The Market of Plastic Surgery: Cosmetic Surgery for Sale-At What Price?

(Here is a great article that explains why every Board Certified Plastic Surgeon will not give away Breast Implants on the Radio)



Plastic and Reconstructive Surgery: Volume 107(7) June 2001 pp 1845-1847

The Market of Plastic Surgery: Cosmetic Surgery for Sale-At What Price?
Rohrich, Rod J. M.D.
Dallas, Texas
Rod J. Rohrich, M.D.
Co-editor, Plastic and Reconstructive Surgery
Department of Plastic and Reconstructive Surgery
UT Southwestern Medical Center
5323 Harry Hines Boulevard, Suite E7.210
Dallas, Texas 75390-9132
rod.rohrich@utsouthwestern.edu

Recently, I was struck by how creative the marketing of cosmetic plastic surgery has become. It is no wonder that despite living in a sophisticated environment like Dallas, patients remain confused by what it means to be board certified in plastic surgery. In this instance, an individual who claimed that he was a cosmetic surgeon (but was actually an obstetrician-gynecologist) was offering free breast-augmentation surgery in a contest hosted by a local radio station. The marketing strategy was to entice young women to expose their breasts on the radio station's Web site so that they could be judged as the person most in need of a breast augmentation. The winner of the contest was awarded the prize of a complimentary breast augmentation by a cosmetic surgeon in an office-based surgical facility.
Once this prize is awarded, this winner now becomes the patient of a physician whom she does not know. Can this be classified as a true patient-physician relationship? What if she is not a good candidate for this procedure or is not psychologically prepared? What happens if the patient finds out that the procedure is being performed in someone's office that may or may not be an accredited office-based operating facility? How will she respond when she learns that her cosmetic surgeon is not a board-certified plastic surgeon?
For members of the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS), such activity is a direct violation of these societies' ethical codes. The bylaws specifically state that any member who participates in a charity raffle, fundraiser, event, contest, or other promotion for which the prize is any procedure is in direct violation of the code of ethics and will be subject to due-process hearings. Of course, this has little meaning if one is not a board-certified plastic surgeon! More important issues, however, are patient safety and the potential for misleading a patient regarding the physician's qualifications to perform a given cosmetic procedure.
Why is this now occurring in the United States? During the year 2000, more than 2.2 million cosmetic and reconstructive plastic surgery procedures were performed by board-certified plastic surgeons. This was an increase of 175 percent from 1992 for cosmetic procedures alone. As fee-for-service medicine has been transformed to its lowest common denominator-managed health care-it has left patients struggling for proper patient care and physicians struggling for survival. Many physicians are now turning to cosmetic surgery as a way to supplement their income. Is this good for the quality of care that we deliver to a cosmetic surgery patient? I think not!
How does a board-certified plastic surgeon market ethically and stay competitive in cosmetic surgery? Every day we see billboards on our major expressways, signs on the back of transit buses, and promotional spreads in local magazines marketing our trade. For many, marketing our practices has become necessary. The question then is, how do we ensure ethical marketing? ASPS recently highlighted ethical marketing through its Plastic Surgery Education Campaign's broad-based and far-reaching programs. This public service campaign was coordinated on a national basis by ASPS, whose members all are board-certified plastic surgeons.
How will this national campaign help the individual plastic surgeon get more patients into his or her office? The era of merely having a Yellow Pages advertisement or a Web site, no matter how large, is no longer enough. It seems timely and appropriate to educate the public. As we talk to our patients, we have a perfect opportunity to educate them about plastic surgery. 1 The following points are plain and simple yet very important and cogent. They should be included in your marketing materials and reiterated to patients, especially during the initial office consultation.
* As more and more Americans have plastic surgery, the most important part is choosing the proper board-certified plastic surgeon. It has been shown 2 that most patients spend more time picking out a pair of shoes than they do selecting a plastic surgeon for cosmetic surgery.
* Practitioners must have a medical license. Today, individuals with dental degrees are performing cosmetic surgery of the face and body. I find it interesting that they rarely inform their patients of their nonphysician status or explain that their primary board certification is in dentistry.
* Having completed an approved and accredited plastic surgery residency training and becoming board certified in plastic surgery are good indications that physicians are properly credentialed. If they are board certified by the American Board of Plastic Surgery (ABPS), the patient can be assured that the physician has done the following:
* Graduated from an accredited medical school.
* Completed at least 5 years of surgical residency training, usually 3 years of general surgery and 2 years of plastic surgery.
* Practiced plastic surgery for 2 years.
* Passed comprehensive written and oral examinations covering both the cosmetic and the reconstructive areas of the specialty of plastic surgery.
* Patients should know and look for the symbol of membership in the ASPS or the ASAPS. Both ASPS and ASAPS members are certified by the ABPS, one of 24 member boards of the American Board of Medical Specialties. 3,4 The training and experience of these members uniquely qualifies them to perform cosmetic and reconstructive plastic surgery of the face and all areas of the body.
