32: A Community Plastic Surgeon Gives Us a Look at His Job

Session 32

Dr. Russell Babbitt is a Plastic Surgeon in private practice for the last seven years. He took the time to share with us his thoughts on what he likes and what he doesn't like about it and what you, as a premed or medical student, should start doing now to become a better applicant for Plastic Surgery.

[01:18] His Love of Plastics

Around that time when the show ER was popular, Russell started medical school thinking he wanted to do Emergency Medicine but realized it wasn't for him. Instead, he liked doing surgical rotation along with his plastic surgery rotation which he describes as gelling very well. He also started college as an art major so the visual-spatial aspects really appealed to him once he got into plastics because it wasn't just a cookbook, do-this-do-that case but it involves applying spatial problems to different situations which appealed to him. The second he got onto his plastic rotation, he knew it was where he needed to be.

Russell went to UMass for medical school and during their third year surgery rotations, they had a three-month block spent on general surgery and the other half was subdivided into other subspecialties. Many of them ended up rotating through plastics. Other specialties he did consider include general surgery and vascular surgery. He likes the disease processes in general and being able to intervene into a lot of different illnesses and have the ability to take care of sick people across the board. Ultimately, he was meaning to be a well-rounded surgeon and the fact that plastics builds on that was nice.

[04:30] Traits Leading to Becoming a Good Plastic Surgeon

Russell cites meticulousness as the primary trait of becoming a good plastic surgeon as well as being a good visual-spatial thinker. Being a good communicator is also very important since. You need to be willing to sit down with the patient and explain the disease process, the problems, the solutions, how you're going to get there, oftentimes, there are many ways to get there and there's many different things that can happen.

Russell further explains that the doctors who don't communicate tend to have more difficulties regardless of what the outcomes are and this is especially true in plastics. Beyond that, you also have to be a good technician and be able to develop a plan, know what you're going to do, and see the technical problem you're going to solve and actually execute it.

Also, you must be able to see the long term outcome, not just the proper three-dimensional result but it has to look good three to four months and years down the road. Blood supply also has to be intact at the end of the day. One of his mentors once told him that when he's out in private practice, one of the things he has to do is while doing a skin graft, you have to make sure every mitochondria survives.

"You have to just be really meticulous in every single thing that you do and that people are watching and the patients are watching. That's one of the things people look for in a plastic surgeon."

Russell adds that another innate trait in a plastic surgeon is being anal. In terms of having an arts background, although not necessary when you become a plastic surgeon, a lot of people that go into medicine in general tend to be very agile-thinkers so Russell thinks a lot of it can be taught. But he personally thinks it helps a lot in terms of little shortcuts that allows him to know what to do before he even thinks about it. This may also help in certain other areas where it would have been hard to to teach it.

[09:00] Types of Patients and Typical Day

Russell sees a mix of 50% cosmetic and 50% reconstructive patients. To his surprise, he's doing a lot of breast reconstruction. They have a very busy breast reconstructive program where he's the director at a local hospital. This was something he didn't expect to be doing a lot but he ended up doing it anyway.

The reason for breast reconstruction is almost always breast cancer in various stages or it may be due to genetic predisposition where the patient has a high risk of developing breast cancer in the future or maybe that the patient has an active diagnosis of breast cancer or very late stage precancerous lesions which would require mastectomy and therefore they would then need Russell to reconstruct the breast. He describes it as a very intense process and oftentimes, he is the one the patient sees the most of throughout the process. They see them after surgery and on a weekly basis to fill tissue expander that expands the breast's skin envelop after radiation and mastectomy. Nevertheless, Russell sees this as a nice aspect of what they do.

Another thing they commonly do is reconstruction after skin cancer resections with dermatologists which can sometimes be very large defects. On the cosmetic side of things, they do a bit of facial cosmetics like face lifts, rhinoplasty, ear correction, fillers, Botox, facial rejuvenation, liposuction, tummy tucks, and a lot of breast surgeries.

"15% of what he does involves taking care of complex cosmetic breast patients which is a fairly challenging field."

Russell finds himself in the operating room at least two full days a week and even up to three full days a week. He works between 40 and 60 hours a week. During his office-only days, he gets in around 9 am and finishes around 6-7pm. His OR days start at 730am and finishes between 4 and 5pm. He does his larger cases first thing in the morning and then the local type cases like mole removals or lesion removals or skin cancer reconstruction in the afternoons.

Russell has an amazing physician assistant who has been with him for about two years now that sees a lot of his postoperative patients in the office. They are very much on the same page and because of the high demands, they've gotten so busier across the board. Nevertheless, they try to balance things out to avoid burnout and try to make it sustainable.

[15:00] Private Practice Goals for Work-Life Balance

Russell would like to have his weekends off so he covers himself 24/7, 365 days except when he's on vacation. Other than that, he's available for patient issues that only he can answer unless his PA is available to answer it. He doesn't do office hours on a weekend and reserves it for family time and he tries to be home every night to help with the kids to bed and stuff. Pretty much, he's going all out throughout the week and works as hard as he can to get as many patients. Most importantly, he makes sure they're taking enough time with each patient.

One reason he shies away from being employed is he doesn't want to be in a position where he's being told how many people he has to see a day. He's okay with this perspective.

"I don't want there to be other metrics that I need to have to use. Other than that, the patients are happy. We're taking good care of them and that my bills are paid."

Basically, this is how he likes to do it right now compared to his colleagues where it's not how they're living so he feel extremely fortunate for it.

[17:30] Patients that Go to the Operating Room

Russell estimates their conversion rate in the high 80%. These people come to his office because they want to see him and they're not doctor-shopping as much. They've waited a decent amount of time to see them so they're there to see him and are typically there to have surgery. Also, nobody goes to the operating room without seeing him in the office first with the exception of local anesthesia procedure where they get to meet him that day, he talks to them, and they'd have to wait for the procedure. But if somebody gets general anesthesia, they may see his PA first and then get a second appointment with him to have another formal sit-down discussion if they're going to go forward. He doesn't do internet-based consultations since it's not how he wants to do things in terms of how he wants to care for patients.

Russell says there are patients coming in who are insecure about something and they come to see you for one thing.

"Just because one thing that bothers. it doesn't mean there are other things that may be addressable as well. It is a strict policy in our office to not mention those other things or to try to market other things."

In other offices, patients would come in for tummy tuck and then the surgeon there would ask you to consider getting a neck lift or breast done, or whatever. They basically walk in to talk about getting fillers in their lips and they walk out with $30,000 worth of clothes and a whole new complex because they didn't realize all those other things need to be addressed.

"As a plastic surgeon or cosmetic surgeon, you have a lot of power to make somebody feel better about themselves or feel worse about themselves."

Doing it ethically and conscientiously, Russell sends a lot of people in the office telling them they don't need surgery and don't listen to anybody that tells you that you do. He emphasizes that this is the right thing to do because at the end of the day, they're still physicians that took an oath to do the right thing for people and he feels it's job to make sure that if people need to do surgery, it has to be done safely and in the right circumstances. He needs to do it well and do it safely. He needs to do it under the right circumstances for the right patients.

Russell admits he is bothered by a lot of plastic surgeons out there that are making a lot of decisions for financial reasons impacting other people's lives negatively and they're doing a surgery for that reason which makes them all look bad collectively, reason plastic surgeons and cosmetic surgeons have a bad name sometimes.

[22:05] Taking Calls

Russell is in a position where he doesn't cover much call at the surroundin