If PS is faculty vs private practice

[infinity123]

Hi,

Are there differences in the quality of work by plastic surgeons who are faculty vs those in private practice?

For example, are plastic surgeons at major teaching hospitals "the best of the best" and more up to date on modern technology, or are surgeons in privace practice perhaps the best because they run their own show, so to speak? Or perhaps you can't generalize at all?!!

I bring this up because I've had several consultations, and one PS, who is a plastic surgeon at one of the world's top hospitals, mentioned that he is paid on a salary, vs surgeons who are in private practice who try to make huge amounts of money. He mentioned this while talking about the possibility of insurance covering gynecomastia surgery. (He said insurance is more likely to cover it at a major hospital.)

[Preds]

I don't think you can generalize.  I know some docs that take a salary from hospital for simplicity.  They do not worry about bookkeeping, nurses, office expences, malpractice insurance cost(or at least as much) plus it helps them get a client base started.  The hospital does not profit necessarily from the office visits and surgery as much as the tests and surgeries that the doc performs at their facility.  Its kind of insurance for them that they will get clients.  Eventually most docs I know will venture out and be on their own or within a group b/c there is more money but it takes a while to get out of debt.
As far as better docs at teaching facilities, who knows.  My wife had to have a special craniotomydone several years ago.  She had a benign bone growth in her eye socket.  It took a plastic reconstructive opthamologist and a neuro surgeon to do the job.  We live near one of the top medical schools (private school) in the country but had to travel 5 hours away to a state run medical school location to get a qualified surgeon to do the job since it was so rare.  So , in other words, just b/c its a great teaching hospital does not always insure the best docs there but it does not disqualify them either.

[infinity123]

Thanks Preds, good answer. I hope others chip in.

[phantom]

When looking for a surgeon, I always advise to get the best there is, where possible irrespective of costs.  I have chosen to go with a private practice with a surgeon who is to my knowledge, the most expensive in the UK.

But basing my judgement on price was the least of my concerns.  If I knew there was a surgeon with a better reputation at a teaching hospital and I was able to use his or her services, I would not hesitate to go with that person.

Cosmetic surgery is a very competitive business and sometimes I have felt hounded by the private clinics.  All their glossy brochures make each and every one of them sound amazing.  Of course there is a profit motivation here.  But I had to see through any marketing and dig down to the capabilities of the consulutant that is responsible for doing the work.

I asked tough questions at initial consultation to all the PSs I saw, questions like "How often are your patients not happy with the outcome?  How are these cases resolved?  Do you offer free revision?  What are you first, a surgeon or an artist?  What makes you different to other surgeons?  Which procedure do you use and why? Why do you prefer your procedure to other ways of male chest reduction?"

I then based my decision on a number of things.  The surgeons quality of answers.  The before and after pics he or she was able (or not able!) to provide and word of mouth from past patients - mainly from this website.

Whilst there is arguably more of a profit motive for private practice, I judged each surgeon on their commitment to medical ethics and patient care.

So I think you are quite right to be aware of motives of private versus state care, but ultimately it comes down to the skill and post-operative care of each and every individual surgeon, followed by your ability to afford any fees that are due.

Finally, irrespective of profit motive, each surgeon has a reputation to uphold.  The last thing any surgeon needs is an unhappy customer dishing out their grievance on a website like this, which could seriously affect how future patients perceive them.  

[phantom]

"mentioned that he is paid on a salary, vs surgeons who are in private practice who try to make huge amounts of money. He mentioned this while talking about the possibility of insurance covering gynecomastia surgery. (He said insurance is more likely to cover it at a major hospital.) "

Whilst I did not hear this first hand, based on what you have written here, I would question this surgeons motives for suggesting that "Private practice try to make huge amounts of money."  I think this is an obvious statement, but it utterly unconnected to the hospitals/surgeons ability to provide quality health care and patient satisfaction.

And just because insurance apparently may be more likely available for a 'major hospital' does not mean you will get a better result.  The only reason I could think why insurance might cover a 'major hospital' is that the fee might be cheaper than private practice - being the sceptic I am

Based on what you say, it's almost as if the surgeon you talk of is trying to 'sell' his services over that of a private practice - which makes him or her 'no better or worse' than the private guy.  Be aware!