Performance anxiety Non-M.D.'s may perform cosmetic surgery, says new California lawPerformance anxiety Non-M.D.'s may perform cosmetic surgery, says new California law

Sacramento, Calif. — Now that California Gov. Arnold Schwarzenegger has signed into law a bill authorizing the state's non-medical-degreed oral and maxillofacial surgeons to perform elective facial cosmetic surgery, there's a high probability that other states will follow suit, experts tell Cosmetic Surgery Times.

According to the American Society of Plastic Surgeons' Coalition for Safe Plastic Surgery, the lawmaking bodies of two states, Indiana and New York, have introduced legislation that would allow dental surgeons without medical degrees to perform cosmetic plastic surgery. Dental surgeons in 17 states have made known their intent to change the law to allow dental surgeons without medical degrees to perform cosmetic plastic surgery, but no bills have been introduced in their respective state legislatures to date.

Fifteen states have already enacted such laws, according to the Coalition, while another 15 states allow only board-certified M.D.'s with a specialization in plastic surgery to perform such procedures.

California Senate Bill 438 drew much attention before Schwarzenegger made it law in early September, largely because of the political machinations involved in getting it through the Senate and onto the governor's desk. Schwarzenegger had vetoed identical legislation in 2004, but directed the state's Department of Consumer Affairs to undertake an occupational analysis of the oral surgery profession to examine education and training requirements for dental surgeons. Some call into question, however, the make-up and objectivity of the study panel.

Whose study?

"The study was done by members of the dental community, not the medical community," says San Mateo plastic surgeon James Newman, M.D., clinical instructor in the department of otolaryngology/head and neck surgery at Stanford University.

"The bill was vigorously opposed by the facial plastic surgery community, which saw it as an attempt by non-medical-degreed oral surgeons and dentists to circumvent the previous rules that limited the extent to which they could perform cosmetic surgery."

The new law requires non-medically degreed oral surgeons and dentists who wish to perform elective facial cosmetic surgery to apply for and receive a permit to do so from the Dental Board of California. The permit will be granted if the applicant can satisfy a number of requirements, among which are:

Turf wars

According to Dr. Newman, the medical community successfully lobbied provisions in the new law, such as requiring the Board to appoint a credentialing committee to review each applicant's qualifications and make recommendations as to whether to issue the applicant's permit and its terms.

The medical community also succeeded in its efforts to include on the credentialing committee a physician/ surgeon with a specialty in plastic/ reconstructive surgery and a physician/surgeon with a specialty in otolaryngology who maintain active status on the staff of a licensed general acute-care hospital in the state. The remaining committee will be comprised of three Board-licensed oral and maxillofacial surgeons, at least one of whom is also licensed in California as a physician and surgeon.

In addition, the new law requires the Board to solicit input from the Medical Board of California, the California Medical Association and the California Society of Plastic Surgeons — a concession gained by the medical community to balance out the presence of The California Dental Association and the California Association of Oral and Maxillofacial Surgeons in deciding appointees to the credentialing committee.

Political prognosis

It may well be these kinds of compromises — versus lobbying against the legislation that is almost certainly forthcoming in other states — on which the plastic/cosmetic-surgery community will focus in the future.