Understanding Board Certification
CHOOSE YOUR COSMETIC SURGEON AS YOU WOULD CHOOSE ANY OTHER HEALTHCARE PROVIDER
Criteria for Determining a Doctor's Qualifications – Individual Character, Education, Training, Experience and Proven Competence
Written by the American Academy of Cosmetic Surgery (AACS)
view original brochure
by the AACS
Choosing a doctor for any healthcare need is an important decision. Patients should choose a healthcare provider based on his or her training, education, experience and demonstrated practice history; the criteria most often used by hospitals in delineating clinical privileges. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), promotes the appropriate delineation of clinical privileges for medical staff and qualified practitioners based on training, experience, and demonstrated competence. The American Board of Medical Specialties (ABMS), supports the same. Consistently, it is the American Medical Association's policy that individual character, training, competence, experience and judgment be the criteria for granting privileges in hospitals, and that physicians representing several specialties can and should be permitted to perform the same procedures if they meet the criteria.
False Messages Misinform Patients
Consumers considering cosmetic surgery are almost universally unaware of the difference between "cosmetic" surgery and "plastic" surgery. For this reason, they are easily misled to believe board certification in plastic surgery evidences a physician's competence to perform cosmetic surgery. It does not. Importantly, with an expanding number of consumers anxious to undergo cosmetic surgery and a highly competitive pool of physicians, it is imperative consumers have access to accurate information. It is equally imperative consumers have the freedom to choose among competitors and that the number of qualified cosmetic surgeons is not artificially restricted. Unfortunately, the public almost universally equates cosmetic and plastic surgery as one and the same.
Consumers' misapprehension in this regard has them relying on incomplete and false information when choosing a physician to perform their cosmetic procedure.
Understand the Difference Between Cosmetic Surgery and Plastic Surgery
Cosmetic surgery is a subspecialty that uniquely restricts itself to the enhancement of appearance through surgical and medical techniques. It is specifically concerned with maintaining normal appearance, restoring it, or enhancing it toward some aesthetic ideal. Cosmetic surgery is a multi-disciplinary and comprehensive approach directed to all areas of the head, neck and body. Cosmetic surgery is practiced by surgeons from a variety of disciplines including board-certified dermatologists, general surgeons, oral and maxillofacial surgeons, ophthalmologists, otolaryngologists, plastic surgeons and physicians from other fields. All of these disciplines have contributed to the vital growth of cosmetic surgery. Cosmetic surgery is primarily learned during a surgeon's post residency through ongoing continuing education, training, and experience.
Unlike cosmetic surgery, plastic surgery deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, crainomaxillofacial structure, hand extremities, breast and trunk and external genitalia. While board certification by the American Board of Plastic Surgery may evidence a physician's competence in "plastic surgery," it does not evidence competency in "cosmetic surgery" nor does it demonstrate more "cosmetic surgery" education, training or experience than that of a board-certified dermatologist, general surgeon, oral and maxillofacial surgeon, otolaryngologist, ophthalmologist or other surgeon.
Yet many board-certified plastic surgeons seek to equate the terms "plastic" and "cosmetic" in order to represent their certification in plastic surgery as evidence of their competency to perform "cosmetic" procedures. The spreading of this misconception reduces patient choice and jeopardizes patient safety. The "message" often repeated in various forums and published in advertisements by various board-certified plastic surgeons across the country falsely and deceptively informs consumers that:
- Certification by the American Board of Plastic Surgery evidences competency in cosmetic surgery
- Physicians who are not certified by the American Board of Plastic Surgery are not competent to perform cosmetic surgery
- The American Board of Plastic Surgery is the only "recognized" board with regard to the practice of cosmetic surgery
- The term "plastic surgery" is synonymous with "cosmetic surgery" or that the term "plastic surgeon" is synonymous with "cosmetic surgeon"
This misinformation has consumers believing that when searching for a cosmetic surgeon to perform cosmetic surgery, they must look only to the universe of Board Certified Plastic Surgeons and that they cannot find a competent cosmetic surgeon among boardcertified dermatologists, general surgeons, obstetric/gynecologists, ophthalmologists, oral/maxillofacial, otolaryngologists or other surgeons. (See Diagram A).
