Cosmetic Surgeons In Training: More And Better Needed?
In our book, Secrets of a Beverly Hills Cosmetic Surgeon
, we devoted a chapter to helping readers understand the overlap between specialties that perform cosmetic surgery and also gave an insight into the training of cosmetic surgeons.
One section of chapter two, The Terrible Truth about Some Cosmetic Surgeons, is entitled, The Training Program Problem.
In that section, we discuss the reality of todays training; that most plastic surgery residents do not receive adequate training in cosmetic surgery.
Plastic Surgery v. Cosmetic Surgery
Remember that plastic surgery and cosmetic surgery are neither identical nor synonymous.
Cosmetic surgery is a branch of plastic surgery. Just as reconstructive surgery is a branch of plastic surgery.
Reconstructive surgery includes correction of defects and deformities caused by cancer, burns, and accidents. It includes correction of congenital birth defects.
Cosmetic surgery, of course, is surgery to only enhance ones given appearance.
In our book, we quoted William P. Graham, III, MD, former chairman of the American Board of Plastic Surgeons, who, in 1994, wrote:
Although aesthetic (cosmetic) surgery is absolutely integral to a basic plastic surgery education, it is the fact that the quality of esthetic training varies greatly among residencies. Training opportunities in esthetic surgery are not as accessible to the large super-specialized university center as they are to the free-standing facility, or small private hospital. How do we ensure the availability of appropriate esthetic surgical training to all plastic surgery residents? What minimum standard should be set for residents experience in esthetic surgery?
That quote appeared in the medical journal, Aesthetic Surgery Journal. It was part of an editorial entitled, Aesthetic Surgery Education: A Personal Perspective, by Stanley A. Klatsky, M.D., the editor-in-chief of the journal.
Plastic Surgeon
We believe that Dr. Grahams comments were very spot on. In fact, we are still dealing with the burden of the residency graduate, including one who is board-certified, having inadequate experience in the narrow subspecialty of cosmetic surgery, whether it is facial cosmetic surgery or body cosmetic surgery.
In the October 2011 issue of Plastic Surgery Practice, there appeared an excellent article highlighting the practice of W.Grant Stevens, MD, FACS, a highly-regarded plastic surgeon here in Southern California. Dr. Stevens raises this exact issue. Here is a quote from his article:
Stevens holds, as a priority, the open discussion of what is in store for the future plastic surgeon. He actively promotes the liability and continuation of cosmetic plastic by plastic surgeons.
It turns out that 72% of board-certified plastic surgeons make the majority of their income from doing cosmetic plastic surgery, Stevens notes. Now there is a disconnect there. If 70% of the surgeons are making more than half of their income from cosmetic surgery, why arent we teaching cosmetic surgery?
"A group of doctors congregate over a paitnet in the operating room."
Cosmetic Plastic Surgeon
The article goes on to confirm what Dr. Graham said: perhaps the best source of education for todays graduate plastic surgeons is additional training apart from the university setting.
Fellowships, which are the finishing school for surgeons, (one of which we were able to join) are extremely valuable. The fellowship is highly specialized training after a young surgeon has successfully finished an approved residency program. In a fellowship, the younger surgeon works side-by-side with a more experienced cosmetic plastic surgeon for anywhere up to a year.
In our case, we served a fellowship after receiving board certification and after a tour of duty as a major in the Medical Corps, U.S. Army.
What we found interesting was Dr. Stevens noting that none of the major residency programs in the country:
Gave emphasis to, and had fellowships in, microsurgery, hand surgery, burn surgery, craniofacial surgery, pediatric surgery all subdivisions of plastic surgery, but did not really have a significant commitment toward esthetic or cosmetic plastic surgery. The fact is, it seemed to be a stepchild, and still is a stepchild, in most plastic surgery divisions. Most people come out, they have very little experience, are self-taught, or they go to a lot of meetings. They go to ASAPS (American Society of Aesthetic Plastic Surgeons) meetings, and it takes them 5, 10, or 15 years to learn how to really do quality Aesthetic surgery.
Facial Cosmetic Surgery
The term stepchild certainly rang a bell with us because in that chapter, The Terrible Truth about Some Cosmetic Surgeons, the last section was entitled, Unfortunately, in Most Residency Programs, Cosmetic Surgery is Still a Stepchild. This is what we noted:
I am aware of several young local surgeons who, although well trained in reconstructive surgery, enter private practice with precious little facial cosmetic surgery experience, particularly in face lifts, neck lift surgery, and nasal surgery. Alas, the aspiring, but neophyte, surgeons, had to learn cosmetic surgery on the job. Uninformed, unwary patients inadvertently became teaching cases that should have been provided during the formal training period.
Graduate medical education in the US needs to get onto this matter and quickly. There are too many surgeons performing cosmetic procedures at less than the highest level because of inadequate formal training and education.
An easy way for the consumer shopping for a particular procedure is to look at the surgeons before and after plastic pictures. There should be many, as in hundreds. The wise consumer would narrow the search to before and after pictures of the procedure, like a face lift, or breast augment, desired.
Now that you know what a fellowship is, ask the surgeon you are interviewing:
- Where (or if) his took place
- With what Master surgeon
- For how long
- Concentrating on what area of the body
by: Heriberto s Cunningham
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