what do you think

[jsaul]

there is an ENT woman who has started a cosmetic and facial surgery practice... she now is doing facial cosmetic surgeries and claims on her bio she is a "facial surgeon" becasue she did ent...


what do you guys think of this

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[xdajzax]

Facial plastic surgeons who have done a fellowship in facial plastic and reconstructive surgery following ENT are good surgeons in what they do. In fact, complicated rhinoseptoplasties are often referred to these guys by general PLS surgeons. Likewise, complicated eyelid and orbital cases are referred to oculoplastic surgeons. Being a general plastic surgeon DOES NOT mean that you are the end all and be all of all plastic surgery.

Do not assume that this person is not qualified.

 

[droliver]

"facial plastic surgeons" may in fact have done no formal training beyond their ENT residency at all as it is NOT a requirement to sit for the exam. The lack of standardization of training is one reason people who call themselves facial plastic surgeons do not automatically get much respect from Plastic Surgeons.

In addition many of the facial plastics fellowships have traditionally been more cosmetic apprenticeships in nature rather then comprehensive or focused head & neck Plastic Surgery training.

 

[Tristero]

i think dr oliver is right on all of his points....

at the end of the day, people will market themselves as they wish, which may or may not be ethical.

to me, its really a non-issue because that its not what brings patients to your practice, what brings them to your practice is your skill as a surgeon.

 

[Dunce]

so did the "ENT woman" do a fellowship?

If not, I agree that she might fall into the shadiness that is all too rampant in the world of cosmetics. However, if she did a FPRS fellowship, I would say that she probably has some right to advertise herself as such....but what do I know?

 

[toofache32]

Everyone's exposure to cosmetics varies, including Plastics, ENT, Derm, OMFS, Ophtho, etc. Some get a lot, some get a little. Notice I included Plastics also....even their exposure is varied from place to place. If this ENT chick has experience with cosmetics and wants to do it, then it's not our place to say she can't do it.

 

[cdql]

As long as she doesn't mess up, I don't see it being too much of a problem.

I'm sure there are plenty of other specialists out there trying to maximize their income by doing cosmetic procedures that they aren't oficially licensed in. (botox injections comes to mind for a lot of docs out there!)

 

[toofache32]

As long as she doesn't mess up, I don't see it being too much of a problem.

I'm sure there are plenty of other specialists out there trying to maximize their income by doing cosmetic procedures that they aren't oficially licensed in. (botox injections comes to mind for a lot of docs out there!)

Are you saying board-certified plastic surgeons don't have poor outcomes? Also, what governing body licenses docs in botox and other cosmetic procedure?

 

[cdql]

Are you saying board-certified plastic surgeons don't have poor outcomes? Also, what governing body licenses docs in botox and other cosmetic procedure?

I'm not really sure what governing body licences docs in botox but if FP docs can do it, and OB/GYN docs can do it, it seems like there's pretty much no requirements as to who can perform that procedure.

And I'm sure there must be plenty of board-certified plastic surgeons who screw up. Those who aren't board-certified are probably more vulnerable from a legal standpoint I'm guessing?

 

[jsaul]

the ENT woman who I am referring to did not do a fellowship... She adevertises that she is a "facial surgeon" due to her training in ENT... she also does all the routine cosmetic stuff like lasers and botox BUT she also does cosemetic facial/plastic surgeries...

 

[GilmanWolsey]

There are no certifying bodies that say who can do what, at least with a few exceptions that do not apply to surgery. The only true form of regulation at the moment is professional regulation, or a hospital not allowing you to operate at their facilities. However, I personally believe that this is a good thing. For one, people will go to you because you are a good surgeon. Just because you have PRS or cosmetic training does not make you a good surgeon. Also, the abilities of a surgeon are largely related to their interest, exposure, additional training, etc. Residency and fellowship provide a base set of skills, which are greatly enhanced over time. The more and more regulated anything becomes, the more and more costly it becomes for you to maintain a practice, and the more and more time you will spend doing administration. Every special interest group attempts to limit the ability of others to practice in "their" feild through licencing, certification, etc, etc...

The problem is that all of these measures often do not greatly impact the desired "problem", namely the desire to decrease adverse effects. We have all seen highly "qualified" surgeons with a stellar pedigree, who you would personally never allow to operate on someone you know and care about; then you know someone with little pomp and circumstance in their education who is an exceptional surgeon and you would trust implicitly to care for the ones you love.

