It is hard to write this article. I have many friends in the community practicing cosmetic medicine who send me referrals. I hope this does not offend them in any way. I am going to define the following: what is a plastic surgeon, how we got there, what we do, and why it is worth it to come to us.

First, let me explain a little about medicine in general. The misnomer that doctors make “too much money” is a fallacy. Physicians have large overheads, large malpractice premiums, staff salaries and four to seven insurance premiums due monthly. It is important to realize that because of declining insurance premiums coming from our insured patient population, physicians are looking at other ways to supplement their income.

A seemingly “easy” target is the cosmetic industry. With payments up front, clientele with semi-disposable income, and a wait list, some “cosmetic doctors” open up with little to no residency training for the procedure, no peer review process to perform those procedures by a hospital staff of doctors, or, most importantly, the ability to admit you to a hospital to care for complications should they arise.

Plastic surgeons and other doctors start their careers as college students where they must achieve a high level of academic achievement just to be considered for medical school. After they get in, they must achieve a high level of academic achievement in medical school (most are top 25 percent of their class, and most of those are top 10 percent) just to be considered for highly coveted one to two spots a year per residency.

They also need very high scores on medical school exams (called USMLE Step I, II, III) to be considered for plastic surgery residency as well. (A score of 85 percentile to 95 percentile for the exams is not uncommon for those who get into plastic surgery residencies.) So in summary, you need to be one highly academically talented individual – even as a medical student.

Residency can be six to nine years after medical school. That’s right! A total of 10-13 years after college in medical school and surgical residency just to graduate and say you are a plastic surgeon. After residency, you must take a written exam within months of graduating. If you pass that, then for the next 1.5 years you must get ready to take the oral boards.

We have to input every patient for one year into a national database that is examined and scrutinized by our peers. We also have to show proof of safety from each hospital where we have privileges. If we are allowed to take the board exam, the exam is a grueling three-day process where 18 cases are presented (12 are not yours) and you must give answers to problems and patients in front of six seasoned plastic surgeons.

The failure rate is 28-35 percent. Think about that. These highly academic individuals actually can fail an exam!

OK, so now you have passed and become an American Board of Plastic Surgery plastic and cosmetic Surgeon. Now comes the fun stuff. We are required to achieve 180 CME credit hours every three years to maintain our credentials and every 10 years to retake the written exam, submit cases for six months, and be required to take safety courses for the rest of our lives.

So, who is a plastic surgeon: One who is dedicated to lifelong learning, academic achievement, constant testing and a culture of safety instilled in us at every meeting. So before you go under the knife (for liposuction or breast augmentation, for example,) ask to see their credentials. The most important is: can they admit you to a peer reviewed hospital (not their office surgical suite) to take care of any complication you may have that can cause long-term harm?

If the answer is no, guess what? A plastic surgeon may eventually have to take care of you. My peers in the community can all give you stories of people who went to non-plastic surgeons for surgery. Ask them to relate a few to you. It is not to say that we do not have complications ourselves. It is to say that we can take you to a hospital to fix them.

This will go a long way to achieving your goals of a happy, cosmetically pleasing result with someone who can perform most all cosmetic procedures you need.

Please visit the American Board of Plastic Surgey Web site at www.abplsurg,org or the American Society of Plastic Surgeon Web site www.plastisurgery.org to find one of the 50 plus plastic surgeons in San Antonio.

Buyer beware.