MJATHE MEDICAL JOURNAL OF AUSTRALIA

N U M B E R 8 • 1 8 A P R I L 2 0 1 1

CareersC1

MENTION the term “plastic surgeon” to the average person on the street, and they’ll think of the TV series “Nip/Tuck”. The assumption is that this specialty is all about cosmetic surgery; restoring beauty to those worried they’ve lost it.

It’s a misunderstanding that real-life plastic and reconstructive surgeons have to live with, but are at pains to dispel whenever a chance arises.

The term plastic can confuse. It is actually derived from the Greek word plastike, which means to mould or give form. Indeed, this is an ancient speciality, and is thought to have been fi rst performed around 3000 BCE in India — where thieves and adulterers were punished by amputation of the nose, and surgeons used a fl ap of tissue taken from the forehead to create a new nose.

The term “reconstructive” gives a better picture of what this surgical specialty entails.

Gaye Phillips, Chief Executive at the Australian Society of Plastic Surgeons, says that although cosmetic surgery to arrest the effects of ageing is part of the job, most plastic and reconstructive surgery is aimed at restoring as near normal an appearance as possible for those suffering the effects of physical birth defects (such as cleft lip and palate), trauma (such as burns and accidents), or cancer (such as melanoma, breast cancer, and head and neck cancer).

As surgical specialties go, plastic surgery is unique. Most other surgery is specifi c to a particular part of the body. Plastic surgeons,

however, repair and rebuild affected areas from the head and neck to the torso and limbs. “No surgery is easy, but plastic and reconstructive surgery requires particular dexterity — involving a range of techniques including microsurgical techniques — and the ability to plan sometimes complex

procedures”, Phillips says.“Wound closure and management

can be challenging, depending on the circumstances and the part of the anatomy affected. Maintaining a viable blood supply in some fl aps can be similarly challenging.”

Most of Australia’s approximately 350

Editor: Dr Peter Lavelle • plavelle@ampco.com.au • (02) 9562 6666

continued on page C3

In this issueC1 A career in plastic and reconstructive surgery

C4 Professor Peter Maitz: burns specialist

C5 Salary packaging for doctors

C7 - C9 LocumsC3, C10 - C11 Hospital AppointmentsC2 & C12 Specialist AppointmentsC13 University AppointmentsC14 Marketplace

The restoration specialists

Image courtesy: Operation Smile http://australia.operationsmile.org/

www.mjacareers.com.au • Number 8 • 18 April 2011MJA Careers

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www.mjacareers.com.au • Number 8 • 18 April 2011MJA Careers

plastic surgeons work as visiting medical offi cers in both private and public hospitals, though some hold salaried posts, mainly in the public system. Some are generalists, doing a mix of reconstructive and aesthetic surgery but, as with other types of surgery, there’s a growing tendency to specialise, for example, in trauma, burns, paediatric, hand, head and neck, melanoma, or breast surgery.

Surgery generally is a team effort and plastic surgeons often fi nd themselves collaborating with other surgeons and medical specialists such as orthopaedic and general surgeons, vascular surgeons, neurosurgeons, oncologists and otolaryngologists.

Being a procedural specialty, remuneration is usually substantial, although this depends on whether the surgeon is in private or public practice (or both), and on the location of the practice.

Among surgical specialties, Phillips rates plastic surgery highly in terms of professional satisfaction.

“There’s tremendous satisfaction in transforming the smile and life of a child affl icted from birth by a cleft lip and palate. There is the thrill of being part of a surgical

team that successfully separates conjoined twins. There is genuine empathy with the woman whose self-esteem is restored after the ravages of breast cancer”, she says.

Even simple results from skin cancer excision and reconstruction can be extremely satisfying.

And the downside? Even with superb technical skills and the best efforts, there are times when a surgeon doesn’t get the results he or she had hoped for.

TrainingWould-be trainees can apply during postgraduate year 2 (PGY2) and, if successful, can enter the Royal Australasian College of Surgeons (RACS) Surgical Education and Training program in PGY3.

Places are hotly contested. About 100 apply each year and, on average, 18−20 are accepted. These days, women make up about 30% of new trainees.

The training takes 5 years and is overseen by the RACS Board of Plastic and Reconstructive Surgery.