* Safety is a major issue for all patients in plastic surgery. Both of our major societies (ASPS and ASAPS) have modified their bylaws to require members to perform surgery requiring anesthesia (other than minor local anesthesia) in a facility that meets one of the following criteria:
* Accredited by a national or state-recognized accrediting agency/organization such as the American Association for Accreditation of Ambulatory Surgery Facilities, the Accreditation Association for Ambulatory Health Care, or the Joint Commission on Accreditation of Healthcare Organizations.
* Certified to participate in the Medicare program under Title XVIII.
* Licensed by the state in which the facility is located.
* If a patient is to have surgery in an office-based facility, then it behooves him or her to ask whether the surgeon has hospital privileges to perform the same procedure in an accredited hospital. This assures the patient that the surgeon is credentialed and subject to peer review.
* What defines experience? Surgeons who market themselves as having performed thousands of procedures could be including simple mole removals. There is no magical number of procedures performed or length of time in practice that defines experience. People must feel comfortable that the surgeon is well trained and up-to-date on the procedure being performed.
* Patients should interview their plastic surgeon in the same way that their surgeon interviews them. Is the surgeon being forthright in presenting options, potential risks, and possible complications to the patient? Are these issues discussed at length until the patient is satisfied that he or she has all of the information needed to make an informed decision?
What can you do as a plastic surgeon? My residents and colleagues often ask me how they can compete with other specialties in the arena of cosmetic surgery and with other plastic surgeons who have aggressive marketing campaigns. The answer is that the evolution of plastic surgery in your practice is much like your life. It is not a sprint, but a marathon! We must learn to pace our personal and professional growth. We all must look at ourselves in the mirror in the morning as we prepare to work in our chosen profession that we love. We must be honest and ethical in representing ourselves, not only to our patients but also to our profession. We have already committed a large portion of our lives in becoming board-certified plastic surgeons, and our continued learning and critical self-analysis are necessary to maintain the highest level of competency and proficiency. In the long run, how we skillfully and ethically practice the art of plastic surgery will always speak louder than any words. The key element is to work out a long-term strategy of marketing our practice internally and externally. The following are suggestions to assist in this process 5 :
* Create a focused mission statement for your practice.
* Become a patient in your own office. Make your practice user-friendly.
* Empower your office staff as your representatives. There should be no weak link in your chain of excellent patient care.
* Do not underestimate the word-of-mouth power of your patients.
* Let patients know all about your services through newsletters, brochures, and your Web site.
* Become involved locally and speak to community, hospital, and auxiliary service organizations.
* Take care of your practice champions (patients who refer patients repeatedly). Make them a part of your internal marketing strategies.
* Exceed patients' expectations and experiences with their initial consult and preoperative and postoperative care.
* High tech still means high touch. Establish a useful and helpful personal Web site with links to your local, state, regional, and national societies' (ASPS and ASAPS) Internet addresses.
* Greet your patients with a handshake, and sit down during your patient consultation.
* Survey your patients periodically about your practice.
* Develop effective communication skills to improve your ability to listen to your patients.
* Provide your patients with visual and educational materials before their initial visit.
* Manage your schedule so that you are on time. Avoid delays, and entertain patients while they wait. If you are late, notify your patients so that they can make an informed decision to wait or to reschedule.
* Use your own or your societies' brochures or newsletters to communicate your areas of expertise.
* Become a cost-effective practice in a managed-care environment.
* Pick one objective that allows you to measure and track your results.
* Work cooperatively with a motivated and talented staff. Reward them for their merit and loyalty to you, your patients, and your practice.
* Develop and maintain a positive image of your practice regionally and nationally.
* Enjoy yourself, and instill humor in your practice. Like your life, your practice is not a dress rehearsal.
So, the next time you are asked to provide a free procedure as a prize for a contest or a charity or are asked to market yourself on the Internet or a radio station to an uninformed, anonymous patient, think again! Look in that mirror and ask, Is this how I want to present myself to my patients, my colleagues, and my profession?
references
1. American Society of Plastic Surgeons. Talking Points on Credentials. Washington, D.C.: ASPS, 2001.
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2. Rohrich, R. J. The increasing popularity of cosmetic surgery procedures: A look at statistics in plastic surgery. Plast. Reconstr. Surg. 106: 1363, 2000.
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3. Rohrich, R. J. The Web and your cosmetic surgery practice. Plast. Reconstr. Surg. 107: 1253, 2001.
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4. Rohrich, R. J. So you are board-certified in plastic surgery: What it means in the new millennium. Plast. Reconstr. Surg. 105: 1473, 2000.
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5. Rohrich, R. J. The 20 commandments of marketing. In W. Erhardt, G. Borah, B. Shack, and J. Wells (Eds.), Marketing Your Cosmetic Practice Resource Guide. Arlington Heights, Ill.: ASPS, 1997.
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