BACKGROUND: Many licensed physicians, dentists, nurse practitioners, and physician assistants market themselves as “board-certified” or “fellows’’ of professional societies that include the terms Plastic Surgery or Cosmetic Surgery, lending the impression to the public that membership confers competency. Aesthetic surgery occurs largely in the outpatient setting; so, practitioners are “self-credentialed” and the public is left to believe website or marketing information. This survey aimed to assess the public’s understanding of the differences between plastic surgeons and other medical professionals who perform cosmetic surgical and nonsurgical procedures for the purpose of identifying public perception of the aesthetic surgery market. Our goal is to gauge public understanding of the differences between plastic surgeons and other medical providers in the aesthetic surgery space who represent themselves as competent practitioners of procedures that are integral to ACGME Plastic Surgery residency core competencies.
METHODS: A 22-question survey was created under the guidance of a survey methodologist on Qualtrics. The survey was released through Amazon Mechanical Turk to reach a representative sample of the adult US population. Factors that influence patient decision-making for cosmetic procedures and/or aesthetic surgery were assessed along with the knowledge of physicians and providers according to specialty, training, and board-certification status.
RESULTS: Two-thousand two-hundred and thirty-eight individuals completed the survey. Although respondents indicated that plastic surgeons are the most qualified to perform surgical procedures (66% followed by cosmetic surgeons 21% and dermatologists 3%), they indicated that cosmetic surgeons (33%) and dermatologists (23%) were more qualified than plastic surgeons (19%) to perform nonsurgical procedures. Thirty percent of respondents said that it was illegal for any licensed physician to perform a cosmetic/aesthetic surgical procedure, while 24% believe that it is legal and 47% were unsure. When asked about nonsurgical procedures, 15% believe that it is illegal for any licensed physician to perform the procedure, while 37% believe that it is legal and 48% were unsure. The most important factor when choosing a physician to perform surgery to improve appearance was experience, while the least important factor was the type of surgeon/aesthetic provider. Multinomial logistic regression showed that if a person has had a cosmetic/aesthetic procedure, they are more likely to say that plastic surgeons (OR 2.547, CI 95%.988–6.459) are the most qualified to perform surgery to improve appearance than if they had not had a procedure. Before visiting a doctor, 46% of respondents reported they always check board-certification, 27% sometimes check, 22% do not check, and 5% did not know about board-certification. The majority of respondents said that it was extremely important (55%) that their physician is board certified.
CONCLUSIONS: This study demonstrates that while respondents believe that plastic surgeons are the most qualified to perform surgical procedures, they are comfortable with a variety of aesthetic providers performing both surgical and nonsurgical procedures. This analysis will help national plastic surgery societies focus their efforts to educate the public by understanding knowledge gaps and sources of misinformation.