TF

While Einstein may not be the best example of unorthodox scientific excellence, there are indeed many examples of such achievements to reflect upon. One example of this is Thomas Alva Edison. Mr. Edison never received any formal training and was basically self-taught (and homeschooled for his elementary education).

Nonetheless, he managed to come up with some of the most trascendental inventions of our civilization, for example:

Automatic Telegraphy
Cement
Disc Phonograph
Electric Generator
Electric Lamp
Electric Light and Power System
Electric Pen
Loud-Speaking Telephone
Motion Pictures
Ore Milling
Quadruplex Telegraph
Stock Ticker
Storage Battery
Telephone Transmitter
Tinfoil Phonograph
Vote Recorder
Wax Cylinder Phonograph

As can be seen from the history of human experience, the common denominator to excellence is not necessarily a formal education in a given field, but individual pursuit of knowledge, preparation, and excellence itself.

A formal education or lack of, is not the final determinant of quality.

Best Regards

http://edison.rutgers.edu/biogrphy.htm

Medhacker: agreed - Edison is a much better example.

Did he really invent the battery and cement, though? I thought it was Volta who invented the battery?

LH: in response to your question, if I was looking for a laser procedure for skin resurfacing for myself, I would choose neither one of your two options. There is a third option...

I would instead go to a plastic surgeon who does his own lasers, and who has a special interest in laser work, and does it a lot. To me, that would be what I want.

This is really not as rare a situation as you might think! Locally, for example, I have a colleague - who happens to be a past president of ASLMS as well - that I would seek out. If he wasn't here in town, I would travel to find one.

But that's just my 2 cents.

The only lasers that the plastic surgeons around me do are the CO2's. One group does have a Fraxel 750 in which I have had to try to fix scars caused by one of them. Otherwise all of the laser procedures are done by nurses and midlevel providers.

I do understand that some plastic surgeons have taken a significant interest in lasers but I think they are the exception not the rule. That is the reason many of the non-core physicians are doing so well because many clients want a physician to do the procedure not a nurse.

I stand corrected. Thank you.
Einstein did indeed receive training in mathematics and physics at a polytech. However, my point is that when he developed the theory of special relativity, he was not working in the capacity of a physicist at the time. Nor did he have any "advanced" training such as a Phd. He was for the most part outside mainstream science until his work became recognized.
I do appreciate Med-Hackers insight however, thank you. Edison is a much better example.
But we are getting off of the subject somewhat.
Before I started practicing ER, I did three years surgical training. I am therefore not a board certified surgeon or plastic surgeon. During my three years, I had approximately 9 months of training on the plastics service. During those 9 months, I scrubbed in on countless flaps and skin grafts. We did very few breast implants, maybe 4 or 5, and as I remember, only 1 liposuction.
I am not in any way demeaning the field of plastic surgery and I have tremendous respect for plastic surgeons. But what I do not understand is why plastic surgeon's believe they are the only ones quialified to do breast implants, and or liposuction. When in fact very little, if any, of their training is devoted to it.
Certainly, if I had a disfiguring accident, I would seek out a plastic surgeon to repair it, as that is what they have been trained for.
Those "non-core" physicians performing aesthetic medicine, can be as good or better than so called "core" physicians given adequate training. There are many ways to get trained. An academic residency program is only one way. We have, with private institutions, countless oportunities to develope the skill set necessary outside of mainstream academia. And in the end, what patient's want are results. If you don't get results, it doesn't matter how many years of surgical training you've had or what institution you graduated from. You may look good on paper, but a piece of paper on your wall isn't going to necessarily get you great results.

Botoxdoc: Well, it wouldn't surprise me that if you were a PGY 1 -3, you would be sent to assist on the more reconstructive cases, such as flaps and grafts. There's more for a junior surgical resident to learn there, in terms of the priniciples of plastic surgery. But it surprises me that you didn't see a ton of breast reduction surgery, or breast cancer reconstruction with tissue expanders, implants and flaps as part of your 9 months of experience - these operations are "bread and butter" plastic surgery, just like breast augmentation. Most of those aesthetic cases including breast augmentation would be done, either in the outpatient clinics, or in private offices....while you were at the hospital, helping with the in-patients.

