Why Board Certification (by the American Board of Plastic Surgery) is Critical When Choosing a Plastic Surgeon

Elective Cosmetic Surgery … Once you have reached the point that you are now ready to decide who will operate on your face or body, it is indeed a “big deal!” Unfortunately, some people choose their electrician, plumber, hairdresser, and even auto mechanic with more care and research than they use in choosing a surgeon. You may ask the opinion of friends you trust, of acquaintances who have similar needs (or experience with a certain provider), a caring family physician, or on the basis of an advertisement that draws you to a certain website. Then, during a consultation where the patient finds out the doctor does indeed perform the requested operation(s), the doctor or his/her staff inform you the doctor is “Board Certified.”

Board certification is obviously important: virtually every doctor who advertises himself or herself as a “cosmetic surgeon” lists “Board-certified” as part of their credentials and list of attributes. So it must be important, right? And it must imply that the doctor is fully trained and “qualified” to perform the requested operation. For example, you must be a fully-trained and appropriately-board-credentialed cardiac surgeon to operate on the heart, right? It might be natural to assume the same applies to cosmetic surgery. HINT: It isn’t! So, what is Board Certification?

Every doctor (MD or DO) who graduates from medical school has earned their medical degree: MD stands for Medical Doctor, DO for Doctor of Osteopathy, both of whom diagnose illness, treat patients with prescription medicines, and perform operations, but not until they have undergone much more training after medical school.

(By the way, other health care professionals use the term doctor, such as DC—Doctor of Chiropractic, or OD—Doctor of Optometry, and there are now practitioners in Holistic Care, Naturopathic medicine, or Traditional Chinese Medicine who sometimes use the term Doctor. None of these providers has the training or credentials to perform surgery, whether in a hospital or a private clinic.)

After graduation from medical school, most MDs and DOs complete an internship year, after which each new doctor (regardless of specialty chosen) must pass a test given by the National Board of Medical Examiners. If the doctor passes, he or she is now certified by the National Board of Medical Examiners and is eligible to practice in the United States as a physician.

However, in today’s world, there are very few “general practitioners” who provide medical care without additional residency training in one of 24 core areas. Most doctors apply for, and if accepted, complete a residency training program of 2 or more additional years after internship, in their choice of medical specialty: Internal Medicine, Family Practice, Surgery, Psychiatry, Pediatrics, or Radiology, to name a few. Additional sub-specialty training (often called a Fellowship) may be necessary to become Board-certified in Neurosurgery, Thoracic Surgery, or Plastic Surgery. There are 24 physician specialties that make up the American Board of Medical Specialties (ABMS), including all of those listed above. A total of 10 surgical specialties or sub-specialties, and 14 medical specialties or sub-specialties, make up these 24 areas of training and expertise within the ABMS.

ABMS Member Boards (24)

(You may note there is NO “American Board of Cosmetic Surgery” within the 24 ABMS Medical Specialty Member Boards.)

Each of these 24 ABMS-member Boards set their individual standards for quality practice in that specialty, and each sets membership criteria (proper and complete residency training, licensure, and rigorous oral and written examinations). Since specialties differ so widely, the criteria that make up these tests are quite different. What makes one doctor a good family practitioner does not necessarily make him or her a competent neurosurgeon. Similarly, just being Board-certified in one specialty does not guarantee training, competence, or expertise in cosmetic surgery. Board certification does indeed indicate expertise and a set of standards that have been met—but in WHAT SPECIALTY is the physician certified? So the question that should be asked is not “Are you Board-certified?” but 3 separate and distinctly joined questions: “Are you Board-certified?”  “By what specialty Board?” and “Is that an ABMS member Board?” The last of these 3 questions is rarely asked, but  will prove to be the most important one, as you will read below.

