Martha S. Matthews, MD, FACS, FAAPS, puts heart and hard work into her New Jersey practice
Academic plastic surgery programs across the country are dependent more than ever on clinical income to support research and teaching. That is certainly the situation at Cooper University Hospital in Camden, NJ, where Martha S. Matthews, MD, FACS, FAAPS, now spends at least half of each work week performing elective face-lifts, nose jobs, and breast enlargements, along with procedures that pay little or nothing and for which universities are best known, such as reconstructive work on trauma and burn victims.
Matthews heads up Cooper University Hospital’s plastic surgery division and runs its cleft lip and palate program. Roughly 85% of the expenses incurred by the division this year will be paid for with revenues she and her colleagues generate—and most of those dollars will come from providing aesthetic services. Don’t misunderstand, though: Matthews is perfectly fine with that. Cosmetic surgeries (comprising fully half her caseload these days) make for a lively practice, she’s quick to say.
And that’s fine, too, with her cosmetic patients, since the cutting-edge techniques she employs in difficult reconstructive cases have applicability in her purely aesthetic surgeries, meaning smoother operations, less painful and faster recoveries, reduced potential for complications and, more important, better results.
Be True to Your School
Although Matthews isn’t eager to see the reconstructive side of her practice eclipsed by the cosmetic, it’s a fact that demand for her talents in the aesthetic surgery realm is on the rise—a reflection of changing market demographics and a growing awareness of her skill among consumers. Even so, she says it’s unlikely she’ll leave her university setting to pursue private practice.
The reason is that for Matthews, one of life’s greatest pleasures is teaching: In addition to her duties at Cooper University Hospital, she is an associate professor at Robert Wood Johnson Medical School, a position in which she might find it difficult to remain were she to leave academia. (Cooper University Hospital, by the way, is a Robert Wood Johnson Medical School teaching site.)
Further helping dissuade Matthews from going commercial is apprehensiveness about running a business.
“I just want to practice medicine, not be a corporate executive,” she says. There’s also the allure of being on the true cutting-edge of plastic surgery, a province that belongs mainly to institutions tending toward ivy-covered granite exteriors.
“It’s tough in private practice—particularly in solo private practice—to keep up with the very newest developments in the field, unless you have the discipline to do that,” she asserts. “And, in solo private practice, you also have fewer opportunities for interaction with colleagues. Frankly, I like having other academicians around to talk to, to bounce ideas off of, to hear what they’re doing.”
Then, there are the opportunities to engage in research, which Matthews contends are more abundant and robust in the environs of a teaching hospital, such as hers. Indeed, at present, Matthews is exploring new processes that one day might bring an end to the problem of rejection in organ transplantations.
“I’m currently involved with a team investigating transplantation of limbs and vascularized bone,” she offers. “Our laboratory has developed an animal model of vascularized bone transplantation, with marrow, and we’ve thus far produced results in which the host organism is able to become tolerant of the donor tissues. We’re hoping this will eventually have applicability in moderating rejection of transplanted tissues and limbs in humans. We also have a model in development of laboratory-built skin that can be used in burn research and burn wounds. An interesting facet of this is the model allows testing without the need to use animals.”
Beyond the research aspects, Matthews finds academic practice preferable because it permits involvement with a range of patients and conditions seldom, if ever, encountered in a private setting. Topping that list are the trauma cases, followed closely in rank by cancer interventions. Still, those that prove most challenging in Matthews’ estimation are the pediatric cleft reconstructions.
“I particularly enjoy performing rhinoplasties on kids with clefts,” she says. “Intellectually, it’s a very interesting operation because there are so many interrelated and interdependent problems in this type of procedure and with this type of patient. It requires a lot of three-dimensional thinking and feel for cause and effect. On top of that, it produces enormous benefit to the life of the patient. It’s fun when the dressings come off and the kids can see their new nose—you can tell it makes them feel better about themselves.”