Also, to be good at reconstructive surgery, you have to have a good understanding of the beautiful normal anatomy as your goal. Obviously, this knowledge is directly translatable to aesthetic plastic surgery. Reconstruction and aesthetic surgery go hand in hand.

Regarding residency: the "piece of paper on the wall" means that you've completed an accredited program, with nationally approved standards, and that you have passed a rigorous exam process. You can't say the same about the variable quality, ad hoc training that exists outside of ACGME approved programs. Completing a plastic surgery residency also means you are much further along the "learning curve" of getting good surgical results, compared to someone that hasn't done it. . That's not to say that every plastic surgery training program is perfect and can't be improved - because they certainly can be - but it's still a very good system overall, for those that can complete the rigorous and lengthy training. Why all the sour grapes about Plastic Surgery, botoxdoc? Is there something you'd like to share with the rest of us?

Regarding the desire for results : of course, that's why patients like to look at before and after photos. You can look at many of mine on my website. Can I see some of your before and afters? Then, we'll talk. After all, training in Emergency Medicine doesn't usually include any time devoted to performing liposuction or breast augmentation.

No sour grapes about plastic surgery (except when I was trying to find a plastic surgeon to do a complex repair on a accident victim in the ER at 3AM. But thats another story. )
I'm not trying to pick a fight, but I think you answered my point. With complex cases such as breast reconstruction, malformations, skin flaps etc, then absolutely all the surgical training is necessary. However, the skill set necessary to do non-invasive cosmetics is a far cry from what your talking about. Even the fundamentals of liposuction are rather simple to master.
The bottom line is that in terms of the procedures that I perform, I beleive my results are every bit as good as anyone irregardless of their level of training. Since I'm not doing cleft lip repairs, or breast reconstructions, i don't see the benefit of having done another 4 years of residency.
And, yes I would be happy to show you my before and afters, but what really matters is what my patients think. They drive my business. If I were not good, then I wouldn't have a whole lot of patients. Unlike insurance based medicine, people can choose whom they go to.
While I do some limited advertising, most of my business is patient referal based.
Yes, I am a "non-core" physician. I am very good at what I do and I have a busy practice.
You can certainly bring up the argument about patient safety, and how non-core physicians make all the mistakes. But the truth is that there is absolutely no evidence to support this except for anectodal examples.
In the past year my clinic performed over 5000 procedures, from laser hair removal, photofacials, to tumescent lipo. I performed 600 lipo cases with only three complications. Two seromas and a skin infection. The seromas resolved with syringe evacuation and the infection cleared with po antibiosis. That's a complication rate of 0.5% which is below what's written in the literature for all specialties doing lipo.
We could argue the point of who is better at aesthetics until were both blue in the face, but what is really the deciding factor is not what you think or what I think, but what patients think. They are the ones who really decide.

So then....show us the before and after photos. Let's see your results of your surgical procedures.

If they compare to the results obtained by the average ASAPS member, I'll concede your point.
Otherwise, you are just someone who likes to talk.....

TF:

With all do respect, I'm not here to fight. I am just reporting what I have observed over the past several years. I too had beleived that one needed to complete a PS residency and fellowship in order to do lipo and breast augs. What I have come to realize and observe however, is that there are many "non-core" physicians doing the same procedures and doing them very well. (If you want before and afters, I suggest you go to the American Academy of Cosmetic Surgery web-site. You will find many examples of "non-core" physicians doing excellent work.) In addition, there are those who are board certified in PS who are not good at breast augs and lipo. Having completed a PS fellowship does not de facto turn an individual into lipo superstar. There are core physicians who get excellent results (and I have refered my own pts. to them for those procedures I do not feel comfortable with), but there are also "core" physicians who get terrible results. And I have revised a few of them.
I'm sorry if you find this difficult to swallow, but, to quote a popular TV show..."the truth is out there"....

