After moving from New York to Los Angeles in 2010 to take a job with a financial services firm, Joan, now 59, believed she needed to freshen her look. So she got a face-lift and tummy tuck from a board-certified doctor in Beverly Hills.
What she did not realize was that his certification was in otolaryngology — ear, nose and throat — not plastic surgery. The outcome was less than ideal: thick scars on her temples and a wavy abdomen.
“I had to use all my savings to get a real plastic surgeon to fix what he did to me,” said Joan, who asked that her last name be withheld to protect her privacy. “I have an M.B.A. I’m not stupid. But when the doctor has a nice clinic and all those diplomas and certifications on the wall, you think he knows what he’s doing.”
With declining insurance reimbursements, more doctors, regardless of specialty, are expanding their practices to include lucrative cosmetic procedures paid for out of pocket by patients. It’s now common to find gynecologists offering breast augmentation, ophthalmologists doing liposuction, even family practice physicians giving Botox injections.
The result, according to certified plastic surgeons, is an increasing number of dissatisfied, even disfigured, patients.
“The public needs to be protected from doctors who are not upfront about what board certifications they have,” said Dr. Malcolm Z. Roth, chief of plastic surgery at the Albany Medical Center in Albany and president of the American Society of Plastic Surgeons.
Members of the society claim there has been a surge in patients requesting revisionary surgery — operations to undo damage caused by botched procedures. “I’m seeing cases like this on a weekly basis now, when a few years ago I hardly saw any,” said Dr. Patti Flint, a plastic surgeon in Mesa, Ariz.
But many of these new alternate practitioners say that traditional plastic surgeons are simply trying to protect their lucrative trade. “For a certain group to wage a turf battle and say for financial reasons that they are the only ones who can safely perform cosmetic procedures is hypocritical and grossly untrue,” said Dr. Angelo Cuzalina, the president of the rival American Academy of Cosmetic Surgery, composed primarily of doctors who are not board-certified plastic surgeons.
About 80 percent of licensed doctors get a specialty certification by one of 24 boards approved by the American Board of Medical Specialties. This requires a minimum three-year residency in the chosen area of concentration, plus extensive oral and written exams.
There are no laws in the United States that require doctors to practice only within the specialty fields in which they were trained. Dr. Cuzalina, for example, was first board-certified as an oral and maxillofacial surgeon and then completed a yearlong fellowship at a cosmetic surgery clinic.
“With my experience, I don’t think of myself as an oral surgeon anymore,” he said.
Only Texas, California, Louisiana and Florida mandate that doctors be specific in their advertising about which specialty board certifications they have. Elsewhere they may say just that they are “board-certified.”
No one knows how many doctors are practicing outside their specialty; they don’t have to report to any oversight authority that they are doing so. And doctors performing cosmetic procedures are not required to report complications.
Still, the unregulated nature of cosmetic surgery is raising concern. Michael Freedland, a medical malpractice lawyer in Weston, Fla., said that since 2008 he had seen a steady rise in the number of patients incapacitated or even fatally injured by cosmetic surgery performed by unqualified doctors.
“Not only are the doctors not properly trained in plastic surgery, but they are also operating in facilities, like tanning salons and med spas, that are not equipped to handle a medical emergency,” he said. “The best they can do for you if things go wrong is call 911, and sometimes they don’t even do that.”
State medical authorities don’t tally deaths or injuries by the type of doctor involved. In any event, many plastic surgery patients are, like Joan, too embarrassed to file formal complaints.
“A doctor may be good and well trained in his or her specialty, but it takes more than a weekend seminar to achieve mastery in plastic surgery,” said Dr. Joel Aronowitz, a plastic surgeon in Los Angeles who is also a clinical assistant professor at the University of Southern California.
He noted that aspiring cosmetic surgeons may attend weekend continuing medical education courses, some held aboard cruise ships, in which they are taught to perform Botox and filler injections, liposuction and breast augmentation. The courses are often taught by physicians who themselves are not certified by the American Board of Plastic Surgery, he said.
Many such physicians claim certification by boards that have names similar to the American Board of Plastic Surgery but are not endorsed by the American Board of Medical Specialties. “They have lower requirements and are not as rigorous,” Dr. Aronowitz said. “There’s a reason they are not recognized boards.”
Dr. Cuzalina said that lobbying by plastic surgeons prevented groups like his from joining the medical specialties board.
Dr. John Santa, an internist and director of Consumer Reports’ Health Ratings Center, which rates hospitals and gives advice on choosing doctors, advised that prospective patients check state medical boards for any disciplinary actions, and also to see whether a doctor has full operating, privileges at a given hospital.
“Above all, I think common sense is in order,” he said. “I would be suspicious of anyone who is operating way outside his or her specialty area, and always get a second opinion.
“When there’s no insurance involved,” he added, “it’s really the Wild West and there’s no sheriff in town.”