Many plastic surgeons do not receive enough experience in cosmetic surgery procedures during their residency training. This is the conclusion of recent research published by the American Society of Plastic Surgeons (ASPS)*.

In this landmark research, survey results taken from program directors and surgery residents at all 89 plastic surgery residency programs in the United States concludes that many plastic surgery residency programs offer inadequate—or, at times, nonexistent—training in cosmetic procedures.

In many programs, cosmetic surgery exposure may last only 3 to 4 months. Of the surveyed senior residents, 51% report that they are not satisfied with their cosmetic surgery training. Of that group, surprisingly large percentages of respondents were uncomfortable performing a range of cosmetic procedures.

For years, the plastic surgery societies have touted that only their members are capable of performing cosmetic surgery. In reality, a neophyte plastic surgeon may take his or her boards and not get tested in cosmetic surgery at all.

Cosmetic procedures need to become a larger part of the plastic surgery resident's training. For years, growing numbers of practitioners have been demanding the same thing.

What's the hold up? Institutions must first admit there is a big problem in this area before improved and expanded courses in certain cosmetic surgery procedures can be integrated into the plastic surgery resident's core curriculum.

Current senior residents know this and, if one believes the results of the aforementioned research, they also know they are not getting the wide range of training needed to compete in an increasingly tough marketplace.

It is worth noting the stated standards for cosmetic surgery requirements in plastic surgery residency programs. The RRC (Residency Review Committee), which is a subset of the ACGME (Accreditation Council for Graduate Medical Education), control residency standards and criteria.

These organizations claim that a plastic surgery resident is stamped trained in cosmetic surgery after he or she is involved in approximately 40 cosmetic surgery cases during residency. However, these graduates enter a highly competitive marketplace where many "real" cosmetic surgeons have hundreds—perhaps thousands—of cosmetic procedures under their belts.

The "40 procedures" requirement is intellectually dishonest. There are plastic surgeons coming out of their residency who may have never done a rhinoplasty. Half of all residency program directors advise their graduates to get postgraduate training in cosmetic surgery fellowships as soon as possible.

Here's the kicker: While these residency programs and supporting institutions offer access to individual physicians for training in cosmetic surgery procedures, there are few, if any, organized, institutionalized fellowships within the plastic surgeon community.

One starts to believe that all plastic surgery residencies should expand from 2 years to 3 years, and that they should incorporate 6 to 10 months (or more) of cosmetic surgery training into their programs.

Significantly, the RRC has mandated that all independent plastic surgery residency programs be a minimum of 3, not 2 years, in duration, effective July 1, 2011. To stay current with the market that will greet new plastic surgeons, the cirriculum should encompass more cosmetic surgery procedures and technologies.

This might be very difficult to pull off successfully without federal funding for such an expansion. Also, the establishment of such new programs would have to follow specific guidelines, and that would be very expensive. Expanding residency for cosmetic surgery in these economic times seems like a non-starter.

Yet, without enhanced and improved programs, ABPS board certification in plastic surgery simply does not equal proven competence in cosmetic surgery.

* Morrison, CM; Rotemberg, SC; Moreira-Gonzalez, A; Zins, J. A Survey of Cosmetic Surgery Training in Plastic Surgery Programs in the United States. Plastic and Reconstructive Surgery: 2008;122(5);1570-1578.