Would you consider an intern who had almost completed their MOHS fellowship qualified to perform a surgery? Where can I find the name of plastic surgeons who also perform MOHS surgery and the repair?
How Many Surgeries Performed Before Considered a Skilled MOHS Surgeon?
Doctor Answers 7
To be accepted into American College of Mohs Surgery (ACMS) fellowship, one must successfully complete medical or surgical internship (1 year), dermatology residency (3 years), and be either eligible to take Dermatology board exam or be board certified. That already gives the nascent surgeon some experience. Depending on the training program, toward the end of their training a fellow may perform close to 500 and, in many cases, up to 1000 cases in addition to observing many more (hundreds to thousands). As of recent, ACMS no longer grants fellowships to specialties outside of dermatology so you may not find a plastic surgeon trained in Mohs surgery in your area. However, in addition to performing Mohs surgery, fellowship trained dermatologists also perform reconstructions of various complexities. The simplest thing is to be forward about your concerns and ask the fellow about the extent of his/her expertise. If you are not comfortable with such approach, you can find a competent Mohs surgeon via mohs.net (go to Surgeon Finder) or call 1-800-500-7224.
Adequate Training for Mohs surgery
By definition a fellow is an individual who has already completed an internship and residency and is completing additional training under the direction of a skilled and experienced Mohs surgeon. By the end of their fellowships, an individual should be quite proficient at performing Mohs surgery and reconstruction, but there may be some individual differences between doctors. Just as one plastic surgeons may be more skilled at performing a particular procedure (e.g. facelift) compared to another plastic surgeon, one Mohs surgeon or one fellow completing his or her fellowship may be more or less skilled than another. So if you don't want the fellow to perform your surgery, tell the fellow or the doctor who supervises him or her. In regards to finding a plastic surgeon who does Mohs, true ACMS-fellowship-trained plastic surgeons are very rare. I know of only one person in the country who is a fellowship-trained plastic surgeon and fellowship-trained Mohs surgeon. If a plastic surgeon says that they do Mohs surgery but somebody else is reading the slides, that is not Mohs surgery and should not be billed as Mohs surgery. By definition Mohs surgery requires that one individual act as both surgeon and pathologist. If one of those jobs is delegated to another person, by definition, it is not Mohs surgery.
Well trained Mohs fellow are well qualified to do Mohs
While the individual experience of every fellowship program may vary, in general, Mohs surgeon who are near the end of their fellowship are well qualified to do Mohs surgery. Fellows trained under the American College of Mohs Surgery are board eligible dermatologist who have completed one internship year and three years of dermatology residency. They have chosen to spend an extra 1-2 years of advanced fellowship training specifically to hone their skills in Mohs surgery, skin cancer pathology, AND reconstruction. They are required to have performed at least 500 cases during their fellowship training. Most fellows perform well over 1000 Mohs cases and the majority of the reconstruction during their fellowship training. Plastic surgeons do not have the pathology experience generally needed to perform Mohs surgery.
As a Mohs surgeon who trains Mohs fellows, I am confident our fellows are well trained before they graduate from our program. At the same time, during their training, they are well supervised to ensure the best care for my patients. I personally participant in the care of every patient. If your Mohs surgeon is well trained and supervised by an experienced Mohs surgeon, I would feel comfortable that you are receiving the best care.
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Experience is a complex thing. There are some people who do more procedures in training than some people who are out of practice..so just saying someone has been out of training for x number of years must be more experienced than someone who is not. I would see what each person's experience is. The Mohs website can give you a list of surgeons who do the procedure. Either than or your local dermatologist can direct you.
Mohs fellows performing Mohs
There may be many Mohs fellows who have almost finished their training but are not yet considered a graduate of their fellowship who have better training than some dermatologists who never went through a Mohs fellowship. Conversely, some dermatologists who learned Mohs surgery in their residency and have performed thousands of procedures in their dermatology practice might be more capable than some surgeons who graduate fellowship programs. Experience is important and you should get recommendations from your general physicians. There are very very few plastic surgeons who are Mohs surgeons. You may find a very talented Mohs surgeon who performs both the reconstruction as well as the Mohs surgery, or you can coordinate having the Mohs surgeon do Mohs and a plastic surgeon do the repair. There are some very good Mohs / reconstructive surgeons, one being Dr. Jeffrey Marcus, in Boca Raton, Fl.
Mohs fellows should have a ton of cases late in the year
Most Mohs fellowships have their fellows do well over 1000 cases per year. This is obviously dependent upon the training program. Is he/she qualified to do your surgery at this point in time? Probably yes, but if you are that concerned, just go somewhere where there is not a training program.
Most plastic surgeons do not do Mohs surgery (there are a few in the Mohs college). The reasoning is that they do not get the pathology training that dermatologists receive. One of the most important parts of the Mohs procedure is your surgeon looking at your cancer under the microscope.
If you are really wanting a plastic surgeon to do your repair, just ask your Mohs surgeon. He/she should be more than willing to refer you on to a qualified individual to close the wound left by your skin cancer.