Thursday, March 30, 2006

Are you a gambler?

Changing your appearance is never without any risk. Often, the greatest factor affecting the odds of a safe outcome versus a disastrous one is the doctor you choose. Many times, though, patients aren't sure how to research a doctor's qualifications. In this blog entry, I'll review some of the issues patients need to bear in mind as they make such a decision.

[Obviously, any doctor writing an article like this is going to argue favorably for choosing him. I'm no different—but all the same, I think you'll find my argument compelling.]

The Reality
black market plastic surgery
It's a fact that payment for medical services is decreasing: doctors are getting paid less for what they do—less by the insurance companies and less by the government (e.g., Medicare & Medicaid). As a result, many healthcare practitioners are looking for ways to supplement the bottom line. Unfortunately for the public, that means that all too many doctors with essentially no real training in the plastic surgery disciplines are hawking cosmetic procedures to the public.

Just here in Orange Park and the surrounding areas of Jacksonville and St. Augustine there are "cosmetic medicine" practices whose doctors are family practitioners (general practitioners), obstetrician/gynecologists, emergency room doctors, and even dentists! All are trying their hand at cosmetic specialties.

Would you trust me to do your Pap smear? So why would you trust an OB/GYN to inject your forehead with Botox? And I don't think you'd want me filling your cavities, yet a dentist—someone who's never been to medical school—offers facelifts and eyelid surgery to the unsuspecting public. His office is only thirty minutes from mine. A family practitioner whose office is only blocks from mine claims to specialize in "cosmetic medicine"—whatever that is—with no formal residency or fellowship training beyond her residency in family practice. An ER doctor performs cosmetic procedures at his local medispa (medical spa) in Jacksonville.

I can assure you that none of their residency programs emphasize cosmetic procedures. None of their boards extensively examine competency in plastic surgical procedures. Weekend courses do not a plastic surgeon make.

Can pediatricians perform liver transplants?

The short answer is yes. You may find it hard to believe, but in the United States when a doctor is licensed to practice medicine, the state license is an unrestricted license. That means that it is perfectly legal for a pediatrician to perform a liver transplant, or for a radiologist to perform brain surgery, or for a psychiatrist to perform a heart bypass.

Of course, most of us in medicine generally know better than to do such things and so we stick to our areas of expertise. And if they don't know better, the traditional checks and balances have been the securing of hospital privileges. That is, while it's perfectly legal for me, a facial plastic surgeon, to do a hip replacement (for which I have no training), no hospital in the country would allow me to do that—they would never grant me privileges to perform orthopedic surgery...and no amount of weekend courses I may claim to have taken will convince them otherwise. But what if I build my own surgery center? Well, I can do anything I want there. And office-based procedures? Same thing. Anything goes...and it does.

Staying safe...How to avoid The Big Gamble

I fully understand that it's hard for the general public to make sense of our credentials. Some are meaningful and some are not. To become a member of the American Academy of Aesthetic Medicine, for example, requires only that you pay $175.00 (for doctors). Less scrupulous practitioners are capitalizing on such the expense of your money and your safety. Here are some tips:

Check what that doctor really trained in

By "really trained in," I mean what residency and fellowship training did they receive...what is their actual specialty? Was their residency in a field that includes plastic surgery? General surgery does, otolaryngology/head & neck surgery does, ophthalmology sometimes does, dermatology sometimes does. And that's pretty much it.

Most specialists also do further fellowship training in their more narrow area of expertise. For example, most facial plastic surgeons will have completed a five-year otolaryngology/head & neck surgery residency and then an additional year of an accredited facial plastic surgery fellowship, as I have. General plastic surgeons typically have spent five years in general surgery followed by two years of an accredited plastic surgery fellowship. Someone whose residency was in family practice, or obstetrics and gynecology, or emergency medicine is not a specialist in plastic surgery. Sure, a family practitioner may call herself an "aesthetic physician" but that has no official meaning (and is backed by no official training or board exams).

You can look up our training on the Florida Board of Medicine's license lookup free of charge. Just type in our name and then look at our Practitioner Profile by clicking on our license number. My medical license is ME 80556. There you can verify our education and specialty certification as well as any criminal convictions, malpractice history, and reprimands by the Board of Medicine.

Don't confuse an Academy with a Board

Academies are our academic organizations, but boards are our certifying authorities. Legitimate certifying boards are recognized by state medical boards and state legal statutes.

So, while I am a member of the American Academy of Facial Plastic and Reconstructive Surgery, I am also certified by the American Board of Facial Plastic and Reconstructive Surgery (and am furthermore certified by the American Board of Otolaryngology...whose exam also encompasses facial plastic surgery).

Becoming a member of an academy is much easier than becoming certified by its corresponding board which requires passing rigorous written and oral exams...and in the case of facial plastic surgery, also submitting for peer review the operative notes from at least a hundred cosmetic and reconstructive plastic surgical cases performed after completion of one's training (nope, Botox and all those non-surgical treatments don't count one iota toward that case log).

Look for appropriate board certification

If someone's ad mentions, "board certified," what exactly are they boarded in? Although the American Medical Association's Ethical Advertising Guidelines suggest that when doctors proclaim board certification that it should be in the specialty for which they're advertising, many times this is not the case. A common trick is to simply claim, "Dr. Wannabe is a board-certified doctor." Fine. They probably are, but in what? OB/GYN? Family practice? My personal opinion is that the following board certifications are reasonable indicators of competence in cosmetic and reconstructive procedures:

I am boarded by both the ABFPRS and the ABOto. Here's an easy way to check my certification: and

If someone is touting membership in one of the less well-recognized organizations, it may be because they lack membership in more prestigious organizations

Being a member of one of these lesser categories isn't by itself a bad thing—but it's suspicious if that's all they have.

Make sure the doctor has privileges to perform cosmetic surgical procedures at a hospital

Let the old system of checks and balances work for you. Even if the doctor does most of his or her procedures at a surgery center, a good indicator of competence is to ask if he or she has privileges at a hospital to perform these procedures. Note that having admitting privileges at a hospital does not mean having surgical privileges for cosmetic and reconstructive procedures.

Confused now? I hope not. In the end, even putting yourself under the care of a doctor with legitimate credentials from reputable organizations who's well trained, is no guarantee of success...but you've certainly improved your odds.

I try never to forget that at the end of medical school I took an oath as a physician. So while I am also a businessman, I am a businessman second and a physician first. Isn't that what you want?


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