Scope of Training vs Scope of Practice
NEW YORK, NY (May 20, 2004) – The growing demand for cosmetic procedures, as well as the attraction of self-pay elective surgery in an era of managed care, has encouraged physicians from various specialty-training backgrounds to assume the mantle of “cosmetic surgeon.” Accredited hospitals require surgeons to be certified by the American Board of Plastic Surgery for the performance of many types of cosmetic procedures; however, any state-licensed medical doctor (MD), even without formal surgical training or certification, can legally perform the same types of procedures in an unaccredited surgicenter or office-based surgical facility. Recent legislation in more than a dozen states permitting dentists to perform cosmetic surgical procedures has created an even more confusing and alarming situation for patients. The American Society for Aesthetic Plastic Surgery (ASAPS), the leading professional organization dedicated to cosmetic plastic surgery education, is committed to informing the public about the specialized training of board-certified plastic surgeons and how this training differentiates plastic surgeons from others, both physicians and non-physicians , who perform cosmetic procedures.
“The issue of untrained or inadequately trained practitioners, some of whom are not medical doctors, performing cosmetic plastic surgery is an extremely serious patient safety concern,” says Los Angeles plastic surgeon and ASAPS President Peter B. Fodor, MD. “ For ultimate patient safety it is essential that our legislators and the general public be better educated about what constitutes appropriate training to perform operations such as facelifts, rhinoplasty and cosmetic eyelid surgery, as well as plastic surgery of the breasts and body, including liposuction.”
ASAPS has an ongoing program to inform the public about the training and certification of plastic surgeons. However, the complexity of the credentialing process and the confusing array of certifying boards, many of which are created independently and not recognized by the medical establishment, can be difficult to understand -- even for the educated consumer.
Patients should familiarize themselves with the education, training, board-certification and experience of any medical professional who will be performing their procedure. At a minimum, patients should confirm that the doctor has surgical privileges to perform the same procedure in an accredited hospital -- even if the doctor operates in an outpatient or office-based facility.
Scope of Training: Plastic Surgeons and Oral Surgeons
Aggressive lobbying by dental practitioners in a number of key states has recently led to legislative recognition of an increased scope of practice for dentists and oral surgeons. “This is particularly unexpected in light of the current nationwide focus on patient safety,” says Dr. Fodor. “The training of the individual performing a surgical procedure is a critical factor in the overall safety of the surgery.”
Plastic surgeons, after completing college, spend four years in medical school and a minimum of five additional years in surgical training. The demanding residency program that all plastic surgeons must complete before they can be considered for certification by the American Board of Plastic Surgery (ABPS) ensures that they not only acquire general surgical knowledge and experience but, additionally, that they master the principles and practice of plastic surgery. Plastic surgical training includes advanced knowledge of specific cosmetic plastic surgery techniques.
Among dental practitioners, oral surgeons are the most highly trained. Oral surgeons, following college, undertake a four-year course of dental study limited to oral health, followed by another four-years of study in dental surgery. This training does not lead to a medical degree; it is considered advanced training in dentistry. It is ASAPS' position that dentists and oral surgeons, who are not medical doctors, should perform procedures limited to treating or correcting dental conditions. Any diagnosis or treatment of a condition of the skin, eyelids, eyes or ears is clearly beyond the scope of dental practice. On the other hand, treatment of fractures involving the jaws, which can result in bite abnormalities, falls within the scope of training of an oral surgeon.
“Oral surgeons have trauma experience and are qualified to treat jaw-related injuries,” says Dr. Fodor. “Plastic surgeons have the medical and surgical training to remold, reshape, and remodel the body, head to toe. In many ways, plastic surgeons are more than well-trained doctors and surgeons -- they also are artists of the human body.”
As part of its continuing patient safety initiative, ASAPS urges:
- Adoption of enforceable standards for physician education and training to perform cosmetic surgery, based on American Board of Medical Specialties board certification in a specialty appropriate to the specific procedures being performed -- for example, certification by the American Board of Plastic Surgery indicates a surgeon's training in reconstructive and cosmetic plastic surgery of the face and the entire body;
- Prohibition of the performance by dentists of cosmetic procedures that are clearly medical in nature and not within the scope of dental practice;
- Prohibition of advertising that represents a threat to patient safety by misrepresenting a practitioner's training and credentials.<
The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world’s leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; active members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and non-surgical aesthetic procedures. International active members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.
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