It may surprise you that every doctor’s state license reads the same: they all allow the doctor to practice “Medicine and Surgery.” State medical licenses do NOT regulate residency training. The individual doctor’s practice in a chosen specialty is based on residency and fellowship training, meeting the criteria for Board certification in that specific specialty, and then (if they practice in a hospital or clinic) credentials committees and peer review that permit practice in that specialty. Practice in each specialty includes detailed lists of permitted procedures; for instance, a MD who is fully trained and Board Certified in Internal Medicine is not allowed to perform surgical procedures, and would be severely disciplined and perhaps dismissed from the hospital staff if he or she did so. From a state license point of view, however, it is legal for any physician to perform any procedure or prescribe any medication (though it may well be unethical or improper to do so outside one’s training or expertise).

It may also surprise you that Cosmetic Surgery is NOT one of the 24 ABMS Boards. The American Board of Plastic Surgery is recognized by the American Board of Medical Specialties (ABMS), which has approved medical specialty boards since 1934. There is no ABMS recognized certifying board with “cosmetic surgery” in its name. Doctors of various specialties perform cosmetic operations. For instance, an ABMS-Board-certified Ophthalmologist may appropriately perform cosmetic eyelid surgery, particularly if they have taken additional fellowship training in Oculoplastic Surgery. An ABMS-Board-certified (General) Surgeon may appropriately perform tumor or skin cancer removal, but does not have the specific training to perform more complex reconstructive surgery. An ABMS-Board-certified Otolaryngologist (ENT doctor) might appropriately perform cosmetic rhinoplasty or facial surgery, but has not received the complete and appropriate training to perform breast implants, liposuction, or abdominal surgery.

Dermatology training after medical school may include a first year of transitional (flexible) program, Internal Medicine, Pediatrics, OB/GYN, Surgery, Emergency Medicine or Family Medicine, followed by 3 years of Dermatology residency. This shows that Dermatologists’ true surgical experience is correspondingly variable and usually quite limited. Many Dermatology programs now include “Dermatologic Surgery” in their training descriptions and certificates, but the actual amount of true surgical training that Dermatologists receive is extremely variable, usually quite minimal, and almost always from other Dermatologists, not surgery or plastic surgery professors. Also, learning mole removal or treatment of skin cancer is a minuscule slice of complete surgical or plastic surgical training. That being said, some ABMS-Board-certified Dermatologists may receive some training in cosmetic surgical procedures (often in weekend courses or at yearly meetings) and may perform a few select procedures reasonably well. But they have not completed a surgical residency or fellowship in ANY surgical discipline, or else they would be eligible for board certification by the ABMS Board that regulates the specific surgical specialty.

Thus, Dermatologists (certified by the American Board of Dermatology) can state they are “board-certified” (in Dermatology, an ABMS member Board) and they can self-designate (and legally practice) as a “cosmetic surgeon,” but not with the same credential committee oversight and peer review of American Board of Plastic Surgery-certified plastic surgeons. And usually in their own offices, since they cannot obtain plastic surgery credentials at most hospitals. That is why such plastic surgeon “wanna-bees” created their own (non-ABMS) “American Board of Cosmetic Surgery” and granted themselves “Board-certification in Cosmetic Surgery!” This “board” also admits Gynecologists, General Surgeons, ENT doctors, and physicians of other ABMS specialties for “Board-certification in Cosmetic Surgery.” The American Board of Cosmetic Surgery is NOT an ABMS member Board!

Plainly-stated, it is a group of physicians of various specialty training who wish to claim “Board-certification” in cosmetic surgery, since they do not wish to advertise the fact that they do NOT have complete plastic surgical training, have trained in other areas of medicine, but still want to be thought of as “specialists in cosmetic surgery.” Misleading? Yes, and unfortunately, intentionally so.

ENT doctors may become Board-certified by the American Board of Otolaryngology, and may subspecialize by completing additional training in Neurotology, Pediatric Otolaryngology, Sleep Medicine, or Plastic Surgery Within the Head and Neck. The latter training is less than half of the full Plastic Surgery subspecialty training program or 2-3 years, but does allow these ENT physicians to receive certification of Plastic Surgery Within the Head and Neck. They often designate themselves as Facial Plastic Surgeons, but there are those less ethical among these doctors who omit the “Facial” in their descriptor, especially at dinner parties where their claim of being a “Plastic Surgeon” sometimes leads them to consider taking on breast augmentation, liposuction, or tummy tuck procedures (although they have no training or experience in these procedures). ENT is a recognized pathway to plastic surgical fellowship training, but this takes 2-3 additional years after ENT training. However, these physicians then become fully-trained plastic surgeons and are eligible for certification by the American Board of Plastic Surgery. The 1-2 years of additional plastic surgical sub-specialty training is a huge differentiation between “Facial plastic surgeons” and fully-trained “Plastic Surgeons.”