Hello everyone

I'm pleased we are having this conversation in the best spirit. TF, if you provide me an email address I can send you B&A photos of a non-core physician I work with, but since I wish to respect his privacy I'd prefer not to post them publicly.

Thanks

MH

Botoxdoc: I'm sorry if I didn't make this clear....I wanted to see pictures of YOUR work, not miscellaneous members of the Academcy of Cosmetic Surgeons.

Some members of that organization are "core trained" - i.e. derm, plastics, ENT, etc ....so using them as an example does not support your argument about non-core training.

While I agree that any training program does not magically transform the trainee into a superstar, whether it's a plastic surgery residency, a cardiovascular surgery residency, or emergency medicine specialty....as always, you are much further along the learning curve than someone who hasn't completed that training, as I mentioned earlier.

By the way, if you are doing breast augmentations, how do you defend yourself in court in case of a complication? Sounds like you are asking for trouble....

TF:

Why are you so keen on seeing pictures of my work? So that you can compare yours to mine and see who's better? I think you have the misguided impression that your opinion matters to me. Unless you are refering pts to me, I could really care less what you think of my work. I have two volumes of before and after pictures that I show propective pts. They are the one's that I care about.
I am simply making observations and reporting them here. You, on the other hand, are insinuating that I'm lying, and you do not trust what I say unless you "see it for yourself". I'm sorry, but, I'm not willing to play that game or fight.
By the way, I don't know about the residency program you went to, but in my training program, ENT's did one year of general surgery then focused on the head and neck. Yet, I know of several who are doing breast augs and lipo. Does that make them "core or "non-core"? And I would be hard pressed to accept the argument that in a Dermatology residency they get enough surgical training to do major cases. In fact with three years of gen. surg. under my belt, I'm sure I'm more comfortable in an OR then a derm who has had only a few months. Yet, I am considered a "non-core" and the Derm is considered a core physician.
What has developed is a system of exclusivity and territoriality. And like it or not, it is changing. For the better, I must admit. Pts. should have a choice to determine who they want to have them do their work. Their choice shouldn't be forced upon them by some outside governing body. After all we still live in a democracy and this is still a free market economy. And when it comes to cosmetics, its a market driven industry unlike some other specialties. If your good at it, pts will come. If your not good, pts. will not come. Its as simple as that.
And, beleive it or not, TF, there are many cosmetic surgeons who are not fellowship trained in plastic surgery who are excellent in cosmetics.
As far as the medico-legal issue goes, I'm fully insured by my med-mal carrier to do both breast augs and lipo. And if its a matter of defending myself in court (if it ever comes to that), all I am accountable for is performing the procedure at the level of a specialist in the field. Therefore, I do only cases I for which I have received training and feel comfortable performing. I know my limitations. If there is a case with which I do not feel comfortable, for example breast ptosis that requires a maxtopexy, I refer my pts to a plastic surgeon. I refer my pts to a local PS with whom I am familiar and I know does good work. My pts trust me, because they know I will look out for them and serve their best interest, not mine.
I have no problem with plastic surgery or plastic surgeons in general. I do have a problem with PS who believe they are the only ones capable of performing aesthetics, both invasive and non-invasive. And I have a problem with a PS who causes deformities in pts doing inadequately trained lipo. Please don't tell me that in a 2 or a 3 year fellowhip (with everything that needs to be learned in those 2-3 years), and only a handful of cases under their belt, an individual who has completed a PS fellowhip is more of an expert in lipo, or injectables than I am. For the past three years, I have been doing nothing but lipo, day in day out 5 days a week. (maybe a breast aug here and there). Yet, I am perceived by you and others as a "non-core" physician. And, yes, I have a problem with that.
By the way, just for your information, liposuction was invented by an OB/Gyn., Dr. Fisher, in Italy who used a D and C canula to extract fat. It was modified by Dr. Fournier and Illoiz (BTW, I wasd trained by one of his students) in Paris, Neither of whom were plastc surgeons. And tumescent lipo was developed by Dr. Klein a Dermatologist. It is truly a multi-disciplined procedure.
I think enough has been said here. I have a practice to run.
I doubt we'll ever see eye to eye on this subject, but you know what? it doesn't matter a hill of beans. And it matters even less that Real-Self.com doesn't allow "non-core" physicians on their web-site. I just don't care. My practice is busy enough as it is.
But, before I sign off, I just want to mention that when I was practicing ER, one of my colleagues was a board certified plastic surgeon. He chose to practice ER instead of a private practice because of the lifestyle it afforded him. Now, the question is, should he have been practicing ER because he was residency trained in a different specialty? According to you, no. Yet, he was (and still is) an excellent ER physician. It would be a desservice to him and his community if he was not allowed to practice ER because he was residency trained in a different field. The same goes for all us "non-core" physicians practicing aesthetics.
TF, I wish you well, and only hope that one day you will open your eyes and see the truth. And maybe, just maybe, one day, all this bickering, name calling, and childhood schoolyard bullying will come to an end and we will be able to work together as grown-up, mature, professionals. But, maybe I am asking for too much.

