I definitely recommend internships abroad

Peter Ondrejka, M.D. worked for many years as an aesthetic surgeon in the United Kingdom.

What is the difference between aesthetic surgery there, the requirements of clients and working conditions of a surgeon in this country?

Dr. Ondrejka, is it possible to compare Czech and British clients?

Surely, the structure of patients in England is substantially different from those in the Czech Republic. There are many people coming from India, Pakistan, the territories of the former British colonies. These people are much more demanding than native English people. It is probably due to the fact that they appreciate money more. It leads to the fact that they are extremely pedant and complain virtually about everything. From this point of view, they are much more risky patients than in this country. In England, there is also the tendency coming from the U.S. that when a person undergoes an operation, he or she plans to complain in advance in order to possibly get some money back. Therefore, every surgeon thinks over carefully when to accept a patient. I believe that this "complaining" wave will come to Czech Republic, as well.

Does medical tourism exist in the U.K.?

Patients from the U.S. and Canada often come there for aesthetic procedures because they are cheaper than at home.  However, there are still not such a wave of medical tourists as in this country,  for sure. Considering the fact that a surgeon in the U.K. must pay substantially higher taxes, high health insurance and the rent for leased premises, the price for the procedure is increased. In the Czech Republic, labor is relatively cheap, as well as the rent and insurance, so it is possible to keep the prices lower. At the same time – which I can compare – Czech plastic surgery is on high level and it also attracts foreigners. However, I also see a risk in it. These people go home a few days after the operation and if any complications occur, they are resolved abroad. And consequently, it gives a bad name to Czech plastic surgery.

In the Czech Republic, aesthetic surgical procedures may be performed by surgeons who are not certified for plastic surgery, how is it in the U.K?

In the U.K., nobody could afford that. If a patient found out, the surgeon would be easily vulnerable and the patient could sue out big money. I myself have not met a surgeon from any other field who would perform aesthetic procedures. In this sense, I see a major imperfection in this country. Non-invasive procedures are something different; they may performed by surgeons from other fields, for example, dermatologists. 

What are the chances for young surgeons in the U.K. to become aesthetic specialists?

It is very difficult because the market is saturated with experienced surgeons. Most of the young surgeons first work in the state system because they see what the risks are in the private enterprise. Until they feel really experienced, they do not dare to go to private practice. If a patient writes a complaint, the certification of the surgeon is the first thing assessed – how many procedures he or she has performed, how many times he or she has performed this particular procedure, and what complaints there have been.

How does the situation in the British health system reflect on aesthetic surgery?

I myself have not come in touch with the national health system. But it is similar as in the U.S.  Unless you have above-standard insurance, a lot of care, for example dental, is unattainable for you. If a person does not have an extra insurance, he or she remains in the long queue of waiting people. If I may compare, the Czech health system is on a very good level.

Surgeons in this country are very much loaded with paper work, how is it in the U.K.?

From this point of view in the U.K. – or at least in the company where I worked – the work was very much facilitated for the surgeons. There were forms ready for everything, the surgeon only filled in. In the U.K., the health-service staff does most of the administrative work and the surgeon does not have to deal with it. 

What is the insurance of a surgeon in the U.K to be able to work?

The insurance in the U.K. is substantially different; the insurance amounts are rather high.  For example, I used to pay GBP 3,900 a month.

In some countries, there is an increasing tendency to perform two procedures in one operation for to financial savings. What is the attitude of surgeons in the U.K. to this phenomenon?

It is common in the U.K.; of course it depends on the assessment and responsibility of a surgeon what procedures he or she will combine and what not. 

You have encountered various surgical procedures and methods. Which one was the most interesting for you?

I have operated on ten patients in the U.K in whom the breast augmentation was performed using stem cells. In 2008, I took a course in Florida where I learned the method. In my opinion, it is a very good method to use to solve various breast deformities. It is important that own tissue is applied and because the fat is applied in subcutis, there is no risk of damaging mammary gland. If a patient has a suitable shape of breasts for this kind of procedure and requires augmentation by one or one and a half size, this method is suitable. However, the procedure is very demanding as for the pre-operative preparation and post-operative care. The patient must wear vacuum bells 3 weeks prior the surgery to enhance the capillary supply in subcutis, to better support the healing of fat cells. Some people think it is too complicated, but there are women who basically reject heterogeneous material and they are able to undergo this procedure.

Didn‘t you feel lonely in the U.K.? Would you recommend such experience to colleagues?

Of course, I was not there completely on my own. Within the company where I worked, there were other Czech colleagues such as Dr. Pross, Dr. Singerová and Dr. Krejča. I am pleased that all three give a very good name to Czech plastic surgery. I recommend surgeons to work abroad because they meet many colleagues from different countries, they learn new operation methods and will be able to compare. Of course, it is also good experience when one has to take care of himself. I would definitely recommend the experience.