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What's in a Name?

What's in a Name?

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Understanding a Doctor's Title

The "alphabet soup" that often accompanies a physician's name is meant to clarify his or her credentials. Unfortunately, without an appropriate glossary of terms and acronyms, often the letters and titles lead to more confusion. Since I have just returned from San Francisco, where I was initiated as a Fellow of the American College of Surgeons (F.A.C.S.), I thought the timing was right to try and explain what's in a name.

In the field of bariatrics, it is not at all uncommon to hear a surgeon claiming to be a "Board Certified Laparoscopic Bariatric Surgeon." What exactly does this mean? Is the surgeon certified in bariatric surgery or laparoscopic surgery? Is the surgeon certified in both? Actually, the surgeon is certified in neither! There is no certification board for either laparoscopic surgery or bariatric surgery.

To help sift through the confusion, here is an explanation of the most important boards that certify physicians in different areas.

The American Board of Medical Specialties®

The American Board of Medical Specialties® is the umbrella organization for the 24 approved medical specialty boards in the United States.

The American Board of Surgery

The American Board of Surgery, on the other hand, is responsible for 1) certifying surgeons by determining whether they have received appropriate preparation in approved residency training programs in accordance with established educational standards, 2) evaluating candidates with comprehensive examinations, and 3) certifying those candidates who have satisfied the board requirements. Physicians who are successful in achieving certification are called "diplomates" of the specialty board. The boards also offer recertification for qualified diplomates at intervals of seven to ten years.

American College of Surgeons

Fellowship in the American College of Surgeons, indicated by the letters F.A.C.S. following a surgeon's name, is a sign that the surgeon has passed through an additional evaluation process. This additional process is intended to establish not only professional competence, but also ethical fitness. In order to become a F.A.C.S., a surgeon typically must be a diplomate of the American Board of Surgery (i.e. a board-certified surgeon) and must be committed to placing the welfare of the patient above any other consideration. This process was established to ensure that patients receive the best possible surgical care.

Questions for Patients to Ask

So what about that "Board Certified Laparoscopic Bariatric Surgeon"? This individual is most likely board certified by the American Board of Surgery and happens to be a laparoscopic bariatric surgeon. In other words, since there is no certifying process and no credentialing body for either "laparoscopic" or "bariatric" surgery, there is no standard for what these terms mean when used by various surgeons. With this in mind, some questions to ask a surgeon using this title include:

  • Has the surgeon completed any special training in the techniques of advanced laparoscopic surgery?
  • Was this part of his/her surgical residency training, or was it above and beyond the usual surgical training?
  • Did the training come in the form of a weekend course practicing on animals, or was it a yearlong apprenticeship program with a nationally known surgeon?
  • Does the surgeon participate in continuing medical education programs designed to keep surgeons current with the constantly changing technology and medical knowledge base?
  • Is the surgeon a member of the national societies with the appropriate focus, such as the Society of American Gastrointestinal Endoscopic Surgeons or the Society of Laparoendoscopic Surgeons?
  • What percentage of the surgeon's practice is dedicated to laparoscopic procedures?

Many of the same questions are applicable for use of the title "Bariatric Surgeon."

  • Has the surgeon completed any special training in the techniques of bariatric surgery?
  • Was this part of his/her surgical residency training, or was it above and beyond the usual surgical training?
  • Was the training in the form of a weekend course, or was it a prolonged preceptorship program with a nationally known surgeon?
  • Does the surgeon participate in continuing medical education programs designed to keep surgeons current with the medical knowledge base?
  • Is the surgeon a member of the national society with the appropriate focus, such as the American Society for Bariatric Surgery?
  • What percentage of the surgeon's practice is dedicated to bariatric procedures?
  • Does the surgeon have a multidisciplinary team approach with the necessary components?
  • Is there a support group?

Some More Tips

If a surgeon claims to be board-certified, make sure the certification is in general surgery and that it is up to date. Look for a framed certificate hanging on the office wall. If a surgeon claims to be a laparoscopic surgeon, ask about the nature of his/her training. If a surgeon claims to be a bariatric surgeon and runs a bariatric program, make sure he or she is experienced and has the full complement of resources readily available to properly care for bariatric patients. Surgeons who display the letters F.A.C.S. after their name are usually so proud of their accomplishment that they prominently display their certificate for all to see. Not all surgeons decorate the walls of their office with their numerous certificates and diplomas, but all should be able to produce them when asked.

So, what's in a name? Opportunity! The adjectives a surgeon uses to describe himself or herself should be viewed as an opportunity for the knowledgeable patient to ask some direct and useful questions. If a surgeon refuses to show his/her credentials when asked to do so, a serious doubt should arise in the mind of the prospective patient.

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