Confused With Board Certification?

Much has been said about Board Certification and patients often ask me what it all means.  Here is the straight story.

The American Board of Medical Specialties (ABMS) has defined and sanctioned a board examination process for each specialty in medicine.  These examinations are rigorous and involve difficult written and oral exams for doctors as well as an examination of billing, advertising, and record keeping practices.  The specialties include such disciplines as Internal Medicine, Family Medicine, Pediatrics, General Surgery, Plastic Surgery, Oral Surgery, Obstetrics & Gynecology, Emergency Medicine, etc, etc.

In order for a physician to sit for an ABMS board exam, he or she must complete an accredited residency training program.  These programs last anywhere from 3 to 7 years depending on the specialty.  So a doctor cannot be board certified in a specialty in which they are not trained.

"Cosmetic Surgery" and "Facial Plastic Surgery" are not recognized by this board as specialties (This may change in the future).  These specialties have their own board examination process.  Some say that their process is less stringent than for those in the ABMS.

Now for the confusing part.

There are generally no regulations of the activities of physicians in their offices.  As long as they have a medical license, they can practice the full range of medicine in their offices.  Hospital privileges, however, do require proof of training.  So, for example, an obstetrician cannot go to a hospital operating room and perform a total knee replacement.  The hospital will not allow them to do that.  But if he or she wanted to do a steroid injection of the knee, in the office, there would be no one there to say no (other than the patient, who should probably know that their OB is probably not the best choice for that).

As cosmetic procedures have become more popular and lucrative, more doctors are getting in on the action by doing procedures in their offices for which they can get paid in cash.  Family doctors are doing Botox.  Oral surgeons are doing facelifts.  And all kinds of doctors are doing liposuction.  These procedures can be safely done in the office and some of the doctors are trained to do them.  For example, oral/maxillofacial surgeons are often very well trained in facial cosmetic surgery and are board certified in OMFS (a specialty recognized by the ABMS).

But just because a surgeon is "board certified", doesn't mean he or she is fully trained to do the procedure you are seeking.  An obstetrician can be board certified in obstetrics & gynecology but that doesn't mean they are trained to do a tummy tuck like a plastic surgeon might be.  So if a surgeon advertises that they can do your plastic surgery procedure, and that they are "board certified", that still doesn't mean they are board certified in plastic surgery, or that they have been formally trained in the procedure they are advertising.

To make matters even more confusing, some "cosmetic" surgeons have created their own board certification calling themselves "board certified cosmetic surgeons", or "board certified facial plastic surgeons".  These specialties are not recognized by the ABMS and may not have the same stringent requirements.  That, however, does not mean they are bad surgeons or unsafe.  It just means you need to be a little more diligent about making sure they can do your procedure well.

So the questions are these:

• Is it safe to have cosmetic plastic surgery performed by someone who is not a board certified plastic surgeon?  The answer is possibly.  Plastic Surgery board certification does not guarantee skill or a good result.  It does, however, imply that a minimum standard of training and testing has been met.  Experience is key and results speak for themselves.
• Are there good cosmetic surgeons who are not plastic surgeons?  Certainly.  
• Are there bad board certified plastic surgeons?  Of course.  
• Is it a good idea to get liposuction from a family practice doctor?  I don't think so.  
• Should I have a tummy tuck from a "cosmetic surgeon" who is board certified in oral surgery?  I would think not, but then again, the training for "cosmetic surgeons" is not standardized and he or she may be well trained in that procedure.

So what should I look for?

• Steer clear of surgeons who advertise heavily for only one specific procedure (ie, liposuction or "natural breast enhancement".  This generally means they are not fully trained plastic surgeons, and they may be more inclined to offer the procedure they do rather than the procedure that is best for you.
• Ask specifics about board certification.  What specialty are they boarded in?
• Ask how many of your procedures they do in a month.  If they do less than one a month, find someone else.
• Ask friends for referrals.  Good reputations spread through the community. 
• Don't shop based on price alone.  You generally get what you pay for.
• Don't put too much stock in a surgeon's own advertising.  If you look at websites and yellow page ads, you'll find that every surgeon thinks they are the best ever.  Look at credentials, training, customer reviews, etc.
• Look on your surgeon's website for emblems from The American Society of Plastic Surgeons (ASPS) and The American Society of Aesthetic Plastic Surgeons (ASAPS).  These organizations require board certification in plastic surgery and high ethical and professional standards.
• Look at before and after photos.  There should be many.
• Understand that surgery is risky, and how a surgeon deals with problems is just as important as getting a good result.  Be sure you can communicate and build a relationship with your surgeon.