Caused a Stir
Matthews has treated cleft lip and palate conditions since she began her career in medicine (she graduated from Pennsylvania State University in l979 and went on to earn her MD in 1981 from Philadelphia’s Jefferson Medical College; this was followed by a general surgery internship and then a general surgery residency at Thomas Jefferson University Hospital, capped by a plastic surgery residency at Eastern Virginia Graduate School of Medicine in Norfolk, Va). She has written extensively about her cleft experiences and discoveries, including an article that caused something of a stir when it appeared three years ago in the Cleft Palate-Craniofacial Journal. In that piece, Matthews described her view of the role of the plastic surgeon in prenatal diagnosis and counseling with regard to cleft-lip and palate babies.
“My point was to encourage plastic surgeons to take the initiative to meet with parents in those instances where cleft is detected prenatally,” she says. “In the past, if cleft was seen on an ultrasound, the conventional thinking was to wait for the birth and then see the surgeon. However, from surveys conducted here at the hospital, we learned that about 10% of our cleft patients were referred to us prenatally.”
Subsequent surveys of parents suggested that many mothers and fathers felt it helpful to meet with the plastic surgeon before the baby was born, Matthews recounts.
“Parents,” she says, “came away from those encounters better educated about the problem, better educated about what it would take to treat it, and therefore more optimistic and less fretful.” Matthews insists her article is even more timely today than when it originally ran.
“Advances in ultrasound technology since then have resulted in far greater image quality,” she explains. “We are able to see detail in the womb that we couldn’t before. As such, cleft conditions are much more readily detectable.”
And they are detectable earlier in the pregnancy, in the months when a decision to abort is often less emotionally painful to make. Matthews worries that expectant mothers who are told that they are carrying a baby destined to emerge with a cleft condition may immediately opt to terminate the pregnancy, needlessly so, not knowing of the ability of plastic surgeons to correct the problem after birth.
“Decisions of this magnitude should be made based on having all the facts, rather than on suppositions or on incomplete information,” says Matthews, who has been heartened by the response her article engendered. Because of that piece, “it’s become commonplace for cleft programs to offer themselves as a resource to perinatalogists and obstetricians,” she states.
Found Her Calling
Medicine—surgery in particular—was a field that held great appeal to Matthews since childhood. Originally, she wanted to become an orthopedic surgeon, but a few weeks into the orthopedics rotation during her internship she became a lot less enamored with the idea. Soon after starting her plastic surgery rotation, she found her calling.
“I really loved the three-dimensional aspects of plastic surgery.” Matthews remembers. “I also liked its sheer variety and the fact that it’s so detail-oriented. To be successful as a plastic surgeon, you have to be meticulous in your work, and that really suited my personality.” Also appealing was the opportunity to perform surgeries on people not desperately ill.
“That,” she says, “was the one aspect of general surgery I liked the least, working mainly with the most infirm of patients.”
Licensed to practice in Pennsylvania in addition to New Jersey, Matthews assumed her first administrative post with Cooper University Hospital in 1994, when she was tapped to serve as associate director of the general surgery residency program there. Matthews held that responsibility until 1999, the year she was named to the program’s principal teaching staff. Later in 1999, she was placed in charge of the Division of Plastic and Reconstructive Surgery.
Her position as an administrator who also engages in clinical practice is made a bit more complicated by the fact that she works from three separate locations.
“In that we’re part of a health system, our senior executives decided we needed to have two satellite offices in addition to our main facility to provide a better level of service to the community,” says Matthews.
Cooper University Hospital is where Matthews performs her major reconstructive surgeries. She maintains an office on its campus, but uses that space only for management purposes. Her consults with patients occur in the two other locations—one in Washington Township, NJ, which serves the exurban southern part of the state; the other in the city of Voorhees, NJ, an upscale suburban market where interest in (and ability to pay for) cosmetic procedures is strong.
Matthews’ division attracts patients from as far as 100 miles away, or about a two- to three-hour drive on the interstates radiating out into neighboring and nearby states.
“Consumers are willing to travel those distances to see us because they perceive that, here, they will receive service of quality sufficient to have made the trip worthwhile,” she says.
