CEBU BUSINESS FORUM - SECTION ON MEDICAL TOURISM

June 22, 2006 - DTI-Cebu Chamber of Commerce's Business Month ended with a big bang today. The main venue is the convention center of Waterfront-Lahug where many activities happened simultaneously, including a very extensive exhibit of Cebu's major trade players and conferences in different venues on different aspects of Cebu Business.

One of the bigger conference was the section on Medical Tourism. The existing major players in Cebu's infant medical tourism business presented interesting perspectives on the issue. Dr. Amores presented "Medical Tourism - the Experience at Cosmetic Surgery Center of Asia". A very interesting discussion followed the presentation.

