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  • The need for a credentialing system for office-based cosmetic procedures is discussed by experts in the field

NATIONAL REPORT — More practitioners from more diverse medical specialties may be making cosmetic procedures mainstream for a wider consumer base. But that trend has also surfaced the somewhat thorny issue of the establishment of a credentialing system for office-based cosmetic procedures — particularly those performed using lasers.

Hospitals, of course, have their own systems in place to credential physicians who have privileges at their facilities, but this does not address the practitioner who performs primarily — or exclusively — in-office procedures. "It's important to have another system other than operating room privileges to assure that physicians are appropriately trained in procedures they perform in their offices," contends Naomi Lawrence, M.D., director of procedural dermatology and associate professor of medicine, Cooper University Hospital, Marlton, N.J.

YAWNING GAP Underscoring the need for a credentialing system is the progressive nature of medicine itself and the breakneck pace of technology. Some experts tell Cosmetic Surgery Times they believe there's a need to fill the training gap that yawns between all these new medical and procedural developments and completion of residency training. "There currently is no standardized mechanism for this to occur in any specialty," states Dr. Lawrence.

Some cosmetic practitioners argue that such testing and credentialing post-residency is unnecessary. Many are doing well with flourishing practices and do not feel the need to pursue additional training; they are skilled in the anti-aging procedures their clients want. Particularly in the area of lasers, they argue that device manufacturers provide training that is less expensive than what they project an alternative certification/credentialing program might cost.

These are all criticisms that E. Victor Ross, M.D., has heard often and is addressing as he heads the certification task force for the American Society for Laser Medicine and Surgery (ASLMS). "I decided as task force chair, 'Let's do something.' Our society has talked about this for many years," he explains. "There will be warts in this process. If we insist that it's going to be perfect, it will never get done." Dr. Ross, who serves as director of the Laser and Cosmetic Dermatology Center, Scripps Clinic, San Diego, says he feels that the current hospital system is satisfactory for hospital-based M.D.s; however, most cosmetic procedures are performed outside the hospital. The providers have no credentialing body to recognize their training or skill level to perform procedures. Some states are looking for bona fide training for laser procedures with some "certificate" of knowledge. Therefore, Dr. Ross believes that a more formal, rigorous process is desirable.

LIFTING THE LEVEL "Everybody wants to lift the prestige level of [laser] procedures so they are not 'back-alley' procedures that just anyone can do. The laser industry wants to raise the bar, too, as it is in their interest that laser procedures are carried out in a professional, competent manner," Dr. Ross says.

"This will be good for new practitioners and nontraditional cosmetic surgeons," such as, for example, an internist who has decided to branch off into cosmetic procedures, says Dr. Ross, more so than for someone who has been performing the procedures for a while.

He notes that, while manufacturer-sponsored training for lasers is usually "pretty good," it still includes a sales component. "You're in a Chevy showroom. They're not going to sell you a Ford." Dr. Ross adds that attendees of such training often have varying degrees of experience and knowledge with lasers, making it difficult for the presenter to address each physician's learning needs.

HURDLING THE OBSTACLES Dr. Lawrence acknowledges that obstacles to getting a credentialing program up and running do exist. She allows that the development of a bureaucratic body to oversee the granting and maintenance of credentials and its associated costs could be perceived as a "negative aspect."

However, she cites significant benefits for both physicians and patients.

"Credentialing will provide the physician with a clear pathway to learn new procedures and assimilate them into his practice," says Dr. Lawrence. "It will increase quality of care and assure patients that office-based procedures are being appropriately done."

Dr. Ross expects that the certification program currently being devised by ASLMS would include a rigorous test that participants must pass to gain certification. Receiving a certificate would indicate "sizeable knowledge about laser and light-based technology."

What would that certificate mean to the cosmetic surgery community? "Hopefully other agencies — state medical boards, hospital credentialing committees — will look favorably on it, sanction it and accept it as the status quo for didactic knowledge in laser procedures," he says.

Dr. Ross estimates that the certificate training would require two or three days and might be piloted at an annual meeting of the ASLMS. After that, the courses might be offered six times per year at various locations across the nation. "I'm optimistic that this type of training will be popular. It simply has to be done right."

BASELINE AND UNBIASED Dr. Ross explains that the certificate program will address knowledge and provide a foundation for skill training but will not measure clinical skills. He recommends individuals pursue skill training with hands-on courses, through colleagues or laser vendors after making a laser purchase.

"Presumably the person would practice procedures and get better." Vendors will be asked to support the ASLMS certificate training through sponsorship and funding. However, the course content should be unbiased; thus, vendor-specific and product-specific information will largely be excluded.

"Vendors are supportive of our society to develop a better system for providing certification," notes Dr. Ross.

Dr. Lawrence encourages others to get on board with the plans being developed by fellow physicians. "Some type of nonhospital credentialing is essential and inevitable," she says. "It is best for physicians to support a system that is developed by physicians."

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