However, many of those at the outer reaches of the catchment area are drawn to Cooper University Hospital because the institution accepts most insurances, something few private-practice reconstructionists in New Jersey do. Other long-distance patients come because they want to be under the care of a female doctor and the only plastic surgeon choices closer to their homes are men.
“A teenager wanting breast-reduction surgery won’t often accept a male surgeon,” says Mathews.
Matthews engages in scant conventional advertising of her cosmetic work. Her main modus is to allow satisfied patients to talk up the service among friends and relatives.
“Word of mouth has been my most effective advertising tool,” she says. “I’ve also received favorable mentions in several local periodicals, which have also been helpful.”
The satellite offices used by Matthews are shared with other types of specialists attached to Cooper University Hospital’s general surgery department. However, those others are present only on days when Matthews and her team are away.
“I’m at Voorhees for the equivalent of a full day each week and at the Washington Township office the equivalent of a half-day each week,” she says. “I also spend the equivalent of a half-day each week at the hospital’s cleft palate program. The remainder of my time is spent in the ORs of various local hospitals or else attending to administrative work.”
The satellites are equipped to handle minor surgical procedures, those requiring nothing stronger than local anesthesia. That’s not a problem, as Matthews sees it.
“If we were to offer anything more than minor surgery services in the satellites, they would have to be accredited, in-office operating rooms, which would be logistically difficult to maintain—not to mention economically infeasible,” she says. “There would be no reasonable way to handle the kind of surgical volume necessary to be viable at that level of service in those locations.” Fortunately, if Matthews needs to perform surgery of a more complicated nature off-campus, the hospital owns and maintains a day surgery center a few blocks from the Voorhees satellite.
“This is where I perform most of my cosmetic procedures,” she says. Meanwhile, the satellites not long ago were outfitted with digital imaging systems to improve physician and staff efficiency. Productivity is important for Matthews because, obviously, it helps quell the economic forces eating away at income.
One such money gobbler is malpractice insurance, but not in the way you might think. In New Jersey, the exorbitant expense of protecting against tort actions has forced many plastic surgeons outside academia to stop performing what liability underwriters consider high-risk procedures—those such as reconstructive surgery of the hand and of fractured facial bones. Consequently, Matthews—whose malpractice protection is supplied as a perk through her self-insured employer—has more reconstructive cases of that type than she can handle. All well and good, except for the reimbursement, which usually amounts to little more than peanuts.
“While malpractice insurance costs don’t directly affect me, they nevertheless have an impact indirectly by driving into my practice those surgeries that are poorly reimbursed,” she says.
On top of that, New Jersey recently levied a 6% consumer tax on all cosmetic services (to go along with the 3% toll on aesthetic-work revenues generated by in-office ORs). As a result, prices for everything from botox injections to tummy tucks are headed skyward in private practices statewide. Matthews worries that cost-conscious elective patients will respond by seeking services in neighboring or nearby states where no such taxes exist and where prices are presumably lower. Once consumers get in the habit of crossing the state line for those services, New Jersey’s academic-based cosmetic surgery providers—who generally are in a better position to keep prices in check—may themselves experience a decline in volume as a spillover effect. Still, Matthews can see a silver lining in all this.
“There’s a lot of energy and innovation in our field; there are many exciting new technologies and techniques that will further help improve the quality of the services we offer as well as the results we can deliver,” she enthuses. “Because of that, I think everything will work out just fine. Plastic surgery will continue to be where it’s at.”
And, as far as Matthews is concerned, where plastic surgery is at is in her own practice setting—an academic setting.
“Now and in the future,” she says, “I want to do just what I’m doing—taking care of patients, participating in useful research and helping train the next generation of plastic surgeons.”
Rich Smith is a contributing writer for Plastic Surgery Products
1. Matthews, M. Beyond easy answers: the plastic surgeon and prenatal diagnosis. Cleft Palate-Craniofacial Journal. 2002;39:174-179.