The purpose of surgical education is to provide the skills of surgery; PRS, ortho, etc provide a altered subset of the general surgical skill set, but as people mature their skills over 20+ years of practice, they often will drift into new areas of interest, and can acheive a high degree of efficiency and success in these fields. The abilities of people leaving training are not nearly as good as they will be 10 years from that point; one could also advocate to have a period of "mentorship" beyond training where you work under the supervision of a senior partner, all in the name of safetly.

Be good at what you do and people will "Choose" to come to you. If they don't come to you, don't try and "choose" for them by moving to enact regulations and laws which are "aimed" to protect them from themselves. America is a free country, lets allow physicians the freedom to be what they want to be, and patients the freedom to choose who they want to choose to see. The cream will always rise to the top in the end.

 

[cdql]

I've heard horror stories about dentists trying to make the transition into plastic surgery and butchering patients in the process. (I'm hoping these were fictional stories and not actually true)

Anyone know if this has happened before?

And are there really no regulations to stop these kinds of practitioners?

 

[gary_ruska]

I've heard horror stories about dentists trying to make the transition into plastic surgery and butchering patients in the process. (I'm hoping these were fictional stories and not actually true)

Anyone know if this has happened before?

And are there really no regulations to stop these kinds of practitioners?

Gary "Stop the Madness" Ruska here,

GR always loves it when plastics types/medical students quote "horror stories" about dentists doing plastic surgery. It's almost as if these people believe that there is an epidemic of GENERAL DENTISTS doing cosmetic surgery in their offices...

Please, anyone, provide a specific example of a general dentist or any other dental specialist besides OMFS performing plastic surgical procedures (excluding BOTOX injections, which are routinely performed by non-surgeons across the country).

The fact is, as many people have mentioned previously on this board, many specialists perform "plastic surgery" routinely, including OMFS, all of whom are dentists, some of whom are also physicians.

Saying that "dentists" are performing plastic surgery is technically true, but it is just non-specific enough to be misinformation. It implies that general dentists are performing these procedures.

 

[toofache32]

Saying that "dentists" are performing plastic surgery is technically true, but it is just non-specific enough to be misinformation. It implies that general dentists are performing these procedures.

Here's the best example of that: http://www.safeplasticsurgery.org/

I thought it was pretty entertaining until I realized that people believe that stuff.

 

[Tristero]

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[gary_ruska]

if you guys have that problem, then stick to the dentistry forum.

dentists do great work and omfs is a great field but the only reason groups like the patient safety group exist is because there have been dentists and other fields marketing themselves as plastic surgeons, which is deceptive and does a disservice to all the people who undergo medical and plastics training.

granted i don't know enough about the issue, but don't come into the plastics forum doggin medical students and plastics guys because that is their field, and it irritates many of them when you guys act like the problem doesn't exist, when it does. you guys can claim this problem doesn't exists but their is LEGISLATION on both state and national levels by professional lobbying groups that arent qualified to practice plastic surgery

i'm sorry, i dont mean to be an dingus but i'm tired of reading these same arguments over and over. do you want to do plastic surgery? thats great, its a rewarding field. THEN DO THE TRAINING, BUST YOUR ASS, AND MATCH TO A PLASTICS RESIDENCY.

and if you OMFS guys want to do cosmetic plastics cases so badly, why not do the reconstructive cases, which are much more rewarding. **** you might get paid less, but it's not about the money, right boys?

Gary "only in it for the money" Ruska here:

You make some interesting points, but seem to be missing the point of the GR's posts. The posts were not meant to demean medical students or plastics guys, just point out the misinformation that is spread from some sources, including individuals on this board. GR will agree with you that it is illegal for anyone to advertise themselves as a "Plastic Surgeon" if they are not board certified by ABPRS, but GR knows of no OMFS who advertises themselves as a Plastic Surgeon. There are some ENTs who advertise themselves as "Facial Plastic Surgeons", but they are allowed to do this under AMA guidelines. There is a monopoly on the title "Plastic Surgeon", but no such monopoly exists, currently, on the title "Cosmetic Surgeon" or "Facial Cosmetic Surgeon", and that is how most non-PRS specialists who do cosmetics advertise themselves.

The point of the previous posts by GR and Toofache was to suggest that many people in the medical community paint with broad strokes when saying "dentists are doing plastic surgery." This is an intentionally misleading statement, as it suggests that GENERAL DENTISTS are doing cosmetic procedures. Anyone with a third grade education can come to that conclusion.