Most “real” plastic surgeons are proud of their training and are eager to present their residency and fellowship credentials and certificates that show exactly which ABMS Board they are members of, and where and how long they studied plastic surgery, which includes reconstructive and cosmetic surgery of the entire body, and requires a minimum of 6 years of full-time surgical training after medical school. Some plastic surgeons complete even more years of specialized training, in addition to ongoing requirements for continuing education in order to maintain active certification. Certification by the American Board of Plastic Surgery (ABPS) requires 6-10 years of post-medical school residency and fellowship, submission of personal surgical case lists, written examination, and oral examination–stringent requirements that Dermatologists, for example, cannot meet, and prevent them from ABPS certification.

(That’s why non-plastic surgeons–doctors whose real training is in other areas–decided to create their own (non-ABMS) “board” of cosmetic surgery. Most patients have the common sense and knowledge to NOT receive cosmetic surgery from a Dermatologist or OB/Gyn doctor, however well-trained in their specialties of treating skin diseases or delivering babies. But “board-certification in cosmetic surgery”–sounds better, doesn’t it? And it’s quicker–complete training takes a plastic surgeon 6-10 years after medical school, but that “American Board of Cosmetic Surgery” certificate sure looks official, and shaves a few years off the process of putting one’s self out to the unwitting public as a “cosmetic surgeon,” regardless of actual training. Obtain a 90210 Zip code for your office location and you’re all set!)

The reason the American Board of Medical Specialties does NOT include a Board of Cosmetic Surgery is because there is already one member Board that certified surgical specialists in plastic and reconstructive surgery (which INCLUDES cosmetic surgery of all areas of the body)–the American Board of Plastic Surgery.

The concern, of course, is when plastic surgery “wanna-bees” imply or suggest (sometimes quite blatantly) that they have more training or expertise than they actually possess. This is not about “turf” or “restraint of trade,” it is about ethics, honesty, and ultimately, the exact training and experience the doctor truly has. Board Certification is one way of selecting that degree of (proven by testing) training and expertise. So, look carefully in which Board your doctor claims certification!

The American Board of Plastic Surgery is the only ABMS-member board that certifies plastic surgeons in reconstructive and cosmetic surgery of the entire body. Although the non-ABMS American Board of Cosmetic Surgery certifies doctors of various specialties which include little or no training in plastic surgical procedures, “certification” requirements are considerably less than those attained by “real” ABMS-Board-certified Plastic Surgeons.

Ultimately, the prospective patient needs to know that Board-certification is important, but also needs to know whether or not the certification is ABMS-recognized or otherwise, and most importantly, in which specialty the Board certification is earned. Any surgeon who calls him or herself a plastic surgeon or “cosmetic surgeon” should be certified by the American Board of Plastic Surgery, not some “bogus” board or Board in a specialty that has little or nothing to do with plastic surgery. Board-certification is a great starting point—take the time to learn just how your cosmetic surgeon gained his or her training and experience. American Board of Plastic Surgery-certified plastic surgeons are happy to share what required so much time and dedication to learn!

Both Dr. Richard Tholen and Dr. Douglas Gervais completed full 5-year residencies in General Surgery, and both received certification by the American Board of Surgery (an ABMS member Board). They both then completed an additional two-year fellowship in Plastic and Reconstructive Surgery, and both have active certification by the American Board of Plastic Surgery (also an ABMS member Board, and the ONLY one that certifies surgeons who perform cosmetic and reconstructive surgery of the entire body). We proudly display each of our plastic surgeons’ diplomas and certificates in our office—each patient will walk past all of them on the way to our consultation rooms and on-site nationally-accredited (AAAASF) surgical facility. Please contact us for a no-obligation consultation with our ABPS-certified plastic surgeons.

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