BotoxDoc,

You will not find a more reasonable Plastic Surgeon than TF. I know him personally and I have a great deal of respect for him. He is one of my heroes.

I am a non-core and I think I am pretty good at what I do. There are good non-cores and bad non-cores, just as there are good and bad Plastic Surgeons and Derms. I would probably be better at what I do if I had had a PS or Derm Residency. No doubt about that!

I guess we have to find a way to value the excellent non-core doctors practicing Aesthetic medicine and not dismiss them out of hand.

BotoxDoc, don't get emotional and leave the discussion! This discussion needs to happen for everyone's sake. Keep advocating for excellent non-cores, but don't forget that there are many FPs, IMs, and Gyn's who do this part time and are terrible.

We are lucky that TF is engaging and willing to discuss.

Thanks for your words of support, JEE.

Botoxdoc, the reason I wanted to see your pictures was because of your own line of argument that "it's all about the results, not the training". Therefore, let's see your results, and judge from there, otherwise don't make that claim. But I'm not really surprised that you won't show them to me.

And no, I'm sure you don't care about my opinion, or that of any other "core trained specialist". You have convinced yourself that whatever the establishment says, it just doesn't matter, because in your world, it's a conspiracy-ridden turf battle, as opposed to really being about patient safety, and doing the right thing.

I'm disappointed that you try to wrap yourself with the "free market" flag, as opposed to being a physician and "doing no harm". I think you've forgotten about the most basic of principles here.

Regarding the medico-legal issue, I think you'll get a rude wake up call one day, if a court case should ever occur for you. I'm sure you have heard the phrase "Standard of Care". In a breast augmentation case, the standard of care would be a comparison to a board-certified plastic surgeon. You aren't one, and your training does not equate to the level of training of a board certified plastic surgeon. End of story. Open up your checkbook and start writing....

I have never claimed that plastic surgeons are the only ones who can do aesthetics, which includes laser work, botox and injectables, as well as surgery. I am very supportive of non-plastic surgeons who do botox, injectables and lasers. I have only made the point that plastic surgery training is currently the best method for training surgeons who want to do total body aesthetic surgery. It may not be perfect, but it's still the standard.

There are no shortcuts in learning how to be a master surgeon. Only those, like yourself, who seem to think that there are shortcuts.

Good luck to you - and your patients....