The bottom line is board certification does not equal skill.  But you have a much better chance of having a good surgeon if he or she has completed all the training and testing required to get certified.  If a surgeon has chosen to pursue a path to practice that does not include board certification by a mainstream board, there is probably a reason.  After that, it's all about the results.  A good doctor gets good results and enjoys a good reputation.

I hope this helps to clarify

One Thing

I think everyone has one thing about their appearance that they would like to change.  It might be reasonable to undertake that one thing.  Where people get into trouble is when they become fixated on that one thing until it becomes bigger than life, or if the list of things gets longer and longer and longer.  For me, it's not complicated.

I would like to get rid of my love handles.  I think my wife would like that too (although she never says anything about it...She's a good person).  I may be able to get rid of them, to a certain degree, at the gym.  I'm going to try. If I can't, I may have one of my partners do me up.

But my point is, I think it's healthy to be dissatisfied with one thing and to think about getting that fixed.  So, here is your permission.  Pick one thing.  Get it fixed if you want to.  Then move on.

Maybe a boob job is NOT the right thing to do

Ok... This may sound funny coming from a surgeon, but breast implants may not be the right thing for you.  The best way to think about cosmetic surgery is in terms of cost and benefit.  It turns out that most people only think about the benefit.  Incidentally, the benefits are obvious.... bigger boobs.  There are also benefits in self esteem.  You will probably love the way you look.  That's worth a lot.  But what are the costs?

Some of the costs are pretty obvious.  Cash.  Pain.  Scars. New wardrobe.  No one ever listening to another word you say...

Here's one cost you may not have thought about.  If you have implants put in now.  YOU WILL HAVE ANOTHER OPERATION in the future.  Implants don't last forever.  Unless you suffer an untimely death, you will outlast them.  In general, you can count on implants lasting 10-15 years.  Then you're looking at another surgery, another surgical fee, and another chance for things to go wrong.  So how do you decide if it's worth it?

Here's an example.  You're a cute 30 year-old woman interested in breast augmentation.  On a scale from 1 to 10, you give your own breasts a 7.  They're a little saggy, a little smallish (maybe a B-cup), and they have some stretch marks.  Basically, they don't look like they did when you were 18.  So you decide to perk them up again with implants.  You get the surgery and now your breasts are a 9.  We can't get to a ten because the surgery will require scars, the implants will have some rippling as all implants do, and the stretch marks are the same as they were before.

So we've gone from a 7 to a 9, up two Warnock Boob Units (WBU's).  But at what cost?

$6,000.
Two weeks of pain.
Time off work.
1% risk of infection (with another surgery and loss of an implant).
15% risk of repeat surgery in the first few years for hardening, shifting, unevenness, or other problems.
And probably another operation at age 45, 60, 75, and 90... at a total cost of at least $30,000 (with inflation) if you live that long.

As a surgeon, I'm happy to do it.  My kids need to go to college.  But it may not be the best thing for you.  Here's how I see it.  If you were my wife, sister, daughter, friend, neighbor, or.... patient, I would probably tell you NOT to do it, not for two WBU's of improvement.  Instead, use the $6,000 to buy a new big screen TV and super soft sofa and invite me (and my wife, and some other friends) over to watch a football game and drink some beer (you could afford a lot of beer).

Now, what if your boobs are a 3?  Thats a different situation because the improvement is more significant.  It may be more worth it.  The benefit to risk/cost ratio is more favorable.  And when your breasts go from a 3 to a 9 on the Warnock boobie satisfaction scale, we'll both be happy.

One final thought.  The one thing that we haven't put into this equation is the "How much I want it" factor.  Only you can say what a cup size or two really means to you.  Self esteem is a delicate thing and good self esteem is priceless.  Only women really understand how breasts affect their self esteem.  I would not pretend to diminish that.

So weigh the costs and benefits carefully... then find an experienced, qualified plastic surgeon to help you.

Dr. Steve