Choose Carefully: Could a Non-surgeon be Performing your Cosmetic Surgery?
Cosmetic Surgery by Non-Specialists
On September 4, 2018, a google search of the “dancing dermatologist” yielded almost one million results. You may be familiar with the story – an Atlanta-based dermatologist was accused of posing a threat to public safety and suspended by the Georgia Medical Board after a number of patients surfaced claiming “disfigurement” and even “brain damage” after complications from cosmetic surgery.1 Dr. Davis-Boutte posted videos of herself dancing vigorously to music while performing these surgeries, videos which were ultimately used to support claims of negligent care.
Almost a million opinion articles about rules, regulations related to this case are posted on the internet. I was surprised to note that after clicking through a number of the top hits, not a single one I read commented on why a dermatologist was performing an abdominoplasty (colloquially known as a ‘tummy tuck’) or inserting breast implants into patients. Dr. Boutte is board-certified by the American Academy of Dermatology (more about board certification later), and many dermatologists are highly qualified to perform dermatologic surgery, such as Mohs surgery for the removal of skin cancers. Some dermatologists may biopsy skin lesions or do direct excisions of smaller masses. Many perform cosmetic skin treatments including chemical peels and employ the use of cosmetic or functional lasers.
However, cosmetic surgery – facelifts, tummy tucks, eye lifts, breast augmentation – is not a part of dermatological training. So why was she performing these surgeries – and how was it allowed?
The surprising truth is that after acquiring a medical license, you are freely licensed to practice medicine regardless of your specialty training. An OB-GYN or dentist can legally provide botox injections.2 A dermatologist can legally perform a breast augmentation. Or a general surgeon can perform a breast reduction. But that does not mean that they should be doing these operations.
Even more confusing for patients, many of these doctors will state that they are “Board Certified” by the American Board of Cosmetic Surgery (ABCS). I have seen a few of these patients after they appear in clinic to deal with a complication from a renegade surgery, and they assure me that they did their homework and found a board-certified surgeon. However, the American Board of Cosmetic Surgery is not a board that is recognized by the American Board of Medical Specialties (ABMS) – the governing board that certifies legitimate boards that patients are familiar with, those of internal medicine, dermatology, ophthalmology, plastic surgery, to name a few. In fact, all it takes to become a member of the ABCS as a physician is $750, endorsement from another member, and possession of a medical license. Authentic board certification is a rigorous process that involves testing (often both oral and written boards, depending on the specialty) to ensure clinical competency and strong knowledge base, and the board holds its certified members to the highest ethical standards of patient care, specifically in cosmetic and reconstructive plastic surgery.
I think it is telling that the main-stream media outlets did not comment on why a dermatologist was performing cosmetic surgery. Perhaps they thought that if this doctor was performing these surgeries, surely she was qualified to be doing so. The reality is that having a medical license allows doctors to legally practice medicine as they see fit – now if such a physician is sued for malpractice, he or she will likely not have a leg to stand on; however, the damage will already have been done. Hospitals help to mitigate this risk by ensuring that their surgeons are board-certified or board-eligible (this latter term generally refers to recent graduates of residency training programs who are beginning or in the process of gaining board certification) in the specialty in which they practice. To perform the surgeries Dr. Boutte was doing, a new plastic surgeon would have to have completed a six-year-long, rigorous plastic surgery residency training program – or three years of plastic surgery residency training after completing a full five-year-long general surgery residency training program. That is what it takes to create a safe, qualified plastic surgeon – not a weekend course in liposuction.
Bottom line – educate yourself, educate your family and friends, and avoid falling victim to fake advertising and ‘board certification.’ Make sure your surgeon completed a residency program in plastic surgery and has hospital privileges in the area – that is another way to double-check that your surgeon is indeed qualified to be performing your surgery. When in doubt, you can always check the American Society of Plastic Surgeons website – all plastic surgeons listed are board-certified by the American Board of Plastic Surgery, which is governed by the ABMS.3 Following these steps will help ensure patients receive safe, effective and quality surgical care when they elect to undergo cosmetic or reconstructive plastic surgery.