Physician Loans: Understanding and Overcoming an Epidemic.

BACKGROUND: Plastic surgeons face increasing financial pressure from debt, largely in two forms: education and practice loans. The authors aim to provide perspective and context when assessing their individual situations while providing straightforward and evidence-based guidance for plastic surgeons to effectively manage their physician loan burden. METHODS: Data from the Association of American Medical Colleges Medical School Graduation Questionnaire were used and analyzed. Resources for physician loans (both public and private) were also explored to determine options available to physicians. RESULTS: By graduation, the education debt for the average medical graduate is roughly $200,000. Medical school debt makes up the majority of education debt, with the 4-year cost of attendance for the class of 2020 at over $275,000 for over half of all medical schools. Over the past decade, the median cost of attendance has grown at a faster rate than median debt levels at a rate double that of inflation. CONCLUSIONS: The two major forms of debt facing plastic surgeons are educational and practice debt. Through financial education and the enactment of sound financial strategies, these debts can be effectively managed, improving physician well-being and bringing the focus more squarely back on patient care.

Ghost Cell Odontogenic Carcinoma Arising in a Previous Calcifying Odontogenic Cyst: A Case Report and Review of Literature.

Ghost cell odontogenic carcinoma (GCOC) is a rare malignant tumor of odontogenic origin, with only about 50 cases reported in the English literature so far. Histologically, it is characterized by ghost cells, dentinoid deposits, high grade malignant cellular features, and areas of necrosis and invasion. Having common histological features with other odontogenic ghost cell lesions (OGCL) like calcifying odontogenic cyst (COC) and dentinogenic ghost cell tumors, it is crucial to recognize GCOC malignant features, as it can be destructive and invasive, sometimes showing distant metastases and high recurrence rate. For this reason, it may entail more aggressive surgical approach and multimodal therapeutic regimen. Here we present a case report of GCOC arising in a previous COC, treated with surgical excision that showed persistence and recurrence after two years. The clinical and histological features of this rare occurrence are presented, in addition to the surgical approach, and a summary of literature review of OGCL.