Legally, Can Any Licensed Doctor Perform Cosmetic Surgery? Technically, Yes. Practically, No
Choosing a good plastic surgeon is not easy. The patient-to-be can expect to hear claims that may be misleading, and the lack of government and peer control is worrisome. Ask physicians about their precise credentials, training, and field of expertise. If advertisements say: "board-certified," find out which board and whether it is accredited by the American Board of Medical specialties. Be aggresive in your questioning. Dr. Norman Cole says: "I am amazed at how few questions people usually ask me about my training and credentials.
Hold on; do not panic. Having heard the media play this tune so often as part of a rating-boosting, sensational story, I must comment. The unstated implication is that a family practitioner, right out of internship, or an allergist, just finishing his specialty training, can start performing liposuction, face-lifts and nose jobs on a whim not quite.
My license to practice is granted by the State of California's Medical Board, the state's regulator. It is a Physician & Surgeon license. So it is for every state's licensed doctors. The license makes no mention of specialty.
Any licensed M.D. can legally perform cosmetic surgery procedures.
-The American Society of Aesthetic Plastic Surgery
Every doctor's license is general and not specialty-specific because it is impractical for California (84,675 licensed MDs as of January 1, 2002) or any state to oversee professional competence in each of the dozens of specialties, subspecialties, and now, superspecialties. However, using a traditionally wise practice, hospitals and outpatient facilities such as radiology centers, laboratories, and surgery centers where doctors ply their trade have been charged with the background check and credentialing of its practitioners. The system works well because each facility has strict, uniform criteria for granting privileges for specialists to perform their work.
The privilege-granting process, after a thorough credentialing and background check, is guided by each specialty's recognized standards. Example of How the System Works If an orthopedic surgeon applies for privileges at the XYZ Surgery Center, he must present proof of licensure, liability insurance, and a credentials packet that reflects medical schooling, internship, and residency training in the doctor's specialty in this case, orthopedics.
Further, the doctor must submit a list of surgical procedures for which he seeks performance privileges. Assuming his credentials are appropriate (board certification or board eligible in orthopedic surgery, an unrestricted state license, and personal list of procedures falling within standard orthopedic practice), he will be allowed to practice, on a temporary/guest basis, until his skills are deemed satisfactory. Only then will full staff membership be granted allowing him to practice orthopedic surgery at the XYZ Surgery Center.
Here's a "hypothetical" example of how the watchdog system, protects you. Another board certified orthopedic surgeon comes to the same surgery center, with intentions of expanding his orthopedic practice to include liposuction on hips or thighs. He states: "Hey, I can do this. I know the anatomy of the hips and thighs. I have been operating there for years."
And indeed, while he is knowledgeable in the anatomy of that area, this alone is not an adequate qualification to begin doing a cosmetic procedure, especially when he admits he has no formal, approved training and no experience.
Consumers should be able to select a surgeon based on informed choice. Consumers have the right to be fully informed of their doctor's credentials and what they mean. Physicians have an ethical responsibility not to misrepresent their training.
-The American Society for Aesthetic Plastic Surgery
His application will have to be evaluated, not by the Orthopedic Surgery department but by the Plastic Surgery department. His application will be promptly denied because he does not meet the professional standard of the surgery center: specialty training in the procedure he wishes to perform.
Cosmetic surgery on the hip area, such as liposuction, is a procedure that is not listed by his board the American Board of Orthopedic Surgery as a procedure within the scope of the specialty. The safeguard to you, the prospective patient, is that an ethical clinic allows only fully-accredited, properly trained professionals to perform specific surgeries.
Besides the moral obligation to protect the public, a hospital or surgery center has a business-driven reason to scrupulously follow the privilege-granting guideline it submitted to inspectors before receiving license, certification or accreditation. Not following these guidelines would disqualify them from government and private insurance payments.
This complex system of internal quality control is all "behind the scenes" for your safety and protection. Ninety-nine percent of the time it works. Ethical surgeons and ethical surgery centers play by the rules: no qualification no surgery. Yes, there have been some shocking stories of general practitioners or other untrained, self- proclaimed cosmetic surgeons doing liposuction without proper training and accepted credentials. Because these doctors could not qualify for privileges in a bona fide hospital or surgery center, they have opted to "go underground" and the danger to patients is real.
We created residencies and said, "medicine is so complex that one can really only be educated satisfactorily in a particular area, and to do that one needs to do a residency." But when it comes to aesthetic (cosmetic) surgery, if you take a two-day course in Boca Raton and can get somebody to lie still, you can do an operation. With the reimbursements and benefits of other medical areas deteriorating, we have numerous individuals with all types of training, calling themselves cosmetic surgeons we have dentists and cardiologists doing it. What we've done is to cheapen what we spent years creating the process of residency training. It also cheapens what we do and tells the public that aesthetic (cosmetic) surgery is really just glorified cosmetology it has no risks and anybody can do it and that's just not true.
-John Grossman, MD in Cosmetic Surgery Times, November/December 2000
The rare unscrupulous physician, with no legitimate facility to accept him, retreats to his office or some under-equipped, inadequately staffed, unlicensed, uncredentialed, underground hideout. These inadequate pseudo-clinics are the wrong place for surgery of any kind, and breed problems for the patients that can have a tragic ending. I can assure you such a scenario is very, very rare. But, as mentioned earlier, my mission is to make sure you are savvy enough not to consider any high-risk shortcuts. These never lead to safety and excellence. By staying "mainstream," you remain safe and you remain distant from danger.
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