Plastic and Reconstructive Surgery

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PRSonally Speaking
Friday, October 26, 2012
Working for “The Man”

By Stephanie Rowen, MD

As I sit on my couch writing this during my second week of paid maternity leave (yes I did say paid) as I approach 38 weeks gestation and am finding it harder and harder to get up off of the couch, let alone walk to the kitchen, I contemplate my decision to join an HMO as an employed physician. 

I started in my current position not long after my fellowship and have been here for nearly seven years now.  I won’t say that it doesn’t have its fair share of frustrations, but it definitely has many upsides.  Right now I am thankful to have 4 weeks of fully paid maternity leave BEFORE my due date, then 6-8 weeks of fully paid maternity leave after the delivery.  I then use my paid vacation to cover more time off.  I can then take up to 30 days of unpaid leave while my full benefits are still covered by my employer.  What a deal. 

The benefits of working as an employed physician are many: 

  • My malpractice insurance is paid for by the organization. 
  • I have a pension – seriously.  Whether there will still be a pension when I finally retire, that remains to be seen, but I can retire with full benefits, including healthcare for life, at age 60. 
  • I have a 401K, and my employer contributes to that as well. 
  • I have fully covered healthcare for myself and my family (which is about to grow by one, with no additional health insurance cost to me).  No copays for anything except $5 for prescriptions, any prescription. 
  • I currently earn 4 weeks of paid vacation a year and earn more time off if I work more than 40 hours a week, whether it’s an OR day that runs long or I come in on call. 
  • I have about 4 months of sick leave I can use when needed. 

Enough about the financial benefits, and I’m sure there are more that I’m not remembering right now, dang hormones.  I have two full-time and one part-time plastic surgery colleagues.  We work together on cases.  For instance, on a bilateral breast reduction we work side by side, each working on one breast, getting the case done in half the time.  If I have a case that requires a little extra brute force (such as a mandible fracture) or one that I just want an extra pair of hands or an extra brain (a complex tendon transfer for example), I just have one of my colleagues scheduled as my assistant.  It’s that easy.  We are in no way in competition.

I would never be able to take this much time off and still be able to pay the mortgage if I were in private practice. 

In fact, my favorite days are the days when I’m the assistant: all operating, no paperwork, no follow up.  We share call between the four of us, but it can be painful as we take hand and face call from our ER.  The upside is that when I’m not on call, I can do anything or go anywhere.  My colleagues will cover my patients no matter what. 

The frustrations?  Where do I begin?  It’s not all rosy for sure. 

One of our biggest frustrations is staffing.  Our organization employs union members as our support staff, from the RNs to the medical assistants to the appointment clerks.  We have little to no say in whom we hire or fire.  We are lucky to have an excellent staff currently, and we can only hope they will continue to want to work with us.  We work for a large company, and even though we are shareholders of the company, we have little say in the “big decisions” that “come down from above”.  Yes, we have a vote, but only one each. 

With the currently changing healthcare environment our leadership is doing its best to position our organization to thrive in the near and distant future.  That translates into metrics and initiatives we are made to follow, to many of which there is dissention among the ranks, but that dissention doesn’t seem to matter.  It can be frustrating to sit back and let things happen TO you when you’re a self-assertive, ego driven surgeon, not that that’s me of course.

As I mentioned, I started working here straight out of training and started my board case collection at that time.  I had no trouble meeting the minimum requirements of case numbers and breadth of plastic surgery as we have nearly every type of patient and problem walk through our doors.  I still have to see just about everything, which is stimulating and humbling, but I have my colleagues whom I can ask for advice or help on a case.  In this age of uncertainty about insurance reimbursements, cosmetic taxes, etc., I have a guaranteed salary. 

It can be frustrating to sit back and let things happen TO you...

Now that I’m on maternity leave I especially appreciate our benefits.  I would never be able to take this much time off and still be able to pay the mortgage if I were in private practice.  If you were to ask me if I am glad of my decision to work here, I would say most definitely right now, but that’s easy to say from the comfort of my own couch while I’m being paid in full. 

About the Blog

Plastic and Reconstructive Surgery

PRSonally Speaking is the official blog of Plastic and Reconstructive Surgery, the journal of the American Society of Plastic Surgeons. Visit our blog for exclusive previews of and discussions on hot topics in plastic surgery as well as insider-tips on open access content. PRSonally Speaking is now powered by frequent contributions from the American Society of Plastic Surgeons’ Young Plastic Surgeons Forum (YPS); these practicing plastic surgeons provide the personal side of the plastic surgery story, from daily challenges to unique insights. PRSonally Speaking is home to lively, civil debate on hot topics and great discussions pertaining to our field. So, bookmark us, subscribe to the RSS feed and join in the on-going conversation with Plastic and Reconstructive Surgery. This is your Journal; have fun, be respectful, get engaged and interact with the PRS community.

The views and recommendations of guest contributors do not necessarily indicate official endorsements or opinions of the Journal, PRS, or the ASPS. All views are those of the authors and the authors alone.


Anureet K. Bajaj, MD is a practicing plastic surgeon in Oklahoma City. She completed residency and fellowship in 2004, had a brief stint in academia at the University of Cincinnati, and then chose to join her father (Paramjit Bajaj MD, also a practicing plastic surgeon) in private practice in OKC, where she focuses on breast reconstruction and general cosmetic surgeries.

Devra B. Becker, MD, FACS, is an Assistant Professor of Plastic Surgery in the Department of Plastic Surgery at University Hospitals/Case Western Reserve University School of Medicine in Cleveland, Ohio. She completed Plastic Surgery residency at Washington University School of Medicine in St. Louis, and completed fellowships with Daniel Marchac and with Bahman Guyuron. She currently has a primarily reconstructive practice.

Henry C. Hsia, MD, FACS is at Robert Wood Johnson Medical School of Rutgers University in New Brunswick, New Jersey and also holds an appointment at Princeton University.  When he’s not working hard trying to be a good father and husband, he runs a practice focused on reconstructive surgery and wound care as well as a research lab focused on wound biology and regenerative medicine.

Stephanie K. Rowen, MD is a senior physician at The Permanente Medical Group in San Jose, California.  She joined TPMG upon finishing residency and a hand surgery fellowship in 2005.  She has a primarily reconstructive practice, about 50% hand surgery.  Outside of work she enjoys participating in triathlons and spending time with her family.

Jon Ver Halen, MD is currently Chief of plastic surgery, Baptist Cancer Center; Research member, Vanderbilt- Ingram Cancer Center; Adjunct clinical faculty, St. Jude Children's Research Hospital. He also acts as Program Director for the plastic surgery microvascular surgery fellowship. His practice focuses on oncologic reconstruction.

Tech Talk Bloggers

Adrian Murphy is a plastic surgery trainee in London, England. He studied medicine in Dublin, Ireland and has trained in Ireland, Boston, MA and the United Kingdom. He is a self-confessed geek and gadget aficionado.

Ash Patel, MD is Assistant Professor of Plastic Surgery and Associate Program Director at Albany Medical College, in Albany NY. His practice is primarily reconstructive.