March 26, 2012
Mark A. Jabor, M.D.
So-what’s the big deal about Board Certification for plastic surgeons? Does it really even matter?
The simple answer is YES it matters and it matters a lot. Why does board certification matter and what does it mean? Let’s begin with the history of plastic surgery.
Plastic surgery was born out of necessity to treat extensive facial war time injuries seen during World War I. In 1937, the American Board of Plastic Surgery was organized and, in 1941, the American Board of Plastic Surgery was officially recognized by the American Board of Medical Specialties. Since this time, plastic surgeons have been dedicated to teaching, training, research and fulfilling the requirements of rigorous written and oral exams to certify competence in the field. It is the only board approved by the American Board of Medical Specialties for the sole purpose of plastic surgery of face and body.
The American Board of Medical Specialties (ABMS), a not-for-profit organization, recognizes 24 approved medical specialty boards which monitor development and maintenance of standards for ongoing evaluation and certification of physicians. ABMS, recognized as the "gold standard" in physician certification, asserts higher standards for physicians means better care for patients.
What does all this mean? Basically, in order to be certified by the American Board of Plastic Surgery, your plastic surgeon has done the following things: earned a medical degree, completed the accredited education and training, fulfilled residency requirements, and been licensed to practice medicine in at least oneU.S.state, passed rigorous examination in their specialty or sub-specialty. For most plastic surgeons, this required 7 grueling years of surgical training after medical school and passing difficult oral and written examinations to ensure competency in plastic surgery.
For the patient, this is great news. Certification sets and maintains continuing high standards for your plastic surgeon certified by the American Board of Plastic Surgery. Although this does not guarantee all surgeries and treatment will go well, certification establishes superior standards which make the chances of success very high.
Aren’t all physicians performing plastic surgery of the face and body certified by the American Board of Plastic Surgery? Unfortunately, the answer is NO. Many so called “cosmetic” surgeons are not board certified plastic surgeons. In fact, some physicians performing plastic surgical procedures were not trained in any surgical specialty.
I’m sure you’re thinking this is impossible. How could a medical licensing board, or the state, allow someone to practice medicine and perform surgeries in a field they have not had specific training in?
Let’s examine why a physician would practice and perform surgeries in a specialty in which he/she was not trained. More importantly, how are they allowed to do that? The answer to the first question is very simple. The answer is that this situation, regrettably, is financially driven rather than service driven. As reimbursements rates for insurance keep decreasing and the whole fate of medicine is uncertain (especially with “Obama Care” looming), some physicians find it necessary to “branch” out. The lure of “easy” money, not having to deal with insurance companies and Medicare, offers temptation. Some doctors are willing to take the risk and practice outside their field of training. This is a problem because, ultimately, most patients are not aware of this. In addition, no standards are set for doctors practicing outside their field of specialty.
In answer to the next question-how is a doctor able to practice outside their specialty field? As long as one is a licensed doctor, one can practice whatever field of medicine one chooses without regard to the area of training the physician completed. However, if there is a problem, the doctor will be held to the standard of that field. Unfortunately, the only way these physicians are stopped from practicing outside their field is in a situation where very serious medical complications result that prompt an investigation. The loser is always the patient. Many complications could have been prevented had the doctor never been allowed to perform these procedures. An example of this exact situation happened several years ago in my own area. An OB/GYN doctor decided that he was going to start performing liposuction. A patient had a very serious complication and died. The Texas Medical Board investigated and did not allow him to practice any other plastic surgery procedures. A little too late for the patient and family though.
Remember, doctors who are practicing outside their field of expertise, are not going to inform you of this or make it obvious to patients. If they did that, no one would go to them. These doctors will often advertise as “cosmetic” surgeons, liposuction expert doctors, etc., or something similar. They will also not tell you that their primary specialty and training is in OB/GYN, pulmonology or other fields not related to plastic surgery. They will not say board certified by the American Board of Plastic Surgery because that is false and they will get in trouble for that claim. However, they can list organizations or societies, such as the “American Board of Cosmetic Surgery”, that they belong to that make it appear as if they are actually board certified plastic surgeons. These other society and boards proclaim expertise in the field but are not members of the American Board of Medical Specialties. They also try to make a distinction between a “plastic surgeon” and a “cosmetic surgeon”. The fact is that a board certified plastic surgeon is trained and certified to practice aesthetic or cosmetic procedures as well as reconstructive procedures. In reality, a lot of cosmetic procedures have come from techniques and lessons learned in the reconstructive patient. Implying that a “cosmetic surgeon” is superior to a board certified plastic surgeon is just more “smoke and mirrors”. Let’s face it, if the public was aware these doctors are actually practicing outside their field, most would not go to them for services.
How can hospitals allow these doctors, practicing outside their field, to perform surgeries at their facilities, knowing they do not have the correct qualifications? The answer is- they don’t. Hospitals generally due extensive background checks on credentials of doctors they grant privileges to and would not allow privileges without the proper credentialing. Nevertheless, there is a way of getting around this. If a physician sets up an office surgical suite, basically the doctor can do whatever he/she chooses at the location. There are certain requirements the state has for the facility, but it does not sanction what specific procedures are performed. This is not to imply that everyone that has an operating room in their office is not legitimate, because most are, but there are certainly those who are not.
What can be done about this? Based on the way the current laws and rules are set up, not a whole lot right now. There was, at one point, a push that a doctor could only perform surgical procedures they were credentialed to perform in a hospital. This proposal would have cleared up a lot of the mess, but this standard was never passed. Therefore, it is up to you, the patient, to check out the doctor and make sure they have the correct credentials. The internet has made this much easier. Three websites that make this very easy to do are: American Society of Plastic Surgeons http://www.plasticsurgery.org; American Board of Medical Specialties https://www.abms.org; American board of Plastic Surgery https://www.abplsurg.org/moddefault.aspx . These sites clearly define if the doctor you are seeking treatment from is certified by the American Board of Plastic Surgery.
Lastly, I do want to say that there is some overlap of different fields within the practice of plastic surgery. Some that come to mind are otolaryngology (ear, nose, and throat), ophthalmology, dermatology and oral surgery. For example, most ENT doctors are trained and proficient in most aspects of facial plastic surgery including rhinoplasty, face lift, skin cancer removal, and head and neck reconstruction, etc. Ophthalmologists are trained to do eyelid surgery and surgery related to the eye region. Dermatologists have made significant contributions to the use of facial injectables and laser treatments and oral surgeons are trained to correct facial trauma and perform jaw surgery. Many of these doctors, in these other disciplines, are very good and well respected leaders in their particular field of expertise and are practicing well within their scope of training. Remember though, the American Board of Plastic Surgery is the only board with the sole purpose of certifying doctors proficiency of plastic surgery of both face and body.
Let’s sum it all up. You, the patient, are your own best advocate. You can not count on the states’ medical board to decipher who is actually qualified to perform a procedure and who is not. However, armed with this new knowledge, you can do some very easy research on your prospective doctor. Use common sense as well. If a doctor is offering a plastic surgical procedure for far less than what most other doctor are, chances are he/she is not fully credentialed in the field. Remember the old adage, if it seems too good to be true-it probably is.
Seeking a qualified plastic surgeon should not be compared to shopping for a car made at the same factory by the same workers, and basing the final selection on getting the lowest price. You are paying for the doctor’s qualifications (board certification), reputation, ability as a surgeon, and optimal post operative care. Keep all this in mind when seeking a plastic surgeon and you will probably do well and be pleased with your outcome.