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"Real" Plastic Surgeons

Discussion in 'Clinical Rotations' started by medstud721, May 16, 2002.

  1. medstud721

    medstud721 Member

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    In my opinion, the only "real" plastic surgeons are fellowship trained otolaryngologists and those that train in plastic surgery. They are equally as good at plastic surgery.

    Unfortunately, other fields like derm, ophtho are performing facial plastics now as well. No offense, but derms aren't even in a surgical field. I understand ophthos doing cosmetic eyelid surgery and have no prob with it, but they shouldn't be doing face lifts like the "real" plastic surgery fields. You agree?
     
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  3. droliver

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    I strongly disagree that anyone who has not done an ABPS-accredited Plastic Surgery Fellowship should use the term Plastic Surgeon in their title including ENT's who do "facial plastics". I do not think however that we can say unilaterally say that some dermatologists, oral surgeons, ENT's, or even optho. guys should be prohibited from doing cosmetic procedures assuming they have proper training & credentials. At present this level of training is not easily available for Derm. & Optho.
     
  4. Winged Scapula

    Winged Scapula Cougariffic!
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    The ability to do procedures outside of the traditional scope of one's residency training is not uncommon, nor is it by any means restricted to non-PRS trained persons doing PRS procedures.

    I agree with RIO that the term "Plastic Surgeon" should be reserved for those who have completed an approved fellowship/residency training program in PRS (much like it is illegal in California and other states to call yourself a Psychologist without the PhD or PsyD degree). I think if someone's practice lends itself to doing procedures traditionally in the realm of another practice and that person has been adequately trained, there is no reason to restrict them from doing so. To do so would change medicine and its practice substantially and I think you will not find support for that - too many practitioners want to be able to expand their practice and repetoire and would argue that they are capable of performing some basic procedures. That said, when it comes time for me to have some aesthetic work done, I will not be visiting an FP who's done a weekend course on Liposculpting! :D
     
  5. spiderman719

    spiderman719 Member

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    From a patient's perspective, those undergoing procedures, cosmetic or otherwise, are most concerned with two things:

    1) Who is most skilled at performing the procedure

    2) Who has the most knowledge and experience with the medical and surgical management of any complications or co-morbid conditions that may accompany the procedure.

    The other things being argued here are issues of semantics and turf battles.

    An Oculo-Plastic Surgeon is an ophthalmologist who intimately understands the structure, function, and pathology of the eye and eyelid and has fellowship training in PLASTIC (or cosmetic or whatever other word you would prefer they use) surgery of the related structures of the eye. Thus, they are a highly-specialized PLASTIC SURGEON.

    A Facial Plastic and Reconstructive Surgeon is an otolaryngologist who intimately understands the structure, function, and pathology of the head and neck and who has fellowship training in PLASTIC SURGERY of the related structures of the head and neck.

    A Plastic and Reconstructive Surgeon is a surgeon who intimately understands the structure, function, and pathology of the human body and who has fellowship training in PLASTIC SURGERY of the entire body.

    They are all BOARD CERTIFIED. They are all highly qualified to perform cosmetic and reconstructive surgery. They all see a high volume of the cases they perform and are very skilled at what they do.
     
  6. droliver

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by spiderman719:
    <strong>

    The other things being argued here are issues of semantics and turf battles.
    They are all BOARD CERTIFIED. They are all highly qualified to perform cosmetic and reconstructive surgery. They all see a high volume of the cases they perform and are very skilled at what they do.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">The issues here are truth in advertising. As their other sources of revenue have dried up from traditional insured procedures, other subspecialties have tried to "tag along" and confuse patients/customers as to what a Plastic Surgeon is. None of these other specialties besides Plastic Surgery are recognized by the American board of medical specialties as anything more then CAQ status and are not "board certified" by the largest & most accepted accrediting organization. This topic has been adressed several times in different threads over the last couple of months
     
  7. spiderman719

    spiderman719 Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by droliver:
    <strong>This topic has been adressed several times in different threads over the last couple of months</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Does anyone have a link to the previous discussions?

    In a related note, a recent essay in JAMA addressed the issue of a "Dermatologic Surgery" fellowship for Derm residents. "Our concern is the type and length of training that entitles physicians to call themselves 'surgeons,'" said ACS executive director Thomas Russell, MD.

