Jack Bruner, MD, former member of the California Medical Board and a board certified plastic surgeon in Sacramento, CA, insists doctors should inform their patients whether they are board certified, and by which board, "because there is massive consumer confusion as to the qualifications of practitioners, and patients are being hurt because of it."
Some California lawmakers think he has a point and are considering legislation that would mandate the practice statewide for any physician, osteopath or podiatrist. If board certified, he or she would have to say so. If not, they might have to say that too.
In Bruner's state, any licensed physician can cut into a patient. And although hospitals usually approve which procedures their staff doctors are allowed to perform, that oversight doesn't happen in a physician's office practice or physician's clinic. And therein lies the problem, Bruner says.
Patients are being injured by the droves in his specialty area alone, he says, rattling off a number of examples of recent harm he's seen in patients from Encino to Sacramento. He knows, he says, because he and his colleagues have had to repair the damage non-board certified doctors did to these patients.
The bill under consideration is backed by Assemblywoman Mary Hayashi, chair of the Assembly Business, Professions and Economic Development Committee. Committee consultant Joanna Gin says that cosmetic surgery, including liposuction, is an area that has had a lot of recent problems.
In California, she says, "cosmetic surgery can be performed by any licensed physician, from a plastic surgeon to a pediatrician. Patients think: 'Oh, that individual is qualified. I'll be in good hands.'
"But, many physicians may not be specially trained in cosmetic procedures. We want to be sure that if you're performing a complex procedure, you inform consumers about your qualifications, especially with the proliferation of medi-spas," which are hybrids between medical clinics and day spas, Gin says.
The Medical Board of California, the agency that licenses and disciplines doctors, lists each physician's board certification. However, interim executive director Linda Whitney says that the medical board staff doesn't have time to check what each physician submits to see if it is accurate and current.
"We don't have the staff resources available to do that kind of verification. It would take a tremendous amount to do that kind of check," Whitney says.
The Hayashi bill would require physicians, podiatrists, and osteopaths "to disclose the name of the certifying board or association either on a name tag in at least 18-point type, in writing given to the patient on the patient's first office visit, or in his or her office," the bill reads.
Any certification listed as a member board with the American Board of Medical Specialties, or a board or association listed with the Accreditation Council for Graduate Medical Education's postgraduate training program, would have to be disclosed if the bill becomes law.
Legislation, such as the Hayashi bill, would at least inform patients if, for example, a doctor proposing to do surgery was not board certified in surgery, or perhaps was board certified in another field, such as radiology.
The idea would be that the patient may start to think twice about whether the doctor had the appropriate qualifications for the procedure under discussion.
Bruner says the requirement may help educate patients who don't know the difference between a physician and other practitioners who have entirely different types of training.
In a recent survey of patients, he discovered that "72% believe a podiatrist is a doctor." Similarly, patients largely believe optometrists and chiropractors are medical doctors as well, he says.
A study in this month's journal, Plastic and Reconstructive Surgery, nine surgeons from Loma Linda, CA, discovered that "a majority (94%) of those providing invasive cosmetic procedures in Southern California have some type of surgical training background, [but] it is disconcerting to see that approximately 40% of the liposuction practitioners in Southern California had no surgical training in liposuction before entering practice."
Lead author Matthew Camp, MD, summed up, "We must question the expanding scope of services that those untrained in surgery are gaining the confidence to offer. The chance of surgical misadventure is high, and the practitioner may find himself or herself in a situation from which extrication [for both physician and patient] to safety may not be possible."
Bruner and Camp say the problem of improperly trained surgeons performing cosmetic surgery is increasing because many non-surgeons—distressed by their declining payments from traditional sources, such as insurance payers or Medicare—are looking to the field to increase revenue.
"These factors are causing an understandable migration into the cosmetic marketplace," Camp wrote. They start out performing procedures that don't require surgical skill, such as injectable fillers, but then "develop the confidence to offer more than just injections and topical treatments.
"Liposuction is one of the most popular aesthetic treatments and has been the focus of much discussion regarding the very real possibility of patient morbidity or mortality when carried out in an inexpert fashion," Camp wrote. "We feel that the provision of such a potentially hazardous treatment by physicians with no training in surgery poses a genuine threat to the safety of patients."