Trainees work as surgical registrars, mainly at major teaching hospitals, on 6-monthly

rotations. They advance from training in general surgery to gradually undertaking more advanced plastic surgery procedures under supervision. These cover the entire fi eld of plastic and reconstructive surgery including hand surgery, microsurgical procedures, treatment of burn injuries, cranial and maxillofacial techniques, and other reconstructive and cosmetic procedures. Each trainee must also undertake a research project.

After passing a fi nal examination and gaining satisfactory supervisors’ reports, successful graduates are awarded a Fellowship of the RACS. Many choose to do further research or spend a period studying a specialised area (eg, cosmetic surgery, hand surgery, cranio-facial surgery or microsurgery) before commencing practice.

Despite a workforce ratio (number of plastic surgeons per capita) that is one of the highest among the Organisation for Economic Cooperation and Development countries, the demand for plastic and reconstructive surgeons is such that graduates can essentially work where they choose, Phillips says.

By Dr Peter Lavelle

continued from page C1

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A first-class health service needs first-class professionals like you.WA Health has a vast range of employment opportunities. We have 111

different places to work across WA and 2.3 million customers. To find

your opportunity, visit www.health.wa.gov.au

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www.mjacareers.com.au • Number 8 • 18 April 2011MJA Careers

Professor Peter K M Maitz, AM MD FRACS

Born in Vienna, Austria, Professor Maitz qualifi ed in medicine at the University of Vienna and emigrated to Australia in 2000. He holds the inaugural chair of Burn Injury and Reconstructive Surgery at the University of Sydney, and is Medical Director of the Burns Unit at Concord Hospital. For his service to victims of the Bali bombings in 2002, he was awarded the Order of Australia that year.

Q&A

Vienna is better known to most people for its composers than for

its burns specialists. What was the path that led you to where you

are currently working?

I studied medicine at the University of Graz and later the

University of Vienna in Austria, and was awarded a fellowship to

Harvard University in 1991. It was at Harvard that my interest

in the treatment of burns began. Subsequently, during my

residency in plastic surgery at the Vienna General Hospital,

I worked in the newly opened Burns Unit. Then, at the age of

37, I received an offer from the University of Sydney to manage

the established Burns Unit at Concord Hospital and to develop

this into a world-class institution.

Are there differences in the way this specialty is practised in

Australia, compared to Europe?

The differences are minor: in Europe, burns surgeons tend

to work exclusively in this area; whereas, in Australia, they

combine their work with other subspecialties of plastic surgery.

This is a good thing, since burns treatment is so demanding.

What aspects of the job do you enjoy the most?

The treatment of burns is highly specialised; the hours are long

and the surgical procedures are physically quite demanding. On

the other hand, the fi eld is rapidly evolving and we have much

to learn about the pathophysiology of burns and how burns are

best treated. Also, for an academically oriented person like me,

the subspecialty provides interesting research opportunities.

How does the surgical treatment of a burn differ from other types

of surgery?

Burns surgery is much more invasive than other types of surgery

and many procedures actually put the patient at risk in the

operating room. The physical demands on the surgeons are

higher, as it is physically diffi cult to remove large parts of burnt

skin from the body. Also, burns surgeons tend to work in a very

warm environment, as the patient is completely exposed and

has lost the ability to control his or her body temperature, since

temperature regulation is a function of the skin.

Have there been any mentors who particularly infl uenced you?

My most infl uential mentor was Professor Julian Pribaz, an

extremely gifted plastic surgeon at Harvard University who is

also the program director for the plastic surgery training scheme

there and a great and enthusiastic teacher.

What do you think are the attributes that make a good plastic and

reconstructive surgeon? Dedication, attention to detail, intellect and high moral standards.

Plastic surgery can easily corrupt people with the income-earning

potential of cosmetic surgery in the private system.

Do you ever fi nd it emotionally confronting to treat a patient who

has been severely injured by a burn?

Yes, but a professional approach helps. The more you understand

the particular injury and its pathophysiology, the easier it is to

approach the patient with your focus already in treatment mode.

