Why Board Certification is Critical When Choosing a Plastic Surgeon.
Elective Cosmetic Surgery . . . Once you have reached the point that you are now ready to choose who will operate on your face or body, it is indeed a “big deal!” Some people choose their electrician, plumber, hairdresser, and even auto mechanic with more care and research than they choose their surgeon. You ask the opinion of friends you trust, of acquaintances who have similar needs (or experience with a certain provider), a caring family physician, or on the basis of an advertisement that draws you to a certain website. Most individuals considering elective cosmetic surgery select a surgeon based on training, experience, area of stated expertise, referral from friend or adviser, and of course: Board Certification.
Board certification is obviously important: virtually every doctor who advertises himself or herself as a “cosmetic surgeon” lists “Board-certified” as part of their credentials and list of attributes. So it must be important, right? But just what is Board Certification?
Every doctor who graduates from medical school has earned their medical degree: MD stands for Medical Doctor, DO for Doctor of Osteopathy, both of whom diagnose illness, treat patients with prescription medicines, and perform operations, but not without much more training after medical school. (By the way, other health care professionals use the term doctor, such as DC—Doctor of Chiropractic, or OD—Doctor of Optometry, and there are now practitioners in Holistic Care, Naturopathic medicine, or Traditional Chinese Medicine who sometimes use the term Doctor. None of these providers has the training or credentials to perform surgery, whether in a hospital or a private clinic.)
After graduation from medical school, most MDs and DOs complete a residency training program in their choice of medical specialty: Internal Medicine, Family Practice, Surgery, Psychiatry, Pediatrics, or Radiology, to name a few. Additional subspecialty training (often called a Fellowship) may be necessary to become Board-certified in Neurosurgery, Thoracic Surgery, or Plastic Surgery). There are 24 physician specialties that make up the American Board of Medical Specialties, including all of those listed above. A total of 10 surgical specialties or subspecialties, and 14 medical specialties or subspecialties, make up these 24 areas of training and expertise within the ABMS. Each of these member Boards set their individual standards for quality practice in that specialty, and each sets membership criteria (proper and complete residency training, licensure, and rigorous oral and written examinations). Since specialties differ so widely, the criteria that make up these tests are quite different. What makes someone a good family practitioner does not necessarily make him or her a competent neurosurgeon. Similarly, just being Board-certified in one specialty does not guarantee training, competence, or expertise in cosmetic surgery.
It may surprise you that every doctor’s state license is the same: they all allow the doctor to practice "Medicine and Surgery." The individual doctor’s practice in a chosen specialty is based on residency and fellowship training, meeting the criteria for Board certification in that specific specialty, and then (if they practice in a hospital or clinic) credentials committees and peer review that permit practice in the specialty. The latter includes detailed lists of permitted procedures; for instance, a MD who is fully trained and Board Certified in Internal Medicine is not allowed to perform surgical procedures, and would be severely disciplined and perhaps dismissed from the hospital staff if he or she did so. From a state license point of view, however, it is legal for any physician to perform any procedure or prescribe any medication (though it may well be unethical or improper to do so outside one’s training or expertise).
It may also surprise you that Cosmetic Surgery is NOT one of the 24 ABMS Boards. Doctors of various specialties perform cosmetic surgery. For instance, an ABMS-Board-certified Ophthalmologist may appropriately perform cosmetic eyelid surgery, particularly if they have taken additional fellowship training in Oculoplastic Surgery. An ABMS-Board-certified Surgeon may appropriately perform mole or skin cancer removal, but may not have the specific training to perform more complex reconstructive surgery. An ABMS-Board-certified Otolaryngologist might appropriately perform cosmetic eyelid or facial surgery, but does not have the training to perform breast implants or abdominal surgery. Dermatology training after medical school may include a first year of transitional (flexible) program, Internal Medicine, Pediatrics, OB/GYN, Surgery, Emergency Medicine or Family Medicine, followed by 3 years of Dermatology residency. True surgical experience is correspondingly variable. Many Dermatology programs now include “Dermatologic Surgery” in their training descriptions and certificates, but the actual amount of cosmetic surgical training that Dermatologists have is extremely variable. That being said, some ABMS-Board-certified Dermatologists have taken some training in cosmetic surgical procedures and perform select procedures well.
Most surgeons are proud of their training and are eager to present their residency and fellowship credentials and certificates that show exactly which ABMS Board they are members of, and where and how long they studied cosmetic surgery. The concern, of course, is when doctors imply or suggest (sometimes quite blatantly) that they have more training or expertise than they actually possess. This is not about “turf” or “restraint of trade,” it is about ethics, honesty, and ultimately, the exact training and experience the doctor truly has. Board Certification is one way of selecting that degree of (proven by testing) training and expertise. So, look carefully at which Board your doctor claims certification by!
There is a non-ABMS American Board of Cosmetic Surgery that certifies doctors of various specialties; training requirements are less than those attained by ABMS-Board-certified Plastic Surgeons.
Ultimately, the prospective patient needs to know that Board-certification is important, but also needs to know whether or not the certification is ABMS-recognized or otherwise, and most importantly, in which specialty the Board certification is earned. Board-certification is a great starting point—take the time to learn just how your cosmetic surgeon gained his or her training and experience. American Board of Plastic Surgery-certified plastic surgeons are happy to share what required so much time and dedication to learn!