Board Certification in Cosmetic Surgery: An Evaluation of Training Backgrounds and Scope of Practice

In the article published in the November 2020 issue of Plastic and Reconstructive Surgery,1 Ms. Long and Drs. Gabrick, Janis, Perdikis, and Drolet seek to "examine the training backgrounds and advertised scope of practice of the American Board of Cosmetic Surgery (ABCS) diplomates using a nationwide sample." However, in their discussion, the authors focus on patient safety and argue that, essentially, patient safety is at risk if the patient does not choose an American Board of Plastic Surgery (ABPS)–certified surgeon. Surely the editorial staff of a prestigious journal such as Plastic and Reconstructive Surgery understands the distinction between a scientific article and an editorial. It is concerning that this article made it through the review process: in the discussion, the authors state that patients are safer having surgery with ABPS-certified rather than ABCS-certified physicians, but their data provide no evidence of safety to support this. They cite "current literature, media reports, and legal proceedings" to make their argument, but sensational anecdotal media cases or medicolegal cases are patently unscientific. It is hoped that these comments were not designed to be inflammatory, but a layperson reading this article might fail to understand the difference between scientific data and anecdotes. With regard to the actual data, which are described in the authors' Table 2, an important methodologic flaw regarding ophthalmology is that the authors assigned the scope of training for these American Board of Medical Specialties disciplines based on residency training. However, most ophthalmologists who sit for the ABCS board are fellowship trained in ophthalmic plastic and reconstructive surgery, which is a 2-year fellowship overseen by the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), with a published curriculum approved by the Accreditation Council for Graduate Medical Education that includes aesthetic facial surgery. Because the authors cite case numbers for plastic surgery residencies, it is worth noting that the mean number of cases documented by ASOPRS fellowship graduates was 1783 for our 2020 cohort (in addition to many hundreds of cases already performed in ophthalmology residency.) Certainly, patient safety is a paramount goal for training and for certification. The mission of specialty boards is appropriately focused on patient safety. Any study that intends to compare the safety results of different specialty boards is fraught with political and economic overlays. Therefore, the bar for careful study design, impartial data analysis, and unbiased discussion based on data is, appropriately, extremely high. The authors of this study failed to demonstrate these benchmarks. As a consequence, we request that the Journal publish this letter, as well as an acknowledgment of the many deficiencies in the article by Ms. Long and Drs. Gabrick, Janis, Perdikis, and Drolet. DISCLOSURE The authors have no financial disclosures to report. Robert Goldberg, M.D.UCLA Stein Eye InstituteDavid Geffen School of MedicineUniversity of California, Los AngelesLos Angeles, California Jill Foster, M.D.Plastic Surgery OhioNationwide Children's UniversityThe Ohio State UniversityColumbus, Ohio Robert Fante, M.D.Fante Eye and Face CentreUniversity of ColoradoDenver, Colo. Mark Lucarelli, M.D.University of Wisconsin-MadisonMadison, Wis.