Here to Stay
A Brief History of the American Board of Facial Plastic and Reconstructive Surgery in Celebration of its Twentieth Anniversary
T. SUSAN HILL & ROBERT L. SIMONS, M.D.
Today, specialization has become a way of life.
In the areas of medicine and surgery, from the perspective of both the patient and the physician, it influences the way we operate. Medical students and residents display an increasing tendency to focus on particular areas of the curriculum, and patients search for the doctor with the special knowledge, training, and experience to care for their individual problems.
Patients, in fact, search not just for specialists, but for subspecialists, as medical knowledge deepens and physicians of necessity restrict their practices to ever narrower subspecialty interests.
By the early 1980s, more than twenty years ago, facial plastic surgery had established itself as the number one subspecialty interest among otolaryngology–head and neck surgeons. Many practitioners belonged to the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), which then had 2,500 members and sponsored more than twenty facial plastic surgery fellowships across North America. With AAFPRS support, substantial, identifiable training in facial plastic surgery became a required component of accredited otolaryngology–head and neck residency programs, and residents had to demonstrate a solid grasp of this area to attain certification by the American Board of Otolaryngology (ABOto).
The growth of subspecialization within otolaryngology mirrored what was occurring on a grander scale in the American Board of Medical Specialties (ABMS) community—and all of these ABMS subspecialists wanted additional recognition so that patients could readily identify the physicians with the expertise they sought. Physicians with ABMS certificates in internal medicine wanted subspecialty certificates in pulmonary disease, cardiovascular disease, gastroenterology, and more. General surgeons wanted subspecialty certificates in pediatric surgery, which is separate from the seventeen subspecialty certificates issued by the pediatric board itself.
Today, there are twenty-four ABMS specialties that offer ninety-one subspecialty certificates—though none in facial plastic surgery. On paper, there is a conjoint certificate in something called “plastic surgery within the head and neck” offered by the ABOto and the American Board of Plastic Surgery (ABPS), but “facial plastic surgery” per se is nowhere to be seen under the ABMS umbrella.
What has happened since the 1980s, when facial plastic surgery was fully recognized within otolaryngology as its largest subspecialty, and today, when it remains a central component of otolaryngology training but certification in facial plastic surgery can be achieved only outside the ABMS? The answer to that question is the story of the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS).
It is the story of how a competing medical specialty (plastic surgery) fought in hospital credentials committees, the media, state medical boards and legislatures, the ABMS, the American Medical Association, and even the U.S. Congress to prevent otolaryngologists from disclosing their expertise in facial plastic surgery to the public.
And it is the story of how otolaryngology itself initially fought the recognition that its subspecialists inexorably sought, lest in doing so otolaryngology—already a small specialty—become fragmented. When support from otolaryngology finally did come, the parent specialty many times tried to support its largest subspecialty’s wish for recognition of “facial plastic surgery,” but ultimately succumbed to pressure from the ABMS to resolve the turf war with the plastic surgeons by naming a conjoint certificate in what the plastic surgeons insisted be called “plastic surgery within the head and neck.” That certificate remains on the ABMS books, unwanted and unused by facial plastic surgeons.
Rather, it is the certificate issued by the ABFPRS that facial plastic surgeons have sought these last twenty years, a certificate attainable by surgeons trained in otolaryngology or plastic surgery who already have achieved certification by the ABOto or ABPS. “The ABFPRS certificate verifies facial plastic surgery training and says we are a bona fide subspecialty,” Regan Thomas recently told me. “It makes contacts with mainstream, organized medicine much easier. And patients know who we are. Also, it makes a practice in facial plastic surgery much more attainable for people who share these interests.”
Today, the ABFPRS is recognized as equivalent to primary boards of the ABMS in every state that has set standards for such equivalence. This did not just happen one day when random circumstances serendipitously aligned. A group of people worked hard for two decades to attain this stature for the ABFPRS, and their actions make an interesting story not only for facial plastic surgeons but also, I believe, for physicians in other emerging medical specialties and perhaps even for anyone who enjoys a tale about what people can achieve when they put their minds to a task.
Drawing from archival records and illustrated with pictures of the people who played major roles, this book details the external battles that forged a steely collective will among facial plastic surgeons to create a certifying board that could withstand the sharpest scrutiny of regulators and competitors and deliver to the public the names of surgeons who meet the highest standards of practice. It further chronicles the internal work required to create a national medical specialty certifying board, from the establishment of an independent entity to the hiring of staff and legal counsel uniquely qualified to advise the new board and the creation of mechanisms to attract the unstinting efforts of young surgeons while retaining the sage counsel of senior people whose practices have exemplified the kind of surgeon envisioned in the ABFPRS standards for certification. All of these elements have been factors that enabled this board to meet its challenges, grow, and ultimately gain the recognition it enjoys today.
The ABFPRS story is not just interesting, but one that needs to be told. As my friend Gaylon McCollough likes to say, “Those who fail to look to the past to understand the present will be ill prepared for the future.” The events delineated in these pages are not merely old facts or ancient history. They are a guide and outline to better understand today’s news and continuing challenges.
Yes, things have changed in the past twenty years. The emphasis on comprehensive and collaborative patient care has eased tensions and fostered cooperation, at times, between previously distanced competitors. The real winner is the patient. The ABFPRS, after all, was founded to set standards for the practice of facial plastic surgery and to assess which surgeons meet those standards so that patients and the public can more readily identify physicians with the expertise they seek.
Now more than ever is the time for each one of us with an interest in facial plastic surgery to help maintain and even further raise the bar, settling for nothing less than the highest level of personal training, performance, and integrity. Embracing the contributions and knowledge of respected colleagues and friends, we will continue to provide the highest level of care for our patients and in so doing, preserve, protect, and honor the existence of our specialty.
—Bob Simons, Key Biscayne, Florida, April 2006