Plastic Surgeon

What plastic surgeons make

Net income after overhead. Hospital reconstruction is billed to the province. Cosmetic work is paid by the patient and can push income well past this range. Pay varies by province and billing model. CIHI (Canadian Institute for Health Information) reports average gross provincial payments of about $538,000 for plastic surgery in 2023 to 2024, before overhead and not counting cosmetic fees.

During residency

Residents are paid employees. Quebec pays the least. Expect 60 to 80 hour weeks and call for hand injuries, burns and facial trauma.

Private cosmetic practice

Patients pay cash for facelifts, breast surgery and body contouring, so there is no provincial fee cap. But you run a business with staff, marketing, a surgical suite and slow years when the economy dips.

What it costs to get there

Undergrad degree (3 to 4 years)

$7,000 to $10,000 a year

Medical school (3 to 4 years)

$15,000 to $28,000 a year

MCAT (medical school admission test), applications, interviews

$2,000 to $5,000

MCCQE (the national medical exam) plus the Royal College exam

$1,500 for the MCCQE, plus several thousand more for the Royal College exam

Setting up a cosmetic clinic, if you go that way

Hundreds of thousands of dollars

Roughly, all in

$75,000 to $167,000

Tuition, fees, exams and kit. Not rent, food or travel

The low end is three years of undergraduate study and a three year medical degree at cheaper Canadian schools, plus the MCAT (Medical College Admission Test), the MCCQE (Medical Council of Canada Qualifying Examination) and the Royal College certification exam. The high end is four years of each at the most expensive faculties. The five or more years of plastic surgery residency are paid, as are the one or two fellowship years that usually follow, so they add time rather than tuition. Setting up a private cosmetic clinic later runs into the hundreds of thousands, but that is a business investment, not a cost of qualifying.

Typical debt at the end of medical school is $80,000 to $150,000. Fellowships add 1 to 2 years at roughly resident pay.

What comes with the job

• No employer pension

  Most surgeons are self-employed and save through a professional corporation.

• Two income streams

  Provincial billing for reconstruction, private fees for cosmetic work. Most plastic surgeons do some of each.

• On-call stipends

  Extra pay for covering hand and facial trauma overnight.

• Malpractice coverage

  Through the CMPA (Canadian Medical Protective Association), partly reimbursed by provinces.

The path

One of the most competitive matches in Canada, for one of the most varied surgical jobs.

1. 1

   High school

   Grades 11 and 12

   Top marks in biology, chemistry, math and English. A very high average is the entry ticket.

2. 2

   Bachelor's degree

   3 to 4 years

   Any major, usually life sciences. High GPA, research, volunteering. Write the MCAT (medical school admission test).

3. 3

   Medical school, the MD (doctor of medicine)

   3 to 4 years

   Acceptance rates are 5 to 15%. Plastic surgery electives and research in your final year decide the match.

4. 4

   Plastic surgery residency

   5 years

   Matched through CaRMS (the residency matching service). Paid, supervised. Burns, hand, breast reconstruction, facial fractures, cleft lip and palate, skin cancer.

5. 5

   Royal College exam, licence, often a fellowship

   1 to 2 years

   Pass the Royal College of Physicians and Surgeons of Canada exam, register with your provincial College of Physicians and Surgeons. Most add a 1 year fellowship.

High school courses that help

• Biology and chemistry

  Required for nearly every pre-med path.

• Physics and calculus

  Tested on the MCAT (medical school admission test).

• Visual art

  Plastic surgery is about shape, proportion and symmetry. An eye for form matters.

• English

  Managing patient expectations is a big part of the job.

Time and money, at a glance

Years after high school

12 to 15

Med school acceptance rate

Roughly 5% to 15%

Plastic surgery residency spots in Canada

About 25 to 30 a year

Total tuition

$90,000 to $150,000

Paid while training?

Only from residency on

Heavily regulated, and the title matters

You need a licence from your provincial College of Physicians and Surgeons to practise, and specialist certification from the Royal College of Physicians and Surgeons of Canada to call yourself a plastic surgeon. Beware the term cosmetic surgeon: in most provinces any doctor can use it, with no surgical residency at all. Licences transfer between provinces with paperwork and fees.

Fellowships that shape the job

• Hand and microsurgery

  Reattaching fingers, nerve repair, tendon work. Lots of trauma call.

• Breast reconstruction

  Rebuilding after cancer surgery, often using the patient's own tissue.

• Craniofacial and pediatric

  Cleft lip and palate, skull reshaping in babies.

• Burns

  Skin grafts and years of follow-up at regional burn units.

• Aesthetic

  A year focused on cosmetic technique before going private.

Nice-to-haves

• Plastic surgery electives and research in med school

  Reference letters from plastic surgeons decide the match.

• Fine motor skills

  Sewing, drawing, instrument playing. Microsurgery is done under a microscope with thread thinner than a hair.

• Business sense

  Useful if you ever open a private clinic.

• Thick skin

  Cosmetic patients can be unhappy even after a technically perfect result.

Going private

Some plastic surgeons leave the hospital entirely for cosmetic practice. Pay can be far higher, and there is no call. But you give up the reconstructive work most people entered the field for, income swings with the economy, and you spend real time on marketing and reviews. Most keep a foot in both worlds.

A typical day

7:30 a.m. rounds on burn and reconstruction patients. 8:00 first case in the operating room (OR): a breast reconstruction using tissue from the abdomen, 4 to 6 hours under a microscope joining blood vessels. Other days are a cosmetic list at a private clinic, or hand clinic with 30 patients. On call, a cut tendon or a dog bite to the face can bring you in overnight.

The honest trade-offs

Work life

Typical hours

50 to 65 a week, plus call in hospital jobs

Remote work

None

Physical demand

High, long microscope cases

Unionized

Residents yes, staff surgeons no

Similar paths

• DermatologistThe skin, hair and nail doctor. Five years of residency, regular hours, and one of the hardest residencies in Canada to get into.
• Ear, Nose and Throat SurgeonTonsils, sinuses, hearing, voice and head and neck cancer. Officially otolaryngology, one of the most varied surgical specialties.
• General SurgeonOperate on the abdomen, breast, skin and trauma cases. About 13 years of training for one of the broadest jobs in medicine.

Plastic has nothing to do with plastic

The name comes from the Greek word plastikos, to mould or shape. The specialty existed long before the material, and it grew up rebuilding the faces of soldiers wounded in the First World War.

Most of it is not cosmetic

In Canadian hospitals the bulk of plastic surgery is reconstruction: burns, cancer defects, hand injuries, cleft palates and facial fractures, all covered by provincial health plans. Cosmetic surgery is the smaller, patient-paid slice.

Sewing a blood vessel 1 millimetre wide

Microsurgeons reattach fingers and move living tissue by joining arteries and veins about 1 millimetre across, using thread finer than a human hair, under a microscope. One stitch off and the tissue dies.

The title is protected, cosmetic surgeon is not

Only Royal College certified specialists can call themselves plastic surgeons. In most provinces a family doctor can take a weekend course and advertise as a cosmetic surgeon. Provincial colleges have been tightening the rules after patient harm.