Signing off,
TF

Yes this is a good and fruitful discussion. But, TF, I never said there are shortcuts. Certainly, I am not equiped nor do I have the skill level to do a maxtopexy for example. But, I certainly have the skil level necessary to perform the procedures I do. Lipo, a few uncomplicated breast augs, and non-surgical procedures. I don't think doing a simple subglandular implant is beyond my level of traing. I did essentially unassisted mastectomies, lumpectomies, etc all the time as a surgical resident. Yes the attending was present, but by the time I had completed my second year of residency, my attending was simply holding the retractors.
Did I somehow forget how to do a lumpectomy because I started practicing ER instead? Or are those three years of surgical training wasted because I chose to persue another career path at the time? In terms of training. If you go to the AACS web-site you will find many different courses on breast implants, lipo, etc. That is not to say that one will become an expert after having taken one of those courses, but there are opportunities to learn and mentor with cosmetic surgeons outside of the usual residency training program. Whatever anyone does repeatedly, one will get good at. If someone does a hundred or more breast implants, they will eventually get good at it, and be able to perform them at level equivalent to anyone doing them irregardles of wether they completed a PS fellowship. A Plastic Surgery fellowship, as I'm sure you are aware, entails a lot more than just lipo and subglandular implants. Yet,it is my belief that a physician can become proficient at those skills without doing a PS fellowship. That is not to say however, that he/she would be proficient at reconstructing a breast with a muscle flap s/p mastectomy. For that level of reconstruction, I absolutely agree that 7-8 , probably longer, years of training would be needed. But thats not what I'm talking about here.
Why aren't I putting up my pictures? well, first of all, I'm not sure how to do that on this website. And secondly, putting up pictures is not going to change anything.
As I said, I'm not here to convince you of anything or to prove a point. I am simply commenting and reporting what I have witnessed first hand. Wether you choose to believe what I have written is certainly your prerogative.
And I certainly agree with JEE that we need to find a way to value non-core physicians practicing aethetic medicine.
While you say, I am wrapping my self in the cloak of the "free market" flag and have forgotten the fundsamentals of being a physician "doing no harm", nothing could be further from the truth. I only take cases in which I am proficient. I would never put a pt. in harms way, nor perform a case which is not appropriate. I have refered many pts to a plastic surgeon when I felt they needed something more than I could provide them. (At the loss of significant revenue, I might add.) On the contrary, I beleive you are wrapping yourself in the cloak of "pt. safety" . It is hubris to beleive I would not have the same concerns as you about pt. safety. But because I am not a board certified PS or Derm, I must be in your mind, a sub-par physician with no regard to my pts well-being, or safety. In fact there is absolutely no hard evidence that supports the argument that having Botox, or any other cosmetic treatment performed by a non-core physician results in more complications. Instead of me showing you my before and afters, why don't you show me a paper (randomized, case controlled, or even a retrospective study) that supports the commonly held belief that non-cores are dangerous. In fact, the complication rate in my clinic is better than what has been documented in the literature. While several months ago at a local hospital, a board certified plastic surgeon performing lipo under general aneasthesia penetraed the viscera and killed his pt. For that he received a reprimand. If I did that, I would probably loose my license or worse. Now I ask you, how fair is that?
In my opinion there needs to be a fundamental change in the system which will allow the acceptance and acknowledges "non-core" physicians performing aesthetics. Until that day arrives, those that judge my work will be my pts. and their families.

You want science - OK, here's some for you.

Subglandular breast augmentation has a higher rate of capsular contracture. Proven in multiple studies.
Subglandular breast augmentation has a higher degree of interference with mammograms. Proven.
Subglandular breast augmentation has a higher rate of unsatisfactory ripples and wrinkles, especially with saline implants. Proven.

Do you offer this procedure because it's the only one you can technically perform?
Do you even offer your patients a choice of sub-pectoral or dual plane techniques?
Do you give a truly informed consent about the other options....Or do you slant it your way, so you can get the patient to book with you?

You claim you are all about patient care - and then you say it's fine to take a weekend course, and then practice unsupervised on the first 100 or so paying customers, so you can master it. Wow. That's messed up!!

You have indeed forgotten the basics, mister.

TF and Botoxdoc,

Let's take a time out.
I kind of ike the spunk of Botoxdoc.
Botoxdoc, you need to join MAPA (www.MapaSkin.com)

TF and Botoxdoc, I think you guys could be good friends.
I believe Botoxdoc when he says he is very experienced and good at what he does.
He had a 3 year surgical residency which counts for a lot when you are talking about Lipo.
I am not sure what that means when you are talking about breast stuff.

Bottomline is that most non-core docs are doing SmartLipo at the most and lasers and fillers.
Since Botoxdoc is a surgeon, he may choose to ventue into areas that I would not touch as an Internist.

