I have been following the travails of a former dentist who in recent years received some training in cosmetic surgery procedures and, soon after completing a minimum of instruction from one or two well-qualified physicians offering classes in his local metro area, advertised new services at his practice: fillers and injectables (such as Restylane and Botox) and some variation on the "lunchtime facelift."
A few weeks ago, that practitioner was about to have his medical license revoked due to a pattern of complaints from ex-patients. The offenses were extreme and significant. One had a seizure on the operating table—a table that was, by the way, in an office-based surgical cubbyhole that was not the least bit certified. Disgruntled or injured patients also went to other physicians to repair overabundant scarring and botched cosmetic surgery. Fifteen patients reportedly sued the physician in question as well.
This is one case that you can point to and say, "That is way over the top. He got what he deserved. The system works."
What system is that? Is it the one that allowed this physician to adopt cosmetic surgical procedures, basically unchecked? Is it a system that treats those who are poorly trained in cosmetic procedures in the same manner the cops treat a criminal? The police know that the criminal is out there. They know his name. However, they can’t act against him until he does something destructive or hurtful to others, which breaks the law. In the case of this unfortunate dentist-turned-cosmetic surgeon, legally it may have been very difficult to stop him from hurting others because our society’s rules and regulations do not usually allow for acting against bad guys in a preventive fashion.
This is where you come in. Many insurance- and government payment-based medical disciplines—from general practices to most surgical practices—are becoming increasingly difficult stages on which the physician can operate. The obstacles are growing: an excessive paperwork load, the climate of government over-regulation, the arrogance of insurance companies that will not cover patients, and federal and state agencies that are so broke they find every excuse in the book to not pay you what was promised for services rendered. On this stage, the mostly cash-only aesthetic medicine field is attracting physicians from all disciplines.
Many are trying to get into the act via the so-called "weekend lipo" courses that arm them with just enough instruction to start with the minimum of expertise and put them into direct competition with you, the thoroughly trained and board-certified plastic surgeon.
On one hand, I am in favor of accommodating physicians coming into the aesthetic field from other specialties. If one can believe the projections for the marketplace, there will be plenty of business to go around for the foreseeable future. On the other hand, if you look closely at the process by which some of these specialists are trained when entering the field, it is no wonder the plastic and cosmetic surgery Establishment has felt threatened.
WHAT TO DO?
The answer, however, is not to circle the wagons when threatened, no matter how tempting that may be. The solution might be derived from answers to two additional questions. First, how can one regulate such a large-scale, short-order entry of so many specialists in terms of training and certification? Second, if we can assume that present attempts at regulation still allow our negligent dentist-turned-aesthetic practitioner to slip through the cracks, is the industry willing to hand over ultimate authority to the courts and the legal system because it cannot regulate itself ade- quately? Should the aesthetic field give up self-regulation in favor of letting the government take a crack at it?
The answer to the second question is, well, no we would rather not. The answer to the first question is what needs to be said in response to this editorial. I challenge you all to take more responsibility for this growing problem. Use all the tools at your disposal: talk about it at society meetings, make an issue of it with medical boards, etc.
Make no mistake: A large majority of specialists entering the field follow a sound and comprehensive plan for learning about cosmetic and plastic surgery procedures, and implement that plan with the help of mentors.
On yet another hand, though, too many are slipping through unannounced and undertrained. Let us move quickly to plug those holes before the lawyers and lawmakers step in and weigh down your practice with yet another impenetrable layer of government regulation. And that could come about if those in high places observe that we can’t take care of our own.