Advocacy must occur on both federal and state levels. Plastic surgeons must reach out to Congress, state legislators and regulators wherever they may be found, from the Food and Drug Administration (FDA) in Washington with regard to plastic surgery devices, including breast implants and tissue fillers, to state boards of medical examiners that regulate the practice of medicine in 50 states.
The task of effecting outcomes in any or all of these venues is enormous. Organized plastic surgery has devoted significant resources in terms of both staff time and volunteer plastic surgical leadership time to this important effort.Many plastic surgeons think that only reconstructive surgery benefits from the efforts of advocacy. On the contrary, the majority of the issues in advocacy today affect the performance of aesthetic or cosmetic surgery. One could argue that the primary beneficiary of federal legislative efforts is third-party reimbursement, particularly Medicare and its spinoffs. On the other hand, FDA regulatory issues primarily affect devices for cosmetic surgery, including breast implants and the increasingly popular fillers and Botox. Advocacy also bears on critical scope of practice issues, which must be dealt with in all 50 states.
A significant effort led by the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) reached out to other specialties and formed a successful coalition in the State of California. When a cosmetic surgery tax was enacted in New Jersey, leadership quickly formed a similar coalition. The multi-specialty coalition spearheaded by the New Jersey Society of Plastic Surgeons has been instrumental in helping ASPS defeat cosmetic surgery taxes in five other states and bring the state of New Jersey's tax close to a repeal. This effort was augmented by significant financial and staff support from ASPS and ASAPS.
Patient safety is a critical issue with regulators at the present time. Office-based surgery regulations are at the forefront of patient safety scrutiny, and organized plastic surgery has put together a coalition with the three nationally recognized accrediting bodies, the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), the Accreditation Association for Ambulatory Health Care (AAAHC) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
This new coalition is critical for fighting the important battle to assure accreditation in lieu of the need for licensure, once again in all 50 states. Accreditation by one of the three bodies represents the highest standard of office surgical care and patient safety. It must be recognized in lieu of licensure or similar local regulatory constraints. Patient safety is the primary beneficiary when the federally recognized accrediting bodies are recognized at the state level.
The cost in terms of resources — financial, staff and volunteer leadership — is dramatic.
Other key initiatives by the profession also figure into the advocacy equation, most particularly the data accumulation and evaluation process by both the professional societies and the accrediting bodies. It is critical that when organized plastic surgery presents its case to regulators and legislators, we have the data to support our positions. As everyone knows, the data-gathering effort also requires significant investment of time and resources.
These investments, however, are already paying off. The rollback of cosmetic surgery taxes and the victories on scope of practice, particularly in California, have set precedents for activity in other states. The profession has been recognized at the national level by the American Medical Association and the American College of Surgeons for its leadership role in advocacy and data-gathering. This is a critical investment in the future of plastic surgery and the safety of our patients.
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— Richard D'Amico, M.D. Medical director, the Plastic Surgery Skin Care Center Englewood, N.J.