This message, which directs consumers to consider only boardcertified plastic surgeons when searching for a qualified cosmetic surgeon, is false and harms consumers in two ways:
- Reducing Patient Choice Among Qualified Cosmetic Surgeons. There are many extremely qualified cosmetic surgeons who are not board-certified in plastic surgery. In fact, many cosmetic procedures were developed by physicians from specialties other than plastic surgery. Residency programs, whether in dermatology, general surgery, oral and maxillofacial surgery, otolaryngology or plastic surgery, do not encompass significant training in the vast array of cosmetic procedures and certainly do not provide adequate training to render a graduate prepared to practice cosmetic surgery. Surgeons develop their cosmetic surgical skills through post residency training and experience. Accordingly, to identify the most qualified surgeon for any given cosmetic procedure, one must look to and compare surgeons' post residency training, experience and practice history. Therefore, a patient may find that the most qualified surgeon available in their community to perform a breast augmentation is a board-certified general surgeon; the most qualified surgeon available to perform a chemical peel may be a board-certified otolaryngologist; or the most qualified surgeon available to perform cervicofacial liposuction may be a board-certified plastic surgeon. The point is that a cosmetic surgeon's skill and ability will depend on the surgeon's cosmetic surgery training and experience, not on his or her core board-certification. Consumers led to consider only board-certified plastic surgeons rely on irrelevant criteria and, accordingly, have their choice among qualified cosmetic surgeons greatly reduced. *
- For Their Cosmetic Surgery. A physician may complete a plastic surgery residency, qualify for the American Board of Plastic Surgery board exam, and become board-certified in plastic surgery without ever performing or receiving training with respect to many common cosmetic procedures. And, while competence in cosmetic surgery is determined by a physician's training, experience and judgment, this message has consumers believing that board-certification in plastic surgery is the golden seal when seeking a cosmetic surgeon. Bestowing expertise and competency upon physicians who may be unqualified (i.e., board-certified plastic surgeons with inadequate or no training with respect to a given cosmetic procedure), places consumers at risk.
To give a practical application of how the message impacts consumers, consider an individual seeking to undergo a blepharoplasty (cosmetic eyelid surgery) in a community where ten cosmetic surgeons are available – two dermatologists, two general surgeons, two ophthalmologists, two otolaryngologists and two plastic surgeons. The "message" proffered by many board-certified plastic surgeons would have the consumer choose from the two plastic surgeons and ignore the other eight cosmetic surgeons (see Diagram A), regardless of whether the other cosmetic surgeons may have more training, education and experience performing blepharoplasty procedures and regardless of whether the plastic surgeons may have never performed a single blepharoplasty procedure.
Information Cosmetic Surgery Patients Should Consider
Instead, the blepharoplasty patient should consider the training, education, experience and demonstrated practice history of all ten cosmetic surgeons in the area. More important, the true message all cosmetic surgery consumers should understand is that there are qualified cosmetic surgeons from various disciplines with various board certifications and there are board-certified physicians from those disciplines who are not qualified to perform cosmetic surgery.
As Diagram B illustrates, each discipline – and each depicted universe of board-certified physicians – includes qualified cosmetic surgeons as well as those not qualified. Those patients seeking cosmetic surgery who are misled to rely instead on a physician's underlying board-certification have their choice among qualified cosmetic surgeons artificially reduced and choose their cosmetic surgeon based on irrelevant information.
* The total number of physicians board-certified in the named specialties (dermatology, general surgery, ophthalmology, otolaryngology and plastic surgery) exceeds 95,000, with approximately the following breakdown among the named specialties: dermatology (11,900), general surgery (49,100), ophthalmology (20,400), otolaryngology (7,000) and plastic surgery (6,600). Board-certified plastic surgeons make up only 7% of the total number of board-certified physicians.
What is the American Academy of Cosmetic Surgery?
The American Academy of Cosmetic Surgery is a professional medical society whose members are dedicated to patient safety and physician education in cosmetic surgery. Most members of AACS are dermatologic surgeons, facial plastic surgeons, head and neck surgeons, oral and maxillofacial surgeons, general surgeons, plastic surgeons or ocular plastic surgeons – all of whom specialize in cosmetic surgery. AACS is the organization that represents cosmetic surgeons in the American Medical Association through its seat in the AMA House of Delegates.