It must be diffi cult for patients to adjust emotionally after suffering

a severe burn. How is this best managed? All our patients have access to, and are reviewed by, a

psychologist and a social worker, and many are also seen by a

psychiatrist. The burns team tends to act like a family to the

patient in the acute phase following a burn, and family and friends

play a vital role in the subsequent treatment and recovery phase.

Have you encountered any patients who have particularly

impressed you, or changed the way you practise?

Yes, there are several individuals who have shown incredible

will to get through the trauma they sustained, and who have

taught me a lot about coping strategies and human willpower.

Can you describe a patient whose injuries you found to be

particularly challenging?

Young people who were unfortunately in the wrong place at the

wrong time; for example, a young student who sustained burns

at a barbeque and who is now left with permanent scarring.

Could you describe the research work you are currently doing?

I am involved in many projects, including two clinical trials

investigating cultured skin grafts, and a laboratory study on

the development of three-dimensional “living skin”, which

is bioengineered skin with the potential to minimise, if not

eliminate, scarring after burns. This is a project I’m very

passionate about.

If you weren’t a burns specialist, what would you be? A sailor! I used to do a lot of racing in regattas but, these days,

I fi nd more peace and relaxation in just cruising around on my

yacht and enjoying the movement of the wind in the sails. ■

MJA Careers profi les interesting and important jobs and the people who do them

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HOSPITAL-SALARIED doctors may regard their fee-for-service colleagues in the private sector with some envy. Not only do doctors in the private sector often earn more, they often enjoy greater fl exibility in terms of tax planning than salary earners; for example, in the use of practice trusts and/or the ability to employ a spouse in the practice.

But salaried doctors do have one advantage over their fee-for-service colleagues; they can usually access more generous salary-sacrifi cing arrangements.

Salary sacrifi ce simply involves an employer directing money from an employee’s gross salary (ie, before tax) towards payment of particular items, thereby reducing the employee’s personal tax liability and reducing the “cost” of the item, says Adam Faulkner, who is a medical wealth strategist at MEDIQ Financial, a fi nancial services group that specialises in advising doctors and their families.

Income tax is only paid on the reduced salary, not the benefi ts, which means an overall tax saving, says the Australian Tax Offi ce.

A wide range of benefi ts may be packaged, including novated car leases (for which the employer makes the lease payments out of the employee’s pre-tax salary, leaving the employee with a lower taxable salary), school fees, child care costs, private travel costs and private health memberships.

The drawback is that, where these benefi ts are for the employee’s private use, the employer must pay a fringe benefi ts tax (FBT) on them that is equivalent to

the top marginal tax rate. The employer usually recovers this from the employee, which goes some way towards reducing the net benefi t to the employee.

Someone on a low marginal tax rate may actually lose out since more FBT is paid than income tax is saved.

However, some benefi ts are exempt from FBT, primarily work-related items such as laptop computers, briefcases, tools of the trade and novated car leases. Doctors on the top marginal tax rate get an obvious benefi t in packaging these items, Faulkner says.

Public hospital benefi tsDoctors who are employees of public hospitals are allowed to package certain items up to a capped dollar fi gure without incurring any FBT. This also applies to employees of private not-for-profi t hospitals and public benevolent institutions (which include some

community care organisations, charities and medical research institutes).

“In making this concession, the government acknowledges the need for the not-for-profi t sector to offer competitive remuneration packages to attract and retain staff for the

long term”, Faulkner says.Rent, credit card payments, utility bills,

meal entertainment, living expenses, loan and mortgage repayments, and more can be packaged up to prescribed limits without any FBT applying.

In effect, a doctor may package a maximum of $9095 for non-GST items (ie, those that don’t attract goods and services tax) and $8233.64 for GST items annually.

Non-GST items include aged care expenses, disability care, external child care, private health insurance, Higher Education Contribution Scheme fees and school fees.

GST items include car-parking, gym membership, utility bills, mortgages, personal loans and life insurance.

The value of the benefi t is best shown by an example. Consider someone starting work in a public hospital as an intern on a wage of $60 000; ie, in the 31.5% tax bracket. If he or she packages $9095 into a personal loan or mortgage, he or she will save $9095 � 31.5%, or $2864.92 a year.

Interestingly, the FBT-free amount applies to individual employers, so doctors who work for more than one public hospital can receive FBT-exempt benefi ts from each employer.

