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USF plastic surgery residents struggle to save careers

Once one of the nation's best, the program is closing. Doctors are scrambling to find other medical schools with room for them.

By WES ALLISON

© St. Petersburg Times, published February 11, 2000


TAMPA -- Dr. Mark McDonough could have trained to be a plastic surgeon at Stanford University, Brown or Harvard.

But, like the young doctors he has studied with for the last five years, he chose the fledgling program at the University of South Florida because it promised to be one of the nation's best and boasted leaders of worldwide renown.

Now it is closing, and McDonough and his peers are literally begging plastic surgery programs at other universities to squeeze them in.

"It was the Roman Empire. You're not seeing the fall of some training program at some Podunk university -- this was the best thing going," McDonough said. "I can't tell you how many heartbreaks there have been in the last month and a half."

The Accreditation Council for Graduate Medical Education, the nation's sanctioning agency for medical schools, has withdrawn accreditation from USF's division of plastic surgery, citing too few faculty and no director. It will close June 30, although USF hopes to revive it.

While the loss is an embarrasment for USF's College of Medicine, it's also a huge blow to the plastic surgery residents who had pinned their careers to what was once a well-respected program.

The three now in their final year -- known as chief residents -- still get to finish from an accredited school this spring, but the six residents in the first and second years must find another place to go.

Most have been placed elsewhere, but residents say their futures are still tentative, and their salaries for the next year are not guaranteed. McDonough, who is married and has three young sons, thought he found a spot at the University of North Carolina at Chapel Hill for his final year. He learned on Thursday that apparently has fallen through.

"I'm still scrambling," he said.

Most residents shoulder hefty loan payments from medical school, and several recently spent about $2,000 in fees to earn their Florida medical licenses. Those are worthless in other states.

"Do I have the money to move? No. I'll have to come up with it somewhere," said Dr. J. Jason Wendel, who spent three years learning general surgery at USF and is now in his first year of a plastic surgery residency. He tentatively has a spot at the University of Michigan, and he's debating what to do with the small house he recently bought in Tampa.

Plastic surgery is a three-year program, but most USF residents do the prerequisite work in general surgery here, too. They work in local hospitals, and moving to other schools means breaking bonds with their teachers and learning new regimens.

"It's going to be difficult (because) they have to make sure that wherever they go, they don't miss anything and there aren't any gaps," Wendel said.

It also may affect those who finish this spring, like Dr. Lee Pu, a chief resident who came from Yale University. "Whoever will take me as a junior associate probably will be more cautious, they'll probably talk to their friends in the Tampa area," he said.

The loss of accreditation represents a giant change for a program that residents and faculty describe as having stellar promise several years ago.

"The vision and the program was like a supernova," said Dr. Richard Karl, chairman of the department of surgery at USF, which oversees plastic surgery. "It came, and it became big and grand, and then started to implode."

USF hired Dr. Thomas J. Krizek, a nationally known surgeon, to start the program in 1992, and he recruited other noted surgeons. Within four years, it was one of the most respected programs in the nation, Krizek said.

"We were getting 150 people for two (resident) slots, we really had our picks," he said. "Our applicants came from Harvard, Yale, Hopkins -- these were first-round draft choices."

Krizek announced his retirement in 1997, but said he would stay while USF looked for a replacement. Last May, he left the program for good and now directs the center for sports ethics at USF.

Meanwhile, several faculty members left for private practice, though many still work with residents. When a representative of the accrediting committee last visited USF in October, the number of full-time faculty had dropped from nine to four, and Karl was reorganizing his search for the director.

"When I signed up four years ago . . . this was a full-blown academic program," Wendel said. "As things dwindled over the last couple years, morale has declined."

Most faculty and residents interviewed Thursday said probation would have been more appropriate. But Doris A. Stoll, executive director of the council's review committee for plastic surgery, said the committee is trying to enforce high standards at a time when the public is quick to complain that the medical profession doesn't adequately police itself.

Karl said the loss of accreditation hurts his ability to recruit a director to rebuild the program, but he is meeting a candidate this week. More are to visit soon.

"We want to appoint a quality person who's going to build a substantive program, and I want to do that expediently as possible, but I don't want to cut any corners," Karl said.

Plastic surgery is more than tummy-tucks and nose jobs. Its practitioners rebuild breasts lost to cancer, fix facial deformities for children, repair the ravages of fire.

McDonough was 16 when his family's house in Cleveland caught fire, killing his mother and brother and leaving 60 percent of his body badly burned. He endured 30 surgeries in the following years, and his experience was a big reason he decided, at age 30, to learn plastic surgery.

Although he could have attended some of the best programs in the country, now he may simply have to find a research position for next year, then try to finish his residency in 2002.

"Here it is, 10 years trying to become a plastic surgeon, and this happens," McDonough said. "I'm about ready to look for another career at this point. It's so disheartening."

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