TF:

Thank you for the insight into subglandular inplants. I've actually only done a few of them, with assistance. But, it just goes to show how much better off we would all be if we stopped fighting one another and instead learned from each other. Correct me if I'm wromg, but, my guess is that you would never teach anyone outside of a PS fellowhip. That is protectionism.
My practice mostly revolves around lipo and non-surgical aesthetics. But, my point is that if I were to have done 100 or more breast implants, I would certainly eventually get very good at it irregardless if i completed a PS fellowship, or even a surgery residency for that matter.
And I still hold the belief that the battle between "non-core" and "core" physicians is a territorial battle nothing more.
Here is an example of what I'm talking about:

Several years ago, while I was still staffing the ER, the ambulance brought in a moderate speed MVA (motor vehicule accident) with a severe complex lac to his forehead. It was deep, through the muscle to the periosteum. It was a busy Saturday (actually Sunday morning by that time) and the ER was swamped. My "to be seen" rack was overflowing.
I consulted the PS on call. The injury was complex with ragged edges. The pt. would have been much better served if the PS had done the closure. On the phone I was asked if the pt had insurance. He was a self pay. I was then instructed to do the closure myself and have the pt. follow-up in clinic the next day.

So here's my issue. When it comes to a "self-pay" (ie, a non-pay) MVA with a major complex forehead lac, I am perfectly qualified to perform that procedure, yet when it comes to injecting a few units of Botox for a pt. who is willing to pay $700 for that service, remove a little fat from her hip, or inject a cc of hyaloronic acid intradermally, I am now "practicing outside my scope of training". I am a "non-core" physician and a black sheep in the medical community.

If you, or anyone else reading this post, does not see the hipocracy in that, then G-d help us all.

I can bring a person in full asystole back to life, I can decompress a tension pneumothorax, I can intubate an obese asthamatic, I've even done an open thoracotomy or two (rib spreaders and all),But, G-d forgive me if I inject a half cc of Botox SQ. "I just can't do that I'm not qualified" is the call from the AAD and ASPS. Give me a break!!! What I'm not qualified to do is take away paying pts from the PS or Derm. is what they meant to say. They hide behind the cloak of "pt. safety", yet there is absolutely no evidence to support that claim, zero, zilch, nada. Anecdotal evidence only. Then they claim, that I'm not qualified to do major reconstructive surgey. I absolutely agree 100%. But I'm not doing major or even minor reconstruction. I'm doing "bread and butter" procedures that anyone with a medical degree and a passion to learn can perform.

Do I think anything will change? Well, it has somewhat over the past year or two, but I don't really think we will ever get the recognition from the medical community that we deserve until legislation is passed. And that's not going to happen until all us "non-cores" can unify into a specialty society with political influence. Until then, I'll keep my mouth shut for fear of retribution, and serve my pts as best I can.

I've said enough here, and "waisted" far to much of my prcious time. May you all find success and may your eyes begin to open. Maybe just a little.

The bottom line is that if nurses and "injectors" are routinely doing Botox and fillers in plastic surgery offices, and technicians are doing various laser and light treatments in "core" offices and medspas all over the country, then why can't I, with my 3 years of IM training and nearly 20 years experience, also learn to do these procedures? It's a turf battle and nothing more. There is no recognized standard of training for any of the non-surgical procedures we are referring to. (I'm staying out of the lipo, breast augmentation arguement.)

Back in the old days before subspecialties in Internal Medicine, the general internists would have a "special interest" and they would be the specialist at the hospital. As medicine became more complex, fellowship programs developed and now we have subspecialists who are fellowship trained. The old guys were grandfathered in or they returned to general internal medicine.

Right now in Cosmetic Medicine, the Derms and Plastics are not producing enough fellowship trained physicians to handle the demand for these services PLUS these services are not that difficult to do!

So all I hear is a bunch of whiners and complainers (TF is excluded from this group of complainers, he is ok, he makes good points). Stop whining and complaining. Do something...start more fellowshiops and outcompete the stupid non-cores! But stop whining and complaining and acting like a bunch of spoiled brats. We KNOW you have vapous arguments. We are not stupid like the legislators and others you try to fool.