Also, for hospital-salaried doctors, meal entertainment allowances are exempt from FBT, with no FBT cap.

Doctors who are employees of a practice company or trust can also salary sacrifi ce, although they are not allowed the FBT exemptions of hospital-salaried doctors. But for doctors at the top marginal tax rate there may be benefi ts in packaging equipment, laptops and novated car leases.

However, non-salaried earnings — such as earnings derived as a contractor or via a practice trust — cannot be salary packaged.

Faulkner says doctors who earn both salary and private fee-for-service income should salary package as much as they can of their hospital-salaried income, leaving private income to be directed to personal spending, and debt-reduction and wealth-creation strategies.

The FBT year runs between 1 April of one year to 30 March of the next year, so now is a good time for doctors to review their salary-packaging arrangements for the FBT year ahead.

It is important to get specialist advice, as the benefi ts will depend on each doctor’s individual tax situation and lifestyle needs.

By Dr Peter Lavelle

Salary packaging for doctors

Money and Practice MJA Careers looks at issues that affect the bottom line

Rent, credit card payments, utility bills, meal entertainment, living expenses, loan and mortgage

repayments, and more can be packaged . . .

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www.mjacareers.com.au • Number 8 • 18 April 2011MJA Careers

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MJA Careers

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Gastroenterologists $2,000 pd19 May to 16 July NT

O&G Consultant $2,200 pd22 Apr to 25 Apr NSW

O&G Consultant $neg1 June to 31 Aug QLD

Orthopaedic Surgeon $2,000 pd 22 Apr to 26 Apr NSW

Physician $2,000 pd23 May to 8 June WA

ED Reg $150 ph5 May to 7 May ACT

ED Reg $145 ph22 Apr to 26 Apr NSW

ED Reg $120 ph11 May to 17 May TAS

Med RMO $90 ph6 May to 8 May NSW

ICU RMO $100 ph20 Aug to 22 Aug NSW

Psych Reg $100 phApr to Aug QLD

Midwife Post GraduateImmediate Canberra

Midwife Post GraduateImmediate Mt Isa

Midwife Post GraduateImmediate Melbourne

ICU / Cert Post GraduateImmediate Canberra

ICU / Cert Post GraduateImmediate Sydney

GP/ED CMO $1,500 pdApr to May NSW

GP/Physician $140 phImmediate WA

GP $neg16 May to 3 June NT

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RESEARCH, GRANTS & FUNDING

SYLVIA AND CHARLES VIERTELCHARITABLE FOUNDATION

GRANTS FOR MEDICAL SCIENCE IN 2011The Trustees of the Foundation are pleased to announce

two classes of research grants to be awarded in 2011and commencing in 2012.

SYLVIA AND CHARLES VIERTEL CHARITABLEFOUNDATION SENIOR MEDICAL RESEARCH

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Up to two Fellowships tenable in Australia of five years tenure at $195,000 per

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VIERTEL CLINICAL INVESTIGATORS$60,000 for clinical researchers who have recently completed

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Only Australian nationals or permanent residents are eligible for these awards.

Closing date-: 1 May 2011Further information is available from-:

The SecretaryViertel Medical Advisory Board

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GPO Box 389 MELBOURNE VIC 3001or Website: www.anz.com/anztrustees

Director Health ServicesOffender Management and Professional Development

Web Search No: 1102

Level/ Salary: Level 24, AMA, Package up to $326,267 pa

Location: Perth CBD

Position Type: Full Time

Employment Type: Fixed Term

A rare opportunity to contribute to a reduction in offending behaviour through the

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Role:

The Director Health Services leads the provision of quality, timely and effective health care

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Offenders often come from disadvantaged backgrounds and are most in need of care

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To fi nd out more about this opportunity and to apply for this position, click on the Apply

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Applications must be received before Monday, 9 May 2011 at 4.30pm

Government of Western AustraliaDepartment of Corrective Services

adcorp F55480A

EXECUTIVE APPOINTMENTS

MJA Careers

HOSPITAL APPOINTMENTS

Peel Health Campus is a busy and expanding privately run peripheral emergency department located in the seaside city of Mandurah, servicing the Peel Region. We are looking to expand our team in the following positions:

Senior Medical OfficerRegistrarResident Medical Officer

The benefits include:-

Short or long term contractsFlexible shifts including casual or full timeExcellent rates of payWorking in an extensively refurbished departmentFor those in training, the department is accredited for 6 months training by the Australasian College for Emergency MedicineWorking opportunity outside the public health sectorBeing part of an organisation that is expanding its services in both the public and private sectors

If you would like to join our expanding professional team working within a friendly, supportive environment please contact:

Dr Aled Williams – Director of Medical Services (08) 9531 8000Forward written applications to:

Samantha Larmour – Practice ManagerPeel Health Campus, 110 Lakes Road MANDURAH WA 6210

sam.larmour@peelhc.com.au

EMERGENCY DEPARTMENTMEDICAL POSITIONS

AVAILABLE IN MANDURAH

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Cairns and Hinterland Health Service DistrictCairns is in the heart of the tropical north and is the primary gateway to northern Australia. Cairns is an ideal base to explore the wider region with front door access to the Great Barrier Reef, rainforests and outback locations with an International Airport located only several minutes drive north of the city centre. Coupled with glorious weather most of the year, swaying palm trees, blue fi sh-fi lled waters and the warm friendliness which abounds within this District, it is a wonderful place to live and work. Quite a contrast to peak hour traffi c jams. The city itself is where much of the accommodation is situated with international standard restaurants, boutique shopping, modern art galleries and nightclubs to keep visitors and residents entertained.

Cancer Care Services, Department of Medicine, Cairns Base Hospital, Cairns and Hinterland Health Service District. Remuneration value up to $386 673 p.a., comprising salary between $169 593 - $179 807 p.a. (L25-L27), or Remuneration value up to $357 175 p.a.,comprising salary between $141 819 - $164 728 p.a. (L18-L24), employer contribution to superannuation (up to 12.75%) and annual leave loading (17.5%), private use of fully maintained vehicle, communications package, professional development allowance and 3.6 weeks p.a. leave, professional indemnity cover, private practice arrangements plus overtime and on-call allowances (Two positions. Applications will remain current for 12 months)

Duties/Abilities: Provide leadership and organisation, management and provision of palliative care services in the Cairns and Hinterland Health Service District and to the wider referral catchment that includes Cape York and Torres Strait; promote and lead the collaboration and integration of clinical resources; initiate the development of clinical links with inpatient, outpatient and domiciliary services, to provide optimal access for palliative care to patients who reside within the District; and if requested, participate in the planning and provision of services across Queensland.

Job Ad Reference: H11CA03120.

Enquiries: Dr Andrew Shearer 0437 330 260.

Application Kit: (07) 4226 5124 or www.health.qld.gov.au/workforus

Closing Date: Thursday, 12 May 2011.

If you are not a Queensland Health employee, a criminal history check may be conducted on the recommended person for the job.

DIRECTOR OF EMERGENCYEuroballa Health Service, located in the Eurobodalla region on the far south coast of NSW is seeking to appoint an energetic Director of Emergency. This is a new appointment and the successful appointee will be expected to expand and coordinate Emergency Department services across the region.The Eurobodalla region has two hospitals located at Batemans Bay and Moruya. These are approximately 30 minutes apart. There are approximately 26,000 ED presentations between the two centres. Bateman’s Bay Hospital has 40 beds, 5000 separations and provides general surgery, gynaecology, orthopaedics and ophthalmology, and is supported by a unit with four monitored beds. Moruya Hospital has 77 beds and approximately 8,000 separations per year, providing services in obstetrics and gynaecology and more major general surgery. It is supported by a four-bed HDU. As this region is a popular holiday resort for both NSW and Victoria, the level of ED activity fluctuates throughout the year.The Eurobodalla Region is located two hours to the east of Canberra and is 3.5 hours drive from Sydney. The main attractions are beautiful beaches, State Forests and National Parks. There are good sporting facilities to complement the outdoor lifestyle and the NSW snowfields are within easy reach. The opportunity for a good family lifestyle is complemented by a range of public and independent schools.Further details may be obtained by contacting Lisa Kennedy, Integrated Services Manager on 0427 429 082.Closing Date: 3 June 2011.

APPLY ONLINE NOW!

