Nick Carr MD, FRCSC, Canadian Plastic Surgeon & Educator

Dr. Nick Carr shares his thoughts on the medical education system in Canada as a plastic surgeon and educator.

Name: Dr. Nick Carr 
Location: Vancouver, Canada
Website: skinworks.ca

That's interesting: Dr. Nick Carr is a Royal College Examiner in Plastic Surgery.

You are the head of Plastic Surgery at UBC. Are you seeing a shift to utilizing the web and technology for medical education? Is technology going to be able to replace conferences? Are you aware of any societies or organizations that are moving in this direction for their conferences?

Yes, surgical education is evolving rapidly. Trainees are adept at accessing web based information and sharing information via smart phone technology is now routine. The use of surgical simulation to teach specific procedures and techniques is likely to become a standard in the next decade. Many plastic surgery societies have introduced the option of “attending” conferences via the internet and instruction via “webinars” is also very common. It is unlikely that any society will move entirely in this direction though, since face to face meeting with colleagues and the resulting opportunities for learning and collaboration are a valued feature of traditional conferences.

As a plastic surgeon, where do you think that new cosmetic technologies have capabilities that surgeons don't? Do you see technology replacing or being synergistic to surgery?

Great question! Technologies are only as good as the artistry of the surgeon who applies them. There are usually a vast number of technologies available for any given clinical problem and it is the skill and experience of the practitioner in sorting through them and deciding what will give the best result that is most important. Having said that, there are many areas in surgery where new technologies would be welcome in solving problems that surgery alone can’t. An example of this is the lack of an effective technology to tighten skin.  Some machines such as Thermage and laser do this to a minor degree but the most effective method to tighten skin is by surgical removal. A new technology that could effectively tighten skin for example over the trunk without the need for excision and scars would revolutionize surgery.

When considering introducing a new technology into my practice, I am looking for something that opens a new therapeutic regime to my patients. I want the technology to solve a clinical problem that I don’t have another solution for or to do it in a way that is safer or in some way preferable. Additionally the technology must be safe, manageable in terms of complexity, and ideally not cost the world.

You're deeply involved with educating future plastic surgeons in addition to running your practice. What advice would you give to other physicians about activities that might not directly benefit them financially but open up other opportunities?

That’s another wonderful question. At the end of the day we all do best in a work environment that stimulates our intellect.

Being a plastic surgeon is a privilege and a gift that can be pursued in many ways. I don’t think it should be perceived simply as a means to a lucrative career. Plastic surgery encompasses vast areas of medicine including wound healing; reconstruction of soft tissue and bone for congenital reasons, trauma and cancer; transplantation of tissues; and yes, aesthetic surgery. A surgeon who limits their practice to small parts of this spectrum is losing out on much of the joy of the specialty. I would advise young plastic surgeons to acquire a broadly based skill set that encompasses as much of their specialty as possible before making decisions about how to limit their activity. They should consider the satisfaction that comes from teaching, research and sharing knowledge before placing a premium on their practice income.  The adage that “once you have expertise, the money will follow” is true. In my own career, I gauge my involvement in new opportunities by how I perceive their potential to positively impact the specialty.

Where do you think that Canadian  medical education is strongest and weakest in preparing young doctors?

Training physicians and working solo are very different and require distinct skills. Many wonderful surgeons are horrible surgical teachers because they can’t stand to watch someone less adept, as all students are initially, doing the surgery while they assist. This is particularly difficult for young surgeons new to practice who in most cases would prefer to do the surgery themselves. I’ve learned to be very specific with students as to what role they will play in each operation so they know my expectations. Their responsibility increases as they become more senior. I never hesitate to take over from a student surgeon if they are not able to perform a procedure to a standard that I expect of myself. In my private esthetic practice the students understand that I have a specific contract with those patients to perform the procedures myself and so in that setting the student’s role is as a surgical assistant only. 

I think in general Canada has a fantastic system for training surgeons of all specialties. I’ve worked elsewhere in the world and seen surgeons trained in many countries and I find the quality of our surgical trainees is uniformly high. Having said that, I think the greatest weakness is a failure in our teaching hospitals to recognize that surgical teaching takes more time and there is a failure to award good surgical teachers with more operating room access in order that they can spend the time required to teach.

Are there any treatments or technologies that you're especially excited about that haven't hit the market yet? What do you think about new therapies that are being developed that you're aware of?

Our plastic surgery lab at UBC is working on a skin substitute using living cells that will someday radically change burn treatment. Our lab and others are making great strides on managing scars at a molecular level and when available that product will radically change our options not only for plastic surgery patients but all surgery and trauma patients. There is fantastic work being done in the area of stem cells and this area of research has the potential to revolutionize regenerative medicine in all areas and permit healing and rejuvenation of tissues injured by aging or disease. It looks like this may be the new frontier in  many areas of medicine from cancer to wound healing to esthetic medicine.

If you could change one thing or correct one mistake that you made earlier in your career, what would that be?

I’ve loved my career and although there are undoubtedly some things I’d do differently a second time around for the most part I wouldn’t change a thing. I have learned and had it reinforced again and again that at the end of the day everything we do is about our patients and I try to listen very carefully to what they tell me.

What is the best advice you've ever received as an entrepreneur and physician?

One of my mentors, Dr. Jim May, then Chairman of Plastic Surgery at Massachusetts General Hospital, advised me as a fellow to always stay in touch with teaching and with plastic surgery research and innovation. He told me that you can become the best surgeon in the world but after doing the same surgeries for a number of decades it will be the excitement of new ideas that makes you love your job. At this point in my career I see the truth in that.

About: Taught school in Africa prior to completing medical and plastic surgery training at University of British Columbia. Plastic surgery fellowship at Harvard. A plastic surgery faculty at UBC since 1990. Head of Plastic Surgery at UBC since 2003. Medical Director of Skinworks Surgery Center.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.