Stricter Cosmetic Surgery Controls? Not Today--Editorial

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The Virginia Board of Medicine could have taken steps in early February, 2011 to prevent botched procedures and even death at the hands of minimally trained practitioners for consumers in the state. Instead, according to the online version of the Richmond Times-Dispatch, the board sent a recommendation to do just that back to a committee for more study.

Lewis T. Ladocsi, head of the Virginia Society of Plastic Surgeons, had issued a letter to the board signed by nine state medical specialty groups. The letter urged the board to adopt the committee’s recommendation for a “guidance document” that would regulate who could perform cosmetic procedures and which could be office-based rather than done in a surgical setting.

The Board of Medicine noted that in more than 9,000 cases in which doctors had been disciplined, there were only 10 cases related to procedures performed in-office. Admittedly, that’s a small fraction.

But it’s not really the point.

The most important aspect of the recommended guidance document was “who” can perform invasive procedures, not so much the "where." Victoria Vastine, a plastic surgeon quoted in the article, got right to the heart of the matter. She said about doctors in general, “all have some initials after their name, and they are all members of something. And for the average consumer, they have no idea of what that means."

The American Society of Aesthetic Plastic Surgery agreed. A Patient Safety Advisory on the ASAPS website stated:

There are many physicians today practicing plastic surgery who have received their formal training in another specialty -- often a non-surgical specialty. These doctors may call themselves plastic surgeons, but they may not be trained in plastic surgery.

Vastine also noted that in the current poor economy, the risk to consumers is greater than ever. The one-two punch of non-plastic surgeons looking to augment their bottom line by taking weekend courses in liposuction, for example, combined with consumers seeking a bargain can lure people to choose cut-rate practitioners.

Some widely publicized stories illustrate the worst-case scenario for those who gamble with practitioners having sketchy credentials: death. A mother of three undergoing liposuction died on the table of a Florida medical spa doctor with questionable training and inadequate emergency equipment in 2009. A Washington state woman died at the hands of a non-board certified cosmetic surgeon in 2008.

Liposuction deaths like these have occurred from California to Canada. The rate of death per hundreds of cases is small, but that’s probably of little comfort to the patients’ families. Especially since complications such as blood clots and overdoses of anesthetics may be prevented in the hands of plastic surgeons with adequate training, knowledge of prevention measures and emergency equipment.

Here’s what the ASAPS has to say about choosing a plastic surgeon:

When we talk about a "board-certified plastic surgeon," we mean one who is certified by the American Board of Plastic Surgery (ABPS), the only board recognized by the American Board of Medical Specialties (ABMS) to certify physicians in the full range of plastic and reconstructive procedures. To be certified by the ABPS, a physician must have at least five years of approved surgical training, including a residency in plastic surgery. He or she must also pass a comprehensive written and oral exams in plastic surgery.

The ASAPS furthermore hinted that the discussion of who gets to perform cosmetic procedures is sometimes more about politics than about patient safety. The organization even refers to the issue as a “turf battle.”

It’s hard to say whether a turf battle played a role in the recent decision by the Virginia Board of Medicine. But it’s also hard to understand why they would refuse to take a step forward to safeguard the general public.

The ASAPS posed this timely question, “Would you want your plastic surgery performed by someone who has never had any formal surgical training? It can easily happen…”

When will government organizations wise up?

References:

http://www2.timesdispatch.com/news/2011/feb/18/TDMET04-medical-board-sends-issue-of-office-based--ar-851712/

http://www.surgery.org/consumers/patient-safety/credentials--training-and-certification-of-plastic-surgeons

Add a Comment1 Comments

Anonymous

It is unfortunate, but sometimes this issue is used to help eliminate the competition. Sometimes, complaints are raised by one group -- say, a plastic surgeon -- when someone from another specialty (let's say, a cosmetic surgeon) moves into the neighborhood, threatening the business of the first group with competition. That's the "turf war" part. This can happen when noncore physicians break into the aesthetic field -- and especially new cosmetic surgeons can run afoul of this. However, even plastic surgeons have been known to make fatal mistakes with patients. So, the issue is complex. Dr Harp at the Virginia Board is known for looking intently at both sides in these cases, which is not always the case with other Boards.
Good article. A follow-up would be appreciated.
Jeffrey Frentzen
PSP: Plastic Surgery Practice
http://www.plasticsurgerypractice.com

March 1, 2011 - 5:37pm

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