NSW Health Service: employer of choice

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SPECIALIST APPOINTMENTS

An opportunity is available to enjoy a clinical and academic career whilst providing clinical leadership for a high quality and comprehensive surgical service at Ballarat Health Services.

BHS is the largest health service in the Grampians region and throughout regional Victoria, offering most surgical specialties. BHS performs 11,100 surgical procedures a year in 6 main operating theatres and a Day Procedure Centre supported by 8 accredited specialist surgical registrars.

The successful applicant will lead the surgical service, delivering direct high quality surgical care within their area of expertise. An in-hours sessional and operating list allocation would be available and participation in the relevant specialty surgical on-call roster is required. Surgical sub-specialty interests will be favourably considered.

BHS is experiencing exciting growth and continues to expand its regional teaching role. You would be joining a progressive health service that will encourage you to develop your interests, and will build a supportive network around you both regionally and with metropolitan referral centres.

With a population of over 90,000, the City of Ballarat has a thriving music and artistic community, first class education facilities and sporting interests catered for. Ballarat is less than 1.5 hours from Melbourne CBD and an international airport.

A primary medical qualification fully registrable with the Medical Board of Australia and FRACS or equivalent are required, as is wide academic and clinical experience.

A generous remuneration package is available, including rights of private practice, superannuation, continuing medical educational allowances, study leave and assistance with relocation expenses.

For further information please contact:

Applications must address the key selection criteria, include at least three professional referees and besubmitted via the BHS website.

www.bhs.org.au

Director ofSurgeryFull Time Equivalent and/or VMO

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UNIVERSITY APPOINTMENTS

Winthrop Professor (Medicine) (REF: 3437)

JOONDALUP HOSPITAL

SCHOOL OF MEDICINE AND PHARMACOLOGY

Applications are invited from appropriately qualified academics for appointment to the position of Winthrop Professor of Medicine at The University

of Western Australia, School of Medicine and Pharmacology based at Joondalup Hospital.

The University’s School of Medicine and Pharmacology is responsible for the teaching of internal medicine and its sub-specialties to undergraduate

medical students at all teaching hospitals and most secondary hospitals in Perth. This position was created in 2007 due to the planned rapid

expansion of the medical student teaching program at The University of Western Australia and major developments planned for the Joondalup

Hospital as part of the Western Australian hospital reform program. Joondalup Hospital is the largest hospital in Perth’s Northern suburbs, providing

24-hour acute care from an integrated public and private campus.

The appointee will be expected to develop and lead a fully-functional clinical academic medical unit and provide clinical leadership at the hospital

during its rapid expansionary phase. The post will be aligned with the Sir Charles Gairdner Hospital Unit of the School of Medicine and Pharmacology.

The position will require duties in undergraduate teaching, research and clinical service. The appointee will participate in the running of the Department

of General Medicine and be expected to take a leadership role within the department particularly in relation to professional development of the

medical staff. There will be opportunities for developing sub-specialty clinical activity provided there is adequate input into general medicine.

For information regarding the position contact Winthrop Professor Fiona Lake, Head of School on (08) 9346 3928, email fiona.lake@uwa.edu.au or

Associate Professor Brendan McQuillan, Head of Sir Charles Gairdner Hospital Unit on (08) 9346 7908, email brendan.mcquillan@uwa.edu.au.

Alternatively, please contact Dr Richard Saker, Director of Medical Services, Joondalup Health Campus, email SakerR@ramsayhealth.com.au.

The appointment will be fixed-term for five years with the possibility for further periods and includes limited rights of private practice or election to a

private practice allowance. The University offers an attractive remuneration package that includes professorial and hospital salaries and a clinical

loading. Benefits include generous leave provisions, superannuation and relocation assistance (if applicable) for the appointee and dependants.

Closing date: Friday, 20 May 2011

The Information for Candidates brochure which includes details to

lodge your application may be found via a link at http://jobs.uwa.edu.au/

or at https://www.his.admin.uwa.edu.au/Advertising/3437CandidateInformation.pdf

or by contacting Ms Toni Pilgrim, Human Resources, email toni.pilgrim@uwa.edu.au.UN

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Committed to recruiting, developing and retaining the highest quality staff jobs.uwa.edu.au

Join a leading Australian university achieving international excellence

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