Posted: June 25, 2013
For a detailed checklist for your search please click here.
The demand for cosmetic procedures and plastic surgery is rapidly growing. A large industry of professionals has also grown to meet this increased demand. The practice can be very lucrative as many of the procedures are paid for in cash rather than by insurance. Because most of these procedures are not covered by insurance, patients are on their own in finding the right physician to perform the desired procedure. When trying to decide which physician should perform the procedure, patients are motivated by cost, convenience of location and how soon the procedure can be scheduled. While these are legitimate and important considerations, they should not override the importance of choosing the right physician.
In Arizona, any licensed physician may perform any procedure that he or she is competent to perform. The law does not prohibit physicians from performing procedures that were not part of their formal training. There are very good reasons for this, but it does require patients to carefully research how a particular physician received training in a particular procedure. The Arizona Medical Board requires all physicians to have the knowledge and skill to perform procedures within the community standard of care, whether the physician learned the procedure as part of the formal education or through informal education.
This leaves the patient with many options in choosing a physician to perform a procedure. Making the right choice can be challenging. To help in choosing the right physician, the Arizona Medical Board is offering this guidance document and attached checklist to assist patients in choosing the right physician to perform a particular procedure.
Getting started: Most patients begin their search for the right physician by asking friends, co-workers and family for suggestions. This may be a great way to identify potential physicians and obtain an actual account from a trusted source. However, the physician that was right for a friend or family member may not be the right physician for you. Each patient is unique. Differences in age, gender, build, weight and skin color can make a difference in choosing a physician. In addition, patients may ask their primary care physician or other healthcare providers for referrals.
Research: Once you have developed a list of potential physicians, you need to research the physicians. One of the best places to start this process is at the Arizona Medical Board’s website, www.azmd.gov. The Arizona Medical Board maintains an on-line profile of every physician it licenses. This profile will identify the status of the physician’s license, list where the physician received formal training, identifies the field of medicine in which the physician received formal training, i.e. surgery, radiology, family practice, pediatrics, etc. The physician’s profile also identifies if the physician is Board Certified in a particular specialty by a Board that is recognized by the American
Board of Medical Specialties (ABMS). If such a Board does not certify the physician, the physician may list an area of practice in which the physician focuses. The web profile also shows whether the physician has been disciplined by the Board.
Training: You should carefully consider the potential physicians’ training. There are several ways a physician can learn to perform a particular procedure. First, physicians can learn a procedure as part of the formal training during a residency or a fellowship. Second, physicians can learn a procedure informally after completing formal training from organizations that specialize in training physicians to perform particular procedures. Third, physicians can learn new procedures by being mentored or trained by other physicians. Regardless of the training method, physicians can become highly proficient and competent in performing a particular procedure.
Board Certified: If a physician is Board Certified by a Board recognized by the ABMS, this indicates that the physician has completed a residency or fellowship in a particular specialty and has passed examination at a level higher than that required for licensure. Additionally, some physician must re-qualify for Board Certification every few years to demonstrate continuing competency in the specialty. Not all Boards that certify physicians are recognized by the ABMS, and these Boards may not require the higher standards of training and examination, however, some non-recognized Boards have high standards for certification. You may need to research a non-recognized Board to determine if it is a legitimate organization.
A number of physicians licensed to practice medicine in Arizona do cosmetic procedures successfully. Some of these physicians may not be Board Certified, but they have had adequate training and possess sufficient skills to perform procedures safely. Therefore, Board Certification alone does not demonstrate whether the physician is competent to perform a particular procedure, but it is one factor to consider.
Assessing the Physician: After selecting a potential physician, it is important that you assess the physician and the physician’s staff during your first visit. When assessing the physician’s office and staff, you should look for such things as cleanliness, courtesy, privacy, etc. In general, you should feel comfortable with the practice upon walking in the door and being greeted by staff. When assessing the physician, you should consider if the physician answered all your questions and spent the time necessary to make you feel comfortable. You should ask general questions about the procedure: for instance, how many times has the physician performed the procedure, how did the physician learn to perform the procedure, will anyone other than the physician perform part of the procedure, what other similar procedures does the physician perform, does the physician have picture of the results of the same procedure on other patients.
Learning the Procedure: Once you are comfortable with the physician, you need to discuss the actual procedure. The physician should explain, in detail, what is involved with the procedure. The physician should explain the actual mechanics of the procedure, how long the procedure should take, how long recovery should take before discharge and how long recovery should take post-discharge. The physician should also explain what to expect with regard to wound recovery and how much pain to expect and how to treat the pain and other post-procedure requirements. The physician should also explain what warning signs or concerns to watch for that might need immediate attention, such as bleeding, infection or excessive pain.
Very often, the sedation used during the procedure has more associated risks than the risks associated with the procedure. Therefore, it is very important that the physician explain if sedation will be used, and if so what type of sedative agent will be used. The physician should explain what level of consciousness will be maintained. Sedation can range from complete unconsciousness to alertness with a mild sedative affect. If the physician plans on using general anesthesia, then the procedure must be performed in a facility licensed by the Arizona Department of Health Service such as an outpatient surgical center or hospital. The physician should explain who would administer and monitor the sedation and their training, skills, knowledge, qualifications and licenses. The physician must also inform you of any other persons involved in the procedure, along with their purpose, training and skills.
Informed Consent: Physicians must have your informed consent prior to performing any procedure. Physicians must not only have consent for the procedure, but they must also obtain consent for every person who will be involved in the procedure and where the procedure will be performed. In order to obtain informed consent, the physician must provide you with sufficient information for you to make an informed decision. Ensuring that you receive sufficient information requires good communication between you and the physician. While the physician knows the risks and benefits of the procedure, knows the individuals who will help perform the procedures, and knows the location where the procedure will be performed, the physician cannot know every issue that may
be of importance to you. So you must ask all questions necessary to ensure your comfort with having a particular procedure performed by a particular physician using particular staff at a particular location. You must also express any limitations or conditions you want to place on your consent.
Only after you feel completely comfortable with the procedure, the physician, the staff and the location, should you consent to proceeding with the procedure. While cosmetic procedures and some plastic surgeries may seem routine and very safe, these procedures do come with some level of risks. The skills of the physician and the physician’s staff bear directly upon the risks of a particular procedure. So, it is critically important for your health and safety that you choose the right physician to perform the procedure, even if it means paying more for the procedure at a less convenient location and at a later date.
For a detailed checklist for your search please click here.