A Word about Board CertificationTrillium Plastic Surgery

May 31st, 2012

You hear lots of buzz these days about making sure your doctor is "board certified". What does that mean?

Let me start by saying that I am board certified in 2 specialties - general and plastic surgery. I'm proud of it. It took lots of hard work to get there. Now, I'm not going to bore you listing my credentials, training, papers or book chapters I've written, etc. That is all listed on other parts of this website and you can see it all there. I want to give you a little insight into the process of board certification, at least as I know and have lived it.

For both general and plastic surgery, board certification is a long and challenging road (if you don't believe me, ask my wife - she lived through it with me and should be sainted for that alone). It means residency training (for 2 residencies and a fellowship I was in training for 9 years after graduating from medical school), followed by an 8 hour written examination. That I had to do twice - once for each specialty.

Then, if you pass the written examination (which ~80-90% do in any given year), you get admitted for the second part - the oral examination. For general surgery, this is a 3 hour examination on any surgical topic the examiners choose. No notes, no books, no internet. Just you and them. Alone. In a hotel room where the exam is given.

If that doesn't sound bad enough, that's just the oral exam for general surgery. The plastic surgery oral examination requires applicants to work for a year and submit a list of operations they have done. The Board chooses 5 for the applicant to present to them and "case books" are created and submitted for review (ask any board certified plastic surgeon for their case books - they take so much work to put together and are such an integral part of the exam, they will still have them and are proud of them). If these pass muster (not all of them do), the oral exam then takes place over a 3 day span. Applicants are questioned about over a dozen unknown cases - you're shown a picture of a deformity, a cosmetic problem, etc and asked to solve or fix it - and are then questioned for an hour about their own cases. Nothing is off limits for examiners to ask about - the how's and why's of your surgery, why you wrote what you wrote in your office or hospital notes, your photography, and even billing information (the actual dollar amounts are edited out) are fair game. Again, no books, no notes, no internet. For some reason, the oral exams are in hotels, and you again sweat through three sessions alone with two examiners continually asking questions and pushing your knowledge and comfort to the limit.

The pass rate for the plastic surgery oral examination in any given year is between 60 and 80%.

The purpose of board certification is to make sure your doctor meets the academic and ethical standards of the medical profession. There are 24 recognized Boards that certify physicians in a variety of specialties.

However, there are only two boards (the American Board of Plastic Surgery and the American Board of Facial Plastic Surgery) that certify plastic surgeons. The ABPS certifies plastic surgeons to operate from head to foot, and the ABFPS is for subspecialty-trained ENT doctors to perform facial plastic surgery only.

Now, in all fairness, I know plenty of ENTs who are certified by the ENT board only (i.e.: they didn't to a subspecialty fellowship in facial plastic surgery) who do excellent nose jobs or facelifts. Like plastic surgeons, they are trained to to these procedures during their residency.

The family practitioner who does tummy tucks, the podiatrist doing breast augmentations, or the ER doctor doing Botox and fillers who call themselves "cosmetic surgeons" are the ones to research a little more. Did they do a dedicated surgical residency accredited by the ACGME, or did they take a weekend course in the procedure they are offering?

So - if you are researching a plastic or cosmetic surgeon and he (or she) is not certified by the ABPS or the ABFPS, then dig a little deeper. Chances are, they are operating outside the scope of practice of whatever specialty they are board certified in. And, from an ethical perspective, they are not being honest with you, the potential patient - lying about their own certification to get you through the front door and make a buck. My advice before seeing them is "buyer beware".

All that being said, I'm proud of my board certification - both of them.