    The link is:

    <a href="http://jama.ama-assn.org/issues/v287n18/ffull/jmn0508-1.html" target="_blank">What Training Do Skin Surgeons Need?</a>

    You may need a JAMA subscription to see this--if you're having trouble following the link, let me know and I'll paste the whole article.
     
  8. droliver

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    What training do skin surgeons need? A hell of a lot more than what you can learn in one year with little background in operative techniques & post-operative care.
    At many derm programs they will finish with little more operative experience than a lot of fourth year med students get. One additional year is supposed to bring you up to speed to practice independently? I agreed with the editorial's author that some standardization is needed, but I just don't see that with the background they (dermatology residents) have that this is adequate training to do much beyond the simplist of procedure
     
  9. Fah-Q

    Fah-Q Senior Member

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    There was a similar thread no too long ago and someone posted there that most ENT residents actually get more experience in facial plastics than residents in a straight plastics fellowship. I know of one ENT program that over the course of the 4-year program receives a full year of experience to facial plastic procedures. Is this the norm? Any thoughts on the idea that more exposure in residency correlates to a greater "capability" to do the cases? If you accept that argument then you must accept that ENT's are more qualified to perform facial plastic procedures.
     
  10. arthur v

    arthur v Member

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    Good article. Am I the only one to see it as revealing the problem with the ACS's position, namely that general surgeons don't know squat about the history of cutaneous surgery or the training that goes into becoming a dermatologist nowadays? Out of curiosity, Dr. Oliver, how many basal cell and squamous cell carcinoma excisions, with grafts and flaps, do general surgery residents usually perform during training?

    AV
     
  11. droliver

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    Fah-Q: exposure to reconstructive and aesthetic techniques in the head & neck will vary GREATLY among ENT programs from almost zero (where I train) to signifigant (say Univ. of Iowa =&gt; a KILLER ENT program). Talking with my friends in ENT, aesthetics training is almost universally weak around the country & reconstructive training varies with the interest of the staff. Here in Louisville, Plastic Surgery does all the big head & neck reconstructions for our excellent MD Anderson oncology trained ENT's (this is the most common scenario in private practice as well). At other places, it may be split or done by ENT themselves (although the length of some of the head & neck resections makes most people less than enthusiastic about starting another marathon reconstruction to follow). As far as whether a graduating ENT will have done more plastic surgery-type procedures than a fellowship trained PRS...... They may have been in the room watching their upper level ENT's do them while holding retractors, but heavy operative experience doing those things is not the norm @ most programs during most of their training.

    That being said, an ENT background does bring a lot to the table for Plastic Surgery should they do a fellowship in it. We had a awesome fellow when I was an intern who had done ENT, then facial plastics, then private practice for 2 years prior to Plastc Surgery (this scenario apparently is not to uncommon as I met a number of people interviewing for fellowships who had already done ENT + facial plastics b/c they felt limited in what they could do) He was really gifted on head and neck anatomy, but struggled with some of the other areas as compared to his peers. General surgeons who do plastic surgery tend to have less experience with facial fractures & some of the anatomy of the mid-face, but bring a much more signifigant experience in vascular, breast, tissue-handling, burns, wounds/wound healing, patient care, and usually overall operative experience. Orthopedic background usually brings a lot of hand and extremity anatomy experience & fracture fixation techniques but with horrible tissue handling habits and little head/neck and no breast work. OMFS is similar to ENT without the oncology background, but with the best craniofacial experience & the best @ mandibular fx. repairs. Each pathway has its advantage/disadvantage, but I humbly submit that general surgery has probably the fewest "holes" in their training. The integreated positions are an attempt @ a compromise b/w an acceptable training & financial constraits. It seems to work @ some places, but the experience from all these other backgrounds is hard to "compress" into 3 years of bits & pieces of each of them to me. It would seem to me that a 4 + 3 model like Univ. of Chicago would be the best compromise, with most of that first 4 being a general surgeon.

    Arthur v- I have probably done @ least 150 excisions of skin cancers including basal cell, squamous cell, melanoma, etc. You can probably half as many liopmas, nevi, warts, debridements,etc.. on top of that. We have extensive experience in skin-grafting during our training (from burns, trauma, & some cancer excisions) & routinely use any number of local flaps and a few specific type of pedicled flaps from head to toe. We do not do major facial advancement-type flaps & I have not done any signifigant MOHS excision-type surgeries, the best technique for SCC excision on the head/neck.
     

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