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As the AAFPRS educational program took shape in the seventies, it seemed logical to approach other medical societies for recognition. Again Carl Patterson got to work, and in 1972 the AAFPRS was seated on the new AMA Plastic Surgery Section. In 1974, a seat was secured on the ACS Board of Governors, and in 1978 representation to the AMA House of Delegates was approved. These events, together with AMA’s inclusion in 1985 of the term “facial plastic surgery” on its physician self-designation list, substantiated the national recognition of facial plastic surgery within the otolaryngology specialty.
During the seventies and eighties, facial plastic surgery became recognized as a national medical specialty society, winning seats on the AMA Plastic Surgery Section, the American College of Surgeons Board of Directors, the AMA House of Delegates, and more. Shown at right, representing the subspecialty at in the AMA House of Delegates in the early eighties, are (from left) J. Regan Thomas and Fred J. Stucker. (Photo courtesy of AAFPRS Archives)
All of this recognition did not sway the general plastic surgeons, who continued to denigrate the facial plastic surgery training of otolaryngologists. A critical point came in 1980, when Jack Anderson wrote an article explaining how otolaryngology had evolved into a head and neck specialty. Titled “An Old Medical Specialty Puts on a New Face… and Head… and Neck,” Anderson’s article was summarized and reprinted in the Journal of the Medical Association of Georgia, jointly bylined by Anderson and William E. Silver. It incensed two general plastic surgeons, who in turn published an article titled “Things Are Never What They Seem, Skim Milk Masquerades as Cream.” Anderson sued and, when he won $1.5 million on appeal in 1988, he donated the proceeds to the Educational and Research Foundation for the AAFPRS. In accepting the gift, then AAFPRS President John R. Hilger said, “No one stands taller in the ranks of facial plastic surgery than Dr. Anderson, and his gift demonstrates the high principles he has set for facial plastic surgery.” Anderson’s gift endowed the fellowship examination administered by the ABFPRS.
(The AAFPRS Foundation, established in 1972, had attracted little monetary support until 1986 AAFPRS President John J. Conley, in response to the 1985 inaugural address of incoming AAFPRS President Robert L. Simons, sent a check for $100,000. The gift prompted Simons and Howard W. Smith, who had served as AAFPRS president in 1983, to establish the Founders Club to generate additional support. Within the year, Leslie Bernstein, who had served as AAFPRS president in 1977, contributed $250,000 for research. Smith himself gave generously, as did 1986 AAFPRS President E. Gaylon McCollough, and soon other leaders followed suit. Today the endowment sustains not only educational but also humanitarian programs, such as the international Face-to-Face program and its companion National Domestic Violence Project.)
As Anderson’s suit was winding down in court, the AAFPRS also approached the ABO, seeking that august body’s support before the ABMS for some form of ABMS subspecialty recognition in facial plastic surgery. It was important for AAFPRS members to be able to identify themselves as “board-certified facial plastic surgeons” so that the public had a few plain English words by which to recognize surgeons essential facial plastic surgery training. This need was underscored by yet another public campaign conducted by the general plastic surgeons, which encouraged patients to see only a “board-certified plastic surgeon” and misinformed the public that the ABPS was the only ABMS board that certified in plastic surgery.
What the AAFPRS proposed to the ABO in 1987 was that the ABO spell out on its certificate the five types of training required of ABO diplomates, including facial plastic and reconstructive surgery. Under pressure from the ABPS and others, the ABMS filed an injunction, preventing this simple compromise. Summarily dismissed by the ABMS in informal conversations was the option of a Certificate of Added Qualifications in facial plastic surgery. The ABO was told it need not bother to apply for this pathway to subspecialty certification because “plastic surgery” was already the domain of a primary board, which arguably occupied it completely.
As the AAFPRS explored and exhausted all traditional means of achieving subcertification, it reached the conclusion that once again, at least for a while, it should proceed independently. The mechanism for subcertification chosen by AAFPRS leaders was the ABFPRS, which had been examining only surgeons completing AAFPRS Foundation fellowships since the ABFPRS’s incorporation in 1986. In 1989, it was decided to expand the ABFPRS examination process to a full-fledged credentialing process to certify post-residency surgeons in facial plastic and reconstructive surgery. In 1991, the ABFPRS awarded its first certificates and, in 1992, became independent from the AAFPRS, moving into its own headquarters office within the AAO-HNS building.
The American Board of Facial Plastic and Reconstruction Surgery was incorporated in 1986 to provide facial plastic surgeons with a pathway for recognition of their training and expertise. Shown in photo are (from left) third ABFPRS President J. Regan Thomas and second ABFPRS President Robert L. Simons. Not shown is first ABFPRS President E. Gaylon McCollough. (Photo courtesy of ABFPRS Archives)
The obvious determination of facial plastic surgeons to achieve subspecialty recognition caused the general plastic surgeons to seek a final battlefield for their turf war. In the late eighties, they asked the Federal Trade Commission to rule that physicians must disclose their certifying board when they identify themselves as board-certified. When the FTC declined, they launched a campaign to encourage state legislatures to pass laws that would permit physicians to disclose only ABMS or equivalent board certification. In every state that passed such restrictive legislation, the ABFPRS has since been recognized as equivalent to ABMS primary boards. In effect, the campaign to illegitimize the ABFPRS only succeeded in providing the opportunity to prove its valid and legitimate existence.
With the increasing universal recognition of the ABFPRS and the heightened activities within the otolaryngology residency programs, the time has come to solidify the position of our subspecialty.
Recognition of the ABFPRS as a board equivalent to a primary board of the ABMS is in large part due to the efforts of surgeons who have worked tirelessly to develop and maintain the ABFPRS examination. Among key contributors hand-picked by Peter A. Adamson are (photo, from left): Lee D. Rowe, Shan R. Baker, Ira D. Papel, and Dean M. Toriumi. Not pictured are Donn R. Chatham and Leslie Bernstein, whose efforts as current and immediate past chairs of the ABFPRS Resource Development Committee added significantly to the examination process. (Photo courtesy of ABFPRS Archives)