Plastic Surgeon

What this level of surgeon makes

Be careful with these numbers. The federal wage survey publishes no separate line for plastic surgeons, so the figures here come from the nearest published surgical line, pediatric surgeons, where the median is $559,030 and the bottom tenth sit near $215,410. Treat it as the right neighborhood, not a plastic surgeon's paycheck. It also counts only surgeons who are employees, and many plastic surgeons own their practice instead.

What you earn while you train

Residents are salaried hospital employees, so this is real income. You are also carrying medical school debt and working the longest hours of your life. The figure follows the cost of living in the city, not the specialty.

Why the spread is so wide

Reconstructive work is billed to insurance at set rates. Cosmetic work is paid directly by the patient, so a surgeon with a busy private practice can earn several times what a hospital-employed colleague does, while carrying the risk and the overhead of running a business.

What it costs to get there

Bachelor's degree, public university, in state

Roughly $11,000 a year in tuition and fees

MCAT (Medical College Admission Test) and applications

About $350 for the test, then $1,000 to $3,000 applying to schools

Medical school, public and in state

Roughly $30,000 to $45,000 a year. Private schools cost more

USMLE (United States Medical Licensing Examination) steps

About $675 each for the first two steps, more for the third

Roughly, all in

$158,000 to $330,000

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

The low end is a cheap undergraduate route into a public medical school at in state rates near thirty thousand dollars a year, plus the admission test, applications and the three steps of the United States Medical Licensing Examination at roughly six hundred and seventy five dollars each for the first two. The high end is four full years of public university tuition then a private medical school, plus the board certification fees at the end. Residency and any fellowship are paid jobs, so the six or more training years after medical school add exam fees but no tuition, and those residency years count toward Public Service Loan Forgiveness if the hospital is a nonprofit or government one. Most medical students finish owing well over one hundred and fifty thousand dollars, so file the Free Application for Federal Student Aid every year.

File the FAFSA (Free Application for Federal Student Aid) every year. Most medical students finish owing well over $150,000. Public Service Loan Forgiveness can cancel the balance after 10 years of qualifying payments at a nonprofit or government hospital, and your residency years count toward those 10.

Benefits

• Malpractice insurance paid for you

  While you are employed. It is expensive in this specialty, and you pay it yourself once you own a practice.

• Public Service Loan Forgiveness

  Academic and nonprofit hospitals qualify, and six or more years of residency count toward the 10.

• The military will pay the tuition

  The armed forces run a scholarship covering medical school plus a monthly stipend, in exchange for roughly a year of service per year of support.

• You can own the business

  Few doctors can build a practice that is not dependent on insurance rates. Plastic surgeons can.

The path

The longest training on this site. Fourteen years minimum after high school.

1. 1

   High school

   Grades 11 and 12

   Top grades in biology, chemistry, physics and math. Nothing here is decisive, but weak science makes every later step harder.

2. 2

   Bachelor's degree

   4 years

   Any major, as long as you finish the pre-medical science courses and keep a high GPA. Sit the MCAT (Medical College Admission Test) in your third year.

3. 3

   Medical school

   4 years

   Two years of classroom science, then two years of hospital rotations. You graduate as an MD (Doctor of Medicine) or a DO (Doctor of Osteopathic Medicine). Both routes lead here.

4. 4

   Residency, one of two routes

   6 to 8 years

   The integrated route is 6 years of combined training entered straight from medical school. The independent route is 5 years of general surgery first, then at least 3 more years of plastic surgery, all 3 at the same institution.

5. 5

   Board certification

   After residency

   A written examination and then an oral examination from the American Board of Plastic Surgery.

High school courses that help

• Biology and chemistry

  Required for nearly every pre-medical program.

• Physics

  Tested on the MCAT (Medical College Admission Test), and useful for understanding how tissue and flaps behave.

• Art, sculpture or woodwork

  Not a joke. This is the one surgical specialty where shape and proportion are the outcome.

• English and public speaking

  You explain permanent, visible decisions to frightened people for a living.