The real issue is that there really isn't a specialty of "cosmetic medicine". Presently it is a multi-disciplinary speciality. Everyone one wants to claim it as their own, particularly Dermatology and PS. Their claim is that those are the only two specialties that incorporate cosmetics into their residency training. Which maybe true, but, their rsidencies are not focused on cosmetics. Its only a small part of their training. In fact, one can complete a residency (fellowship) in either of those specialties without doing ANY cosmetics. Its not a requisite to have completed a curriculum in cosmetics in order to get board certified in either plastic surgery or Dermatology. (Correct me if I'm wrong. I finished my residency many years ago. But, when I was a resident, cosmetics was not a requirement for completing the curriculum.)
When I attended a meeting of the AAD, I was sitting right next to a group of Dermatologists who were essentially learning the exact same material I was. And at a recent symposium on fillers, there were a few plastic surgeons who had never used a laser before, nor injected any fillers. So I get a little peeved when I hear that I am a "non-core" physician, yet a Dermatologist who completed his residency 15 years ago and has never once used a hyaloronic acid filler is de facto an "expert". I'm sorry I just don't buy that story. The ONLY difference between myself and a PS or Derm doing cosmetic medicine is one of perception. (With the exception, as TF pointed out above, more complex reconstructive surgery...but thats different from the nuts and bolts of a med-spa, or laser clinic.)

Allow me to give you some information from a respected source:

Here is what the ACGME expects from a plastic surgery residency...and they make the rules.

http://www.acgme.org/acWebsite/downloads/RRC_progReq/360pr703_u704.pdf

If you will take the time to read it, you will see that aesthetic (cosmetic) surgery of the face, trunk and extremeties, as well as plastic surgery of the breast, are specifically listed as part of the expected core competencies in Plastic Surgery.

We are tested in our in-service and Board exams on chemical peels and lasers and fillers, their use & application and their complications. (As a matter of fact, one of my oral board exam questions was a detailed laser question. )

These cosmetic topics are certainly part of the plastic surgery curriculum, and have been for years.

Training can't be emphasized enough. Protocols constantly change so continued training is a must.

Thank for enlightening me TF. But when I did my residency, fillers had not even been invented yet, nor had most of the lasers we routinely use. There was this big old clunky CO2 laser we used for cutting, but none of these new fangled fraxels, fractionated CO2 etc. So really, a PS who did his/her residency 15 years ago would not have anymore experience than myself in using them. S/He would have learned them, as I did, at symposia and hands on training after finishing their residency/fellowship.
Enough said. I can see this dialogue is going no where. You're protecting your "turf" as I would if I were in your shoes. It is only human nature.
BTW, I asked if you could produce a paper proving that there are more complications when "non-core" physicians practice cosmetic medicine. (which of course you can't because none exist). You gave me a "scientific" guideline on the best approach for a breast implant. Fair enough, but not what I was asking for.
TF, I think you need to realize that there are some very smart and talented physicians out there who did NOT complete a PS, or Derm residency and who are doing both cosmetic medicine AND cosmetic surgery. And are pretty damn good at it.
I wish you success in your career and life.
Good-bye.

Once again, Botoxdoc, you are trying to pick a fight with me on fillers and lasers - an area which I've repeatedly said is shared by multiple specialties and training backgrounds.

You are completely missing the point here...which is all about the appropriate qualifications for performing surgical procedures.

TF

Point taken. But, where do you draw the line when you describe a "surgical procedure". You could define it as anytime a scalpel is used, but Is doing a shave biopsy surgical procedure? Placing a central line or chest tube? I think we need a better definition of "surgical procedure" . If you read my license, it says "medicine and surgery". That is not to say I'm going to take a scalpel and remove a gallbladder, but I do have an unrestricted license and perform those procedures with which I am comfortable and competent.

@ LH, looks like you're still waiting for an answer.

We're all aware that, once you're competent, you're real skill comes through repetition and practice. Still, all things being equal, specialties can still charge more.

