Aesthetic turf war

A turf war between plastic surgeons and cosmetic surgeons is heating up in Chattanooga.

Recent attention to the planned opening of a cosmetic surgery center in the Southside has brought to a head long-simmering concerns over who is qualified to perform cosmetic surgery, elective procedures geared toward improving appearance.

Plastic surgeons, trained in both reconstructive and cosmetic surgery, are touting the rigorous standards of their residency training and board certification, compared with what they say is a less-intensive certification to become a cosmetic surgeon.

That certification, through the American Board of Cosmetic Surgeons, is not recognized by the American Board of Medical Specialties, the nonprofit group that oversees 24 approved medical specialty boards, including plastic surgery.

A local cosmetic surgeon defended the caliber of his training and emphasized the difference between his fellowship program and the training of doctors who venture into cosmetic procedures like tummy tucks and face-lifts after only a weekend crash course.

Dr. Carey Nease, who plans to open a cosmetic surgery center on Cowart Street next year, also said the uproar is more about business than concern for patients.

“It’s a territorial thing. You can call it a turf war. There’s obviously financial implications. Plastic and cosmetic surgery is a business as well as a medical surgical practice,” he said. Dr. Nease operates a cosmetic surgical center in Calhoun, Ga., and a satellite office in Dalton.

But plastic surgeon Dr. Christopher Chase of Associates in Plastic Surgery in Chattanooga said this conflict is more than just a battle over cosmetic surgery business in town.

“We get new plastic surgeons in town all the time. ... They’re potential competition; yet it’s friendly competition,” he said. “The main thing is, people that don’t have the training shouldn’t be doing it.”

Plastic surgeons maintain that too often, they find themselves trying to repair damage in patients who were treated by a physician who was not trained in plastic surgery.

“Every plastic surgeon in Chattanooga has their ire about this,” said local plastic surgeon Dr. Mark Brzezienski. He trains medical residents in the plastic surgery program at the University of Tennessee College of Medicine in Chattanooga. “When you get bad results from these guys, it besmirches all of our image.”

Dr. Brzezienski was one of 15 area plastic surgeons who took out a full-page ad in last Sunday’s Chattanooga Times Free Press, highlighting the “real board-certified plastic surgeons” in the region.

Move to Cosmetic Procedures

Facing declining reimbursements from health insurers, more doctors from specialties other than plastic surgery — such as dermatology and ophthalmology — have ventured into cosmetic surgery, offering eye lifts, Botox and even bigger procedures such as breast augmentations in their offices, said plastic surgeon Dr. Joel Williams in Dalton, Ga.

Typically patients pay out-of-spocket for those procedures.

“I think a lot of physicians are turning to cash-reimbursement type cosmetic procedures to make up that gap,” he said.

Peter Canalia, executive director and general counsel for the American Board of Cosmetic Surgeons, said cosmetic surgeons are well trained for those procedures.

To receive certification through the board, a candidate must first have a board certification in one of six specialties, from general surgery to dermatology, that are recognized by the American Board of Medical Specialists, Mr. Canalia said. They participate in a one-year or two-year fellowship program, perform a certain number of procedures and then take a board exam.

“What they try to say is we’re some sham board that just offers a certificate over a weekend,” Mr. Canalia said.

Board certified as an ear, nose and throat doctor, Dr. Nease completed a one-year fellowship in general cosmetic surgery through the American Board of Cosmetic Surgeons.

Dr. Brzezienski argues that a fellowship program cannot compare with the rigors of an approved plastic surgery residency program, overseen by the Resident Review Committee of the Accreditation Council for Graduate Medical Education.

All plastic surgeons have competed a three- to six-year surgical residency followed by two to three years of a plastic surgery residency. Many go on to specialize in a type of plastic surgery, like hand surgery, Dr. Brzezienski said.

“If an ENT (ear, nose and throat doctor) could stand up to the competition and take a plastic surgery residency, that’s fine with me,” Dr. Brzezienski said. “They want to arrive without taking the trip.”

Misconceptions

Plastic surgeons here stressed that misconceptions are rampant among consumers, who see “board certified” in an advertisement and assume that means their doctor took the boards in plastic surgery.

In Chattanooga, Dr. Bruce Pancake, a board certified ear, nose and throat doctor, faced charges of gross malpractice and unprofessional, dishonorable or unethical conduct brought by the Tennessee Board of Medical Examiners. The charges were dropped in 2007 after the doctor’s death but a lawsuit has been filed in Hamilton County Circuit Court filed by 10 of his former patients.

Though he claimed to be a board-certified plastic surgeon, the lawsuit states, “Dr. Pancake was not board certified by the American Board of Plastic Surgery or the American Board of Facial Plastic and Reconstructive Surgery. He did, however, pay a fee to join the American Academy of Facial and Reconstructive Surgery,” according to Chattanooga Times Free Press reports.

In 2003 Dr. Pancake performed neck liposuction and an eye lift on Linda Pickett, of Whitwell, Tenn. Now 65, Ms. Pickett said she had to seek treatment in 2005 from a plastic surgeon in Chattanooga to reattach muscles in her neck and face, which she claimed Dr. Pancake tore during the liposuction procedure.

“I’d never let anyone touch my face again that didn’t have references and wasn’t well established,” said Ms. Pickett, who is not part of the Circuit Court suit.

Too few patients pay attention to the specifics of their doctors’ training, Dr. Williams aid.

“When I see people who have consulted with others who are not board certified, it comes as a total shock to them” that their other doctor wasn’t a plastic surgeon, he said.

Cosmetic surgery proponents don’t dispute the importance of checking into a surgeon’s qualifications. Mr. Canalia acknowledged that some rogue cosmetic surgeons do try to present themselves as plastic surgeons.

“If we see one of our own advertising improperly, we discipline our own,” he said.

QUALIFICATION STANDARDS

* For a board certification in plastic surgery, which includes training in reconstructive and cosmetic surgery, a doctor must have completed a three- to six-year surgical residency program, followed by at least two years in a plastic surgery residency program approved by the American Board of Medical Specialties.

* For a board certification in cosmetic surgery through the American Board of Cosmetic Surgery, which is not recognized by the American Board of Medical Specialties, a doctor must have completed a residency in one of the following specialties: dermatology, general surgery, obstetrics and gynecology, ophthalmology with completion of an approved oculoplastic fellowship, otolaryngology or plastic and reconstructive surgery. The doctor then completes a one- or two-year fellowship in an area of cosmetic surgery, including a certain number of approved procedures. The doctor is then eligible to take the board examination.