Dr. Wells: First, board certification is a voluntary activity. There’s no mandate that anybody become board certified. But it has become a gold standard when looking for credentials of physicians. For the public, it assures them that doctors have a certain amount of training in their specialty and have been tested by examination in their field of training. For doctors, it helps keep our skills up to date.
Medscape: Who provides the certification for plastic surgery?
Dr. Wells: I’m talking about the ABPS, and its certification program as overseen by the American Board of Medical Specialties (ABMS). The ABMS was originally developed through the Council on Medical Education of the American Medical Association and has 24 member boards.
Medscape: Aren’t there other agencies that offer certification?
Dr. Wells: It’s confusing because the term ‘board certified’ is used by many self-designated boards. There are organizations out there that offer certificates in various areas of medicine, and they create their own certifying agency that does not report to any central organization. When talking about board certification, people need to find out if it’s a legitimate board, and if it has a testing process that is recognized and acknowledged as a valid method for determining qualifications. There are over a hundred self-created boards that are not part of ABMS but provide some type of certification.
Medscape: What about the American Board of Cosmetic Surgery (ABCS)?
Dr. Wells: That is a self-designated board. It’s an organization whose members come from different training programs such as obstetrics and gynecology, dermatology, general surgery, and other areas of medicine, but who indicate an interest in cosmetic surgery. The ABCS created their own certification process, but are not members of ABMS.
Medscape: What’s the advantage of certification overseen by the ABMS?
Dr. Wells: The ABMS is recognized for its training and its educational process. It has a 75-year history and works with the Accreditation Council for Graduate Medical Education — which is the accreditation body for approval of residency training programs for the 24 recognized medical specialties. The Residency Review Committee reviews each training program and accredits each program. They can also disapprove a program for deficits in their training.
Medscape: Is it tough to get certification from the ABPS?
Dr. Wells: There are prerequisite training requirements to satisfy the ABPS testing process, such as completing a general surgery residency training program. Doctors need to have completed 3 years of general surgery or be certified by the American Board of Surgery to qualify for a 3-year plastic surgery training program. There are different venues, such as otolaryngology, to get into a plastic surgery training program. Once residents are finished with training they may sit for the written exam; if they pass that, they may sit for the oral exam. Certification is awarded upon successful completion of both the written and oral examinations.
Medscape: Can doctors also be certified to perform certain plastic surgery procedures through other specialties?
Dr. Wells: Yes. Some physicians do plastic surgery procedures coming out of other specialties that have a certain amount of overlap with plastic surgery training. For instance, ophthalmology has its own credentialing through the American Board of Ophthalmology.
Medscape: Are there issues related to the variety of people doing these procedures?
Dr. Wells: It comes down to, “Do I have the appropriate training, skills, and experience to do what the patient is seeking that I do?” Patients, on the other hand, need to spend time verifying that their doctor has that kind of training. The ABPS has a list of questions on their Website that patients should ask doctors when considering plastic surgery.
Medscape: What sorts of skills or knowledge does the ABPS-certified plastic surgeon have that others don’t?
Dr. Wells: ABPS training and testing covers the entire spectrum of plastic and reconstructive surgery of the entire body. A big part of the certification process is Maintenance of Certification, which means doctors stay up-to-date with changes in their particular specialty. Changes occur in medicine rapidly — new technologies, new approaches to treatment, new surgical techniques. It’s an evolutionary process, and tough to keep up with. If you maintain board certification, you’re more on top of things. If we’re really interested in the patients that we say we’re there to take care of, then it behooves us to be committed to lifelong learning.
Medscape: Are there data showing differences in outcomes between procedures performed by ABPS-certified people and ones who aren’t?
Dr. Wells: There is no reliable database that reports outcomes. The problem is each organization collects its own statistics. For instance, the ASPS and the American Society for Aesthetic Plastic Surgery both have databases showing the numbers of procedures done by their members. The ASPS statistics also overlap with procedures done in dermatology and otolaryngology. Plus, doctors can be members of more than 1 society, and may provide data to more than 1 group. Comparing statistics is difficult.
Medscape: Accredited facilities seem to go hand-in-hand with certification. What are the key issues there?
Dr. Wells: Facility accreditation is a voluntary process — except for ABPS members who are required to work in an accredited facility. In nonaccredited places, there are some safety issues. Are the people there appropriately trained? Are you using anesthesiologists who are appropriately trained and credentialed?
Accreditation of facilities may be done through the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), which covers all ambulatory surgical facilities. Individual States also have accrediting bodies, for instance, there are four main accrediting organizations in California alone, including AAAASF and MediCare. The AAAASF has safety data that represents thousands of patients specifically from their facilities.
Medscape: Are there data showing problems with places that are not accredited?
Dr. Wells: I don’t know. The nonaccredited facilities are often not even listed, and there’s nobody following them per se. It’s an area for study.
Medscape: Nobody seems to really know what the risks are for patients going to nonaccredited facilities, nor of going to noncertified doctors practicing plastic surgery. Isn’t this of concern?
Dr. Wells: Yes, but a state agency has to be willing to try to accumulate that data. The logical party would be a medical board of a particular state. One would think that as a state organization, it would be in their interest to protect their citizens. Another possibility would be a national medical organization. The difficulty is how that information can be presented so it’s not perceived as defamatory against the individuals who may be cited. There are potential litigation issues.
Medscape: Do you have any key messages for doctors in general about these topics?
Dr. Wells: With physicians it’s often a push-back about another examination, more training, another testing modality. The process of certification and its maintenance is so patients know we are who we say we are. For doctors, it assures we have the training to take care of people and do things right. It’s about doing the right thing for patients for the right reasons. It lets us sharpen our skills, and gives us incentive to learn new processes. It behooves us to stay up-to-date and informed, and to make sure the public understands that we’re informed as well. The certification boards are, in reality, consumer protection organizations.
Source: Medscape
Author: James Wells, MD