Finding a Properly Certified Plastic Surgeon
It is important to recognize the difference between plastic surgeons and others who practice cosmetic surgery so patients can better understand their healthcare options.
The distinction between plastic surgeons and others is important because at this time in Virginia, a wide variety of physicians and non-physicians who have varying levels of education and training are performing cosmetic surgery while proclaiming qualifications equivalent to a plastic surgeon that is certified by the American Board of Plastic Surgery.
The definition of “plastic surgeon” is sometimes confused with “cosmetic surgeon”, yet there may be significant differences in the education, training and experience of plastic surgeons and other surgeons. Virginia law defines the requirements for licensure as a medical doctor. These include educational requirements (going to an approved medical school, where students are educated about medicine) and training requirements (residency training, where students learn the practical skills needed to treat patients).
The Virginia Code also describes the requirements for educational institutions to be recognized by the state as sufficient to appropriately prepare students for the field of licensure. These institutions (medical schools and residency programs) must be accredited by nationally recognized and independent certifying organizations. Medical school diplomas are not recognized by the State of Virginia as valid for licensure unless the school has fulfilled the requirements of these certifying organizations.
The certifying organization for surgical training is the American Board of Medical Specialties (ABMS). This organization “… oversees the certification of physician specialists in the United States.”
The ABMS is comprised of 24 member boards, which includes The American Board of Plastic Surgery. These member boards evaluate and certify candidates as qualified to practice in the various fields. Recognition by one of these Boards is usually necessary for physicians to be granted privileges to admit and treat patients in hospitals, and to be accepted by insurance plans as qualified providers; examples include pediatricians, obstetricians/gynecologists, general surgeons and internists.
The American Board of Plastic Surgery defines plastic and surgery Thus:
Plastic surgery deals with the repair, reconstruction, or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk, external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles both to improve overall appearance and to optimize the outcome of reconstructive procedures.
From this description, I hope it is clear that the term “Plastic Surgeon” means a physician who has gone to accredited medical school, then completed residency training in an accredited institution. The title “Board Eligible Plastic Surgeon” indicates that the surgeons’ training meets the standards set by the American Board of Plastic Surgery. Successful completion of a multistep examination process results in a Board Certified Plastic Surgeon.
Now that I have explained what a “plastic surgeon” is, I would like to discuss “cosmetic surgeons”. The ABMS does not recognize any cosmetic-specific board.
As medicine has changed over the past several decades, a number of “self-proclaimed” boards and other organizations have been created. Many of these deal with cosmetic surgery. Examples include the American Board of Cosmetic Surgery.
Members of such organizations frequently include individuals also certified by ABMS-recognized boards like dermatology, otolaryngology, gynecology, family practice, and others, as well as non-physicians including dentists. However, certification by this and similar organizations is not the same as certification by a board recognized by the American Board of Medical Specialties. PATIENTS MUST UNDERSTAND THIS FACT.
I do not intend to disparage individuals who designate themselves as “cosmetic surgeons”. However, it is necessary for patients to understand that unlike the plastic surgeons, the designation “cosmetic surgeon” does not require the same level of education, training and certification as commonly recognized surgical specialties. In fact, some simply require that you fill out the application and pay the fee without any vetting at all. In addition, unlike plastic surgeons that are members of the American Society of Plastic Surgery, they may not be required to operate in accredited surgical facilities.
Some individuals performing cosmetic surgery have little or no formal surgical training at all. For example, there are some physicians that are board certified in family medicine performing facelifts, abdominoplasties and liposuction. Some are members of the American Academy of Cosmetic Family Medicine.
Individuals without recognized surgical training are generally not granted hospital privileges to admit and treat patients. They may, however, perform complex surgical procedures in medical offices. Such facilities may or may not be accredited by organizations that ensure adequate standards for patient safety. There are only a few certifying agencies that can certify the surgical facility. Patients should be sure that their procedure is being performed in an accredited facility. Accreditation Boards include AAAASF, which is the American Association for the Accreditation of Ambulatory Surgical Center, AAAAHC, the American Association for the Accreditation of Health Care Facilities, and JACHO, the Joint Commission for the Accreditation of Hospital Facilities. All of these organizations are recognized as proper certifying bodies, and the surgical facility should be certified by one of these entities.
Another factor to take into account is whether the plastic surgeon and his staff are advanced cardiac life support certified. Although this is not a requirement, having the physician and recovery staff certified in advanced cardiac life support (as we have in my office) ensures the highest level of supervision, evaluation, and care of all patients, should there ever be an emergency.
If a physician performing cosmetic surgery in his office should ever have a complication such as uncontrolled bleeding and if he does not have admitting privileges at a nearby hospital, the patient’s life may be at risk. Even if he does have admitting privileges, he may not have operating room privileges. Who will take the patient to surgery to stop the bleeding? Patients should make it a point to ask how complications are handled when consulting any physician for a procedure.
Be certain to request a tour of the surgical facility. Is the surgical facility properly outfitted? Is there proper cleanliness, proper lighting, and proper space for the procedure as well as the recovery room? I have operating privileges at the Blue Ridge Surgery Center and within the LewisGate Regional Health System.
I hope this clarifies what I think is an important public misconception about the specialty of Plastic Surgery, and the market for cosmetic surgery. Much of the lay public including readers and editors of local area publications may not understand the differences between the education, training, certification and practice restrictions of the various providers available.
Until recently, complex cosmetic surgical procedures for the face and body were only performed by plastic surgeons, with the same level of education, training and certification as other surgeons. Now that market forces have so greatly affected this portion of our healthcare system, patients have a variety of options to choose from. Some of these individuals are medical doctors, and some are not. Some have formal surgical training, and some do not. I think it is necessary to understand the differences between providers available so patients can make an informed choice. I hope this explanation is helpful in educating patients about the choices they have and gives them the tools and references to do their own research on physicians and facilities that have come to their attention.