I enjoyed reading all the arguments for and against the non core doc. As a practicing physician (anesthesia) for over 20 years I have seen many surgeons in training. One particular memory is in the very early 1990's when a laser company came to the OR to teach ablative laser resurfacing. I was the anesthesiologist and I don't know why this patient opted for this but a virtual line of surgeons was there all the perform a few passes over her face. These consisted of plastic surgeons. I don't know how much time each actually spent but over the next 48 hours there was a sudden explosion of ablative procedures booked with the surgeons talking as if they invented the procedure ten years ago.
I remember when Botox crossed from something I used to treat spasticity to a cosmetic drug. again, everyone took a weekend class and by Monday were Botox experts.
My point is I don't think its horrible for a non derm or plastics person to perform some cosmetic procedures ( non invasive, I'm not big on "smart lipo" by non surgical doctors. What is important is proper training. I was in a university and do not recall the derm residents going to a Botox clinic nor the surgeons going to a laser course. Physicians my age had to take these weekend classes. I
What I really don't care for is the caviler attitude, when I wanted to learn laser therapy I took a four week course and became certified just as a laser esthetician would. The laser company however thought I could learn in one afternoon which I think puts everyone in danger. Its getting quality training and understanding your ability that's important.
One thing that definately has to go is spas running amok with "overseing physicians" who are never around. There lasers should be medical devices. We have in town a business man calling his practice a "dermatological" practice, he is not a doctor and supposedly has one somewhere in town, god only knows where.

How much does advertising on Real Self cost beyond the free profile? Can someone provide details and foea it help?

The premise is not correct. Realself recognizes several specialties as core cosmetic specialists including Ophthalmology and Otolaryngology. I don't understand what the problem is? If you can't get hospital privileges for the procedure, then you shouldn't be doing it. A nurse doing injections in a core specialist's office is under direct supervision, an internist isn't and shouldn't be doing it. An internist or even worse, none residency trained physicians are not trained or qualified to do these procedures and create a high risk for injury. I have personally asked internists or Ob/Gyn simple questions about different laser wavelengths and their chromophores or even layers of the skin and they could not answer. Please do mislead clients into thinking they are safe having serious cosmetic treatments at your hands if you are not core.

Ent-I am a "non core" physician who has devoted full time to esthetic medicine for the last 8 years. I have had extensive training in lasers and cosmetic procedures I do not "mislead" my patients. I only provide those services that I am fully trained and competent to provide. Please post your questions about chromophores-I bet I can answer them to your satisfaction..

ENT
It depends on where you are in your career and the character of the physician offering services out of their training. I myself am 60 years old, practicing since the early 80's and also began aesthetic practice about a decade ago. Im my situation it was less clear, I suffered a lung injury which made it quite easy for me to develop pneumonias. I had nine in all and was a board certified critical care MD. All were nosocomial and my career abruptly ended. It was horrible to say the least however I had been using Botox for spasticity since 1988 and cosmetic use was in its infancy. I worked with allergan and learned about cosmetic uses of botox. I started in small rental of 2 rooms in a larger MD office slowly adding services and learning lasers via preceptorships. I had no full time career anylonger so I could afford to do a preceptorship for a few weeks to months at a time.
I limited myself to procedures I felt capable of doing , no liposuction or surgery. One f my preceptors was a well known dermatologist and we were the same age. I told him that I felt uncomfortable learning laser resurfacing as a preceptor in that I had an academic career and strongly believed in full residency or none. He told me something I didn't think about, he said do you think I was instructed in lasers in my residency, come on we trained in the early 80's it was unheard of. Anyone over the age of 40 ( at the time) never had one day of laser training. He said we all learned this way and it put my mind at ease.

Its important not to misrepresent, I am NOT a cosmetic surgeon and I correct any patient that calls me that. I refer any surgical procedures down to biopsy to the proper specialist.

One thing in this field that makes absolutely no sense to me is handing off procedures legal or not to aestheticians. They balk non core non core then they have someone with no medical credentials and a few hundred hours of training if that handle surgical lasers without a concern in the world. That happened on that bull shit doctors show all the time. they would say make sure you have a board certified surgeon then Inga the tech would go firing away at the tissue. I guess that ne didn't count.

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