Medical Turf War: Cosmetic Surgeon vs “Cosmetic” Surgeon

A recent article published in the International Business Times (it’s ok, I hadn’t heard of the publication before either!) compares real plastic surgeons and doctors that call themselves “cosmetic” surgeons. While there is no legitimate, independently-recognized board certification for “cosmetic” surgeons, the article conferred credibility on “cosmetic” surgeons to the detriment of the consumer confused by conflicting information.

Rather than me trying to explain the confusion brought about by this article, I’m reposting, in its entirety, a letter written by the American Society of Plastic Surgeon’s President, Scot Glasberg, in response to the original article.

Letter from ASPS President, Scot Glasberg

Letter to the Global Editor-in-Chief
International Business Times

Dear Editor,

As the president of the American Society of Plastic Surgeons, I found your recent article investigating the performance of plastic surgery procedures by non-board certified plastic surgeons (Medical Turf Wars – September 7, 2015) disgracefully unbalanced. I am deeply disappointed and, frankly, shocked that the article did not include any input from the American Society of Plastic Surgeons (ASPS), the largest plastic surgery organization in the world, and the subject of serious negative accusations throughout the piece. I feel compelled to address some egregiously presented points.

The article, inspired by the recent dismissal of a case against ASPS for the implementation of a public service campaign encouraging consumers to “Do Your Homework” when considering plastic surgery, points out that physicians who perform cosmetic procedures without the benefit of being board certified in plastic surgery charge board certified plastic surgeons with protectionism.

We are not interested in protectionism. We are interested in protection – of patients, of the reputation of our specialty, and of an essential component of our mission – advancing the highest standards of training, ethics and physician practice.
By educating consumers on the importance of choosing a board certified plastic surgeon, ASPS believes we are not only guarding the specialty of plastic surgery from the indelible mark of illegally performed, often fatal procedures by non-physicians, but also protecting patients and assuring they make choices that assure the safest, highest quality of care.

This objective is the foundation of our Do Your Homework and “truth-in-advertising” efforts. The current president of the American Board of Cosmetic Surgery (ABCS) asserts that our objective is financial, but this is not the case. (I would note, however, that ABCS is conducting a nationwide campaign to undermine the sort of truth-in-advertising, described below, that ASPS is seeking to instate. The benefit for ABCS if they are successful? More money.) He claims that ASPS is seeking to prevent physicians who are not board certified plastic surgeons from providing cosmetic surgery. This is simply false. In reality, such a pursuit would be an antitrust violation. What our efforts are aimed at is instead preventing under-trained, under-qualified physicians from acquiring a substandard “certification” – like, for example, the certification offered by ABCS – and then advertising themselves to the general public as “board certified.”

While our members can look at the ABCS training requirements and see that they are lacking, the general public typically doesn’t have a nuanced understanding of just how dramatically quality in medical training can vary. However, what they do understand is that the phrase “board certified” is a sign of excellence. We seek only to maintain that truth and, in doing so, maintain patient safety.

Through the messages of the ASPS’s Do Your Homework public service announcements, consumers learn that Board certified plastic surgeons are certified by the American Board of Plastic Surgery – the specialty board in Plastic Surgery that is overseen by the American Board of Medical Specialties (ABMS), an organization that is widely recognized as the gold standard in specialty certification. They learn that board certified plastic surgeons undergo vast, specific training in plastic surgery that includes residencies and fellowships that are certified by the Accreditation Council for Graduate Medical Education (ACGME), the body responsible for accrediting the majority of graduate medical training programs, and have passed rigorous oral and written board exams to demonstrate that their training and education have successfully prepared them to practice Plastic Surgery.

While the article clearly states that members of the American Board of Cosmetic Surgery also receive education and training (a “fellowship” and the completion of 300 cosmetic procedures) it fails to mention the most important piece of information about that training.

It is substandard.

Think of it this way: there are 38 ABMS specialty board certifications and 88 subspecialty certifications available, and there are 38 AOA specialty board certifications, 25 certifications of special qualifications, and 40 certifications of added qualification. Nowhere among this huge number of potential certification options is one for the practice of “cosmetic surgery.” This is the case because there are no ACGME-accredited cosmetic surgery fellowship programs in existence.

That’s not to say that cosmetic surgery is not a legitimate component of medicine or that physicians cannot be well-trained cosmetic surgeons. Instead, this reflects the fact that cosmetic surgery is a component of the comprehensive training board certified plastic surgeons receive. It is not a discipline unto itself. And when board certified plastic surgeons receive cosmetic training – and this is the key – it is a part of an ACGME-accredited program. Because its standards are so high, ACGME accreditation is one of the driving forces behind the quality of American medicine, and its independence ensures that participating training programs must strive to meet those standards.

The ABCS certification programs, on the other hand, create their own criteria, their own training qualifications, and their own standard for what is an acceptable level of training. Since when does the student write the test? It all comes down to quality.

Sadly, patients are bombarded with confusing messages about their choices when seeking a plastic surgery provider. Ambiguous promotions made by physicians who are not board-certified in plastic surgery maintain that their training is equal or even superior to that of a board certified plastic surgeon. For the earned esteem

I stand by the ASPS’s mantra that patients should do their homework. Respected publications reporting on this important consumer healthcare issue should, perhaps, do a bit more homework, as well.

Respectfully,