Time and money, at a glance

Years after high school

14 by the integrated route, 16 by the independent route

Residency competitiveness

Integrated plastic surgery is among the hardest programs in the country to match into

Total tuition

$120,000 to $250,000 before living costs

Paid while training?

Yes, from the first day of residency

Licensed by your state, certified by a national board

Every state runs its own medical board and issues its own license, so moving states means a new application. The national exam is the USMLE (United States Medical Licensing Examination), taken in three steps. Board certification is separate and comes from the American Board of Plastic Surgery, which requires that your training be completed in the United States or Canada at a program accredited by the ACGME (Accreditation Council for Graduate Medical Education) or its Canadian equivalent.

Watch the words on the sign

The title surgeon is protected by your medical license, but in most states the phrase cosmetic surgeon is not tied to any particular training. Doctors from other specialties can and do advertise cosmetic procedures. Board certification by the American Board of Plastic Surgery is the thing that actually says you completed this training, and the American Society of Plastic Surgeons builds its whole public message around telling patients to check for it.

Fellowships after residency

One extra year that narrows what you operate on.

• Hand surgery

  Nerves, tendons and microsurgery. The American Board of Plastic Surgery runs a separate hand surgery examination for it.

• Craniofacial surgery

  Cleft lip and palate, skull shape in children. Often the most rewarding and the least profitable.

• Burn surgery

  Critical care as much as cutting. Very short of people.

• Microsurgery and breast reconstruction

  Moving tissue with its blood supply attached, usually after cancer.

• Aesthetic surgery

  The cosmetic side, and the route into private practice.

Nice-to-haves before you apply

• Research and publications

  Integrated plastic surgery programs weigh them heavily, more than almost any other specialty.

• Hours inside an operating room

  Shadow early. Standing still for eight hours suits fewer people than expect it to.

• Manual craft of any kind

  Sewing, carving, model making. The dexterity is trainable but the interest is not.

• A second language

  Spanish especially, in busy trauma and burn centers.

Most of the work is not cosmetic

Public picture, actual job. A large share of plastic surgery is reconstruction: rebuilding a breast after cancer, closing a wound that will not heal, repairing a hand crushed in a machine, treating burns, fixing a cleft palate in a child. Hospitals hire plastic surgeons because nobody else can do those operations. If the only part that appeals to you is the cosmetic side, you will still spend most of your training years in the other half.

A typical day

Two or three operating days a week and one or two clinic days. A straightforward procedure runs an hour or two, a microsurgical reconstruction can run eight or more without a break. Clinic days are consultations, photographs, measurements and long conversations about what surgery can and cannot do. Then dictation, insurance authorizations and post-operative checks. Emergency call means hand injuries and facial trauma at unsociable hours.

The honest trade-offs

Work life

Typical hours

50 to 65 a week, far more in residency

Remote work

None

Physical demand

High, hours standing and operating under a microscope

Unionized

Rarely, though resident unions are growing

Similar paths

• General SurgeonThirteen years of training to become the person who opens someone up and fixes the problem.
• DermatologistA doctor for skin, hair and nails. Very well paid, and one of the hardest residencies to get.
• Ear, Nose and Throat SurgeonEars, sinuses, voice, swallowing and head and neck cancer. One of the few surgical specialties where you also run a clinic.

There are two completely different ways in

The American Board of Plastic Surgery accepts an integrated route of 6 years entered straight from medical school, or an independent route where you first complete 5 progressive years of general surgery and then at least 3 years of plastic surgery. Since 2014 all 3 independent years must be at the same institution.

The hand gets its own exam

Plastic surgery, orthopedic surgery and general surgery all lead to hand surgery, and the American Board of Plastic Surgery runs a separate hand surgery examination with its own date each year. The hand is complicated enough to need its own specialty.

Cosmetic surgery is still growing

The American Society of Plastic Surgeons reported in its 2025 statistics that cosmetic surgical procedures rose 7% on the previous year. The demand side of this career is not the problem. The training length is.

The specialty grew out of war

Modern plastic surgery was built largely on rebuilding the faces of soldiers wounded in the First and Second World Wars, when surgeons had to invent skin flaps and grafting techniques from nothing. Burn and trauma reconstruction is still the backbone of the field.