resident clinic where I trained and I think we provided a good safe value.  It is certainly a better option than leaving the country for a variety of reasons.  As with all decisions, be informed.

Arnold S. Breitbart, MD, FACS · Answer

If you are getting your rhinoplasty at a hospital resident clinic, the surgery is usually performed by a resident under the supervision of an attending surgeon.  The resident could have little rhinoplasty experience or has done several such cases or more.

Patrick J. Byrne, MD, FACS · Answer

We certainly think it can be very safe. It is always a requirement that even if a resident physician is participating in a procedure, that he or she is being supervised, and guided, by an attending surgeon. Ultimately the attending surgeon is responsible for your safety, wellbeing, and the outcome. There are some cases that only an attending can do, and there are also times when patients ask that only the attending surgeon ac as the primary surgeon. This is completely acceptable.

Reza Momeni, MD, FACS · Answer

Safetly (meaning your health) depends on the certifications of the health system / center where you are operated on.  Most teaching hospitals are certified by the state and inspected routinely, so they are very safe.RESULTS, will depend on the skill level of the person operating on you.  If your operation is done by a skilled surgeon, you have a better chance of a good result.  What you gain with a teaching hospital / residents is lower cost.  What you lose is personal relationship, involvement, and access to the experienced surgical attending.This is a personal decision and you should make sure you are comfortable with the pros and cons, and are aware of the trade-offs.  There's no wrong decision, just a careful choice that you need to make, and as long as you know the reasons you are choosing one over the other, you should be able to deal with the consequences, if any arise.Best wishes,RM

William Marshall Guy, MD · Answer

Hello JonathanBravo,There are certainly pros and cons to getting a surgery at a teaching hospital.  First off, it is important to know the level of the resident surgeon who will be operating on you.  The higher the level the more experience he or she will have and the less risky.  Furthermore, the resident will be overseen by a more experienced faculty member who is skilled in the procedure.  The biggest drawback is you won't have access to before and afters and the resident surgeon will likely only see you a few times if any for follow up before the next resident will rotate through the hospital.  The faculty member who was there for the operation will be present long term and you will have to find out if this person will be seeing you in clinic or if the clinic is run by residents.  Of course the biggest pro is the price cut.  You'll have to weigh the risks mentioned above with the benefit of the cheaper surgery.  I hope this helps and good luck.

Dennis Barek, MD (retired) · Answer

If you are a private, paying patient, you have the right to request that only your surgeon operate and that the resident assist or observe.I would not let a resident do a rhinoplasty on any family member of mine.Being an excellent rhinoplastic surgeon is a unique skill that is gaiined from talent, training AND experience. A resident will only do a minimal number of aesthetic rhinoplasties in their residency. If you signed up for free surgery at a clinic, then you will most likely get a resident and usually an attending plastic surgeon of unknown experience in rhinoplasty. This will be  a crap shoot, as far as aesthetic results go.Safety shouldl be up to snuff in these places.

Is it safe to get a rhinoplasty at a teaching hospital/ university resident clinic?

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