GR simply asked anyone to provide evidence of a general dentist doing cosmetic surgery, which you have not. This problem, of general dentists or any other non-OMFS dentist doing cosmetic surgery, is unsubstantiated, and neither you nor anyone else here has proved otherwise. GR is even willing to bet that, yes, there may be a general dentist or two who has tried to do a facelift and failed, but this is hardly the epidemic that certain people make it out to be. In addition, many people behave as though the OMFS guys doing these types of cases are just cowboys who wake up one day and say "hey, I've taken out wisdom teeth and put in implants, how hard can it be to do a facelift?" This is hardly the case, as the vast majority of OMFS who do these types of procedures learned them during residency or did a post-residency fellowship in cosmetic surgery.

As far as legislation goes, it is not up to you nor GR to decide who is qualified to practice cosmetic surgery. You certainly cannot claim that OMFS people are unqualified, just like GR is not qualified to claim that Plastics guys shouldn't be doing orthognathic surgery just because they didn't go to dental school. GR has been to both dental school and medical school, and neither teaches you how to be a plastic surgeon or an oral and maxillofacial surgeon. These skills are learned in residency.

In addition, ENTs, OMFS, Derms, Ophthos, General Surgeons, anyone who moves tissue surgically practices, at some level, plastic surgery. Plastic surgery is defined as "surgery to remodel, repair, or restore body parts, especially by the transfer of tissue." You seem to be equating plastic surgery with "cosmetic surgery".

There are plenty of OMFS who do reconstructive cases, and vying for a piece of the cosmetics pie is certainly not only limited to OMFS. ENTs, Ophthos, Derms, and Plastics guys are shying away from reconstructive cases...

 

[Tristero]

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[gary_ruska]

As far as legislation goes, it is up to people like me and you, because professional lobbying groups are the ones who are pushing brainless politicians. Does it make sense that lawyers and business men dictate to us how to practice medicine? Of course not, but it happens everyday.

I don't have time to look up cases for you, but I can assure you that if OMFS guys are pushing for this legislation, its happening. And the cosmetic fellowships you speak of...are they accredited?

I ask this because I know for a fact that BOARD CERTIFIED PLASTIC SURGEONS cannot match to ACCREDITED facial plastics fellowships, only ENTs can. May sound absurd to you, but its true. Why is that? It's because medical training is stringent and specialized, and your insinuation that ANY surgeon after ANY plastics fellowship is qualified to practice plastic surgery is just wrong. There's a reason we have accreditation and strict standards for medical training and various subspecialties of surgery, and it's to prevent whats going on right now by very disingenous medical professionals who don't have interest in the field, don't care about patient safety, and are out to make a quick buck.

Plastic surgeons don't take out wisdom teeth because that's not what they're trained to do-sure it's lucrative at ~$1000 a tooth, but that's not the issue. In today's medical climate there are pressures in many fields for people to take on cosmetics procedures when they are not qualified; I just pity their poor, unsuspecting patients.

All fair points, but GR will ask you these questions:

What do you say to general surgeons who do cosmetic breast surgery?
How about ophthalmologists/dermatologists who do face and neck lifts?
What about Ob Gyns who do abdominoplasties?
What about Plastic Surgeons who do orthognathic surgery?

Are these groups putting the public health at risk?

You seem to think that the ACGME is the only accrediting body that cares about patient safety, and that all others are just out to make a buck. The ACGME does not accredit OMFS residencies, the ADA does (via CODA), and GR thinks you'd be hard pressed to make the argument that the ADA has such a blatant disregard for patient safety. Both the CODA and the ACGME report to the US Dept. of Education, so both accrediting bodies answer to the same higher authority.

And, FYI, most cosmetic surgery fellowships are accredited by the American Academy of Cosmetic Surgery, which, despite what many people will say, is a body recognized by the American Board of Medical Specialties and the AMA. Many people will claim that it is not an "official" medical specialty board, like Plastics or ENT, but that could be said of all specialty boards, at one point or another.

And again, you seem to be confusing plastic surgery with cosmetic surgery. The terms are not synonymous.

Good point about plastic surgeons and wisdom teeth. However, many OMFS are trained, in ACCREDITED programs, which are overseen by an accrediting agency (CODA) that reports to the US Department of Education, and licensed by state boards to perform facial cosmetic procedures, as it falls within the scope of practice acts of those states. And, if you think that the OMFS lobby is more powerful than the combined efforts of the Plastic Surgery, ENT, Dermatology, and Ophthalmology societies, then GR has some Enron stock to sell you.

However, GR thanks you for your cordial response - it would be very easy for this to become a pissing contest.

 

[Tristero]

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[toofache32]

I think the GR writes well, takes on an impressive tone, and acts like he knows more than he actually does.

and if you OMFS guys want to do cosmetic plastics cases so badly, why not do the reconstructive cases, which are much more rewarding.

Am I the only one who sees the irony here? OMFS has historically been the major contributor to the literature on bony reconstruction (with a lot of Plastics contributions also) while Plastics has done most of the soft-tissue literature. This distinction is much more blurred over the past couple of decades. Trauma has been a relatively new addition to ENT's scope over the past 2 decades also.

It's also interesting that the Plastics people don't moan when OMFS does big trauma cases which happen at 3am on non-paying patients. It's hard to say OMFS can turn a coronal flap for a NOE repair but not do bascially the same flap for a browlift.

I'm guessing the money issue is a bigger deal for the Plastics guys because cosmetics are their main money-maker, while teeth & implants get an OMFS more dollars per hour.

 

[NufinButTheToof]

You need the specific case load that will only come with a plastics residency

I completely agree with you that at the end of the day.. it comes down to how many cases you have logged that make you competent to provide a surgical service (whatever it may be) to your patients.

But, does it only come with a plastics residency? What are these case loads you speak of?

Can you quote your logged numbers of head and neck cosmetic procedures for us?

We should be able to agree that ENT, optho, and OMS are only taking on head and neck plastic work.

So, lets see how they compare. Please do share

 

[Tristero]

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[gary_ruska]

Gary "Third Person Bandit" Ruska here,
GR has just realized that you must be a medical student - because clearly you don't live in the real world, nor do you know about the history of many things in the respective specialties mentioned...the example of OMFS doing veneers comes to mind...

Another example - did you know that, in the early/mid 1980s, many PRS surgeons were pushing for orthognathic surgery training, claiming that they were the best equipped to handle those cases. Such a push does not exist today. GR wonders if it has anything to do with the fact that orthognathic surgery used to pay big $$$$ in the 1980s, but does not today...It's probably just a coincidence.

You are right to say that OMFS doing cosmetics procedures are doing it for the cash payment that comes along with those procedures. What you neglect to point out is that they are trained to do these procedures, and, in some instances, do more of these procedures during residency than your precious plastic surgeons.

You are wrong about GR's motivations. GR is just defending OMFS, as any surgeon loyal to their specialty would, against your ignorant view of history and the specialty. Which is a real shame, because most PRS at GR's program get along very well with OMFS. GR would most definitely rather do dental implant cases than face lifts. More money, less stress, and happier patients.

Finally, GR and Toofache both have MD degrees. An MD degree does not allow you to do anything, residency does. So, as far as qualifications go, wait until you've matched and actually operated on someone before passing judgement. Get over yourself and realize that, while you should be proud of your specialty, that does not give you a license to say whatever you want about another specialty. Actually, you probably don't have a license to do anything, except maybe drive.

OMFS are getting to do cosmetic procedures, whether you like it or not. And, no matter how big your ego gets, you are not in a position to change that, and likely never will be. Even the infamous "California bill" that caused such a rukus a few years back, here and elsewhere, has passed:

http://www.medicalnewstoday.com/medicalnews.php?newsid=53335

 

[Tristero]

Ruska-

I apologize. I can't counter your points, because I am clearly out of my league. I thought you guys were medical students based on your previous posts.
I reacted and responded to what I felt was a ploy that OMFS was doing for more money-and what I feel from my subjective and limited experience represents surgical training. I defer to you all, surgeons with much more experience.

It takes a bigger person to admit his mistakes, and I hope you will accept my apology. Good luck to all of you.

 

[medhacker]

And now for the philosophical question of the day...

does apoligizing make someone a bigger person when that person does it because she/he believes it will make her/him a bigger person?...

 

[Tristero]

assumptions are the mother of all ****ups med hacker...as i learned on this thread...

i wasn't trying to say i was bigger person, it's just something i've heard in the past about admitting fault. I'M SO SORRY IF YOU THOUGHT I WAS TRYING TO BOOST MY EGO.

why don't you stop trolling and let this thread die for christ sakes.

 

[medhacker]

assumptions are the mother of all ****ups med hacker...as i learned on this thread...

i wasn't trying to say i was bigger person, it's just something i've heard in the past about admitting fault. I'M SO SORRY IF YOU THOUGHT I WAS TRYING TO BOOST MY EGO.

why don't you stop trolling and let this thread die for christ sakes.

I never thought you were trying to boost your ego, and believe me I am not trolling. I am not sure why you said what you said. I only hope my comment would make you dig/think deeper about things we often say without thinking much - I was sincerely only trying to help. Best wishes tristero!

 

[jsaul]

gary "why they hell do I refer myself in the third person" ruska::::

why is that