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Doctor's Notebook

AMA Policy H-230.994: supports the principles of open staff privileges for physicians, based on training, experience, demonstrated competence, and adherence.

So what does this mean, what determines the 'best' training and why would board certification not be the gold standard alone? Well, to start, board certification by a reputable board such as the American Board of Cosmetic Surgery does test the surgeon in general knowledge by rigorous written and oral examinations solely in cosmetic surgery. One should be proud to be a member of this elite group. However, no board actually tests the surgeon in 'true competence'. For instance, it is conceivable to have a surgeon who is of high intellect and can pass written and oral board exams but be less than capable with regard to hand skills or simply lacks a keen aesthetic eye for cosmetic surgery. The arguments between surgeons on whose board is better may be irrelevant if the surgeon of any board does not have proper education, training, experience and show competence in their respective field.

The trend in cosmetic surgery training as well as other surgical specialties is moving toward specialized post residency or fellowship training in addition to certificates of proficiency. Competency or proficiency is much more difficult in some ways to measure than standard board exams and potentially places the certifying boards at risk if they mistakenly qualify a surgeon that then has a problem later in their career. Still, it is the ideal way to help the public evaluate a surgeon's credentials more completely. Until this becomes the norm however, the patient must take the whole picture into account.

The average patient must keep in mind that the business of 'cosmetic surgery' can be a very bitter and unfortunate battle between competing specialties. Too often the egos of some surgeons lead to misinformation through scare tactics in hopes of steering patients to a particular doctor or away from a competitor. Regrettably, the public is often given misinformation about many surgeons training through advertising. In general, well trained, busy or successful surgeons rarely go out of their way to denigrate a similar specialty surgeon in the same region as themselves. The vast majority of surgeons have had a preponderance of training and education and rarely represents a major safety risk to the public. Hopefully, if there are those who pose an unusually high risk, they are quickly restricted by the state medical boards when their training, education or experience is suspect. It is patient's right to be confident in their surgeon's abilities and deserve to know the truth regarding specific training in the field of cosmetic surgery.

Patients seeking cosmetic surgery definitely want to know if their surgeon has adequate education, training, experience and competence for any specific cosmetic procedure they are considering. Potential cosmetic surgery patients should know that there is no such thing as a 'surgical residency' in 'cosmetic surgery'. Many surgical residencies have some training in various aspects of cosmetic surgery, such as, Otolaryngology, Oral & Maxillofacial Surgery, Plastic Surgery, General Surgery, OBGYN, Dermatology, and Ophthalmology) but NONE of them are devoted to cosmetic surgery. For super-specialized training in strictly cosmetic surgery, a surgeon may elect to extend their training beyond residency by completing an accredited post residency 'fellowship' program.

One trend is unmistakable in cosmetic surgery education in the 21st century and that is the growing need for more cosmetic surgery fellowship training programs to accommodate the rising number of extremely qualified applicants who are already board certified in their original field of surgical training. The surgeons who now devote at least an extra full year of their lives to master the art of cosmetic surgery are the new breed of 'cosmetic surgeons' with the education, training and experience that one looks for in a surgeon.

This is not to say that experienced surgeons do not have the same level of competence, however, it simply took longer to achieve the competence in cosmetic surgery 20 years ago for some due to the lack of super-specialized training and the extended time it took to gain the same experience from shear case volume. Some cosmetic surgery fellowships today have fellows directly involved with over 1000 cosmetic surgery procedures per year as well the initial evaluations and follow up care. Today, it is the gold standard in 'cosmetic surgery' training. The American Academy of Cosmetic Surgery prides itself in continuing medical education and patient safety along with accreditation of numerous cosmetic surgery fellowship programs throughout the country. The trend for a continued higher bar for cosmetic surgery education is a welcome trend and one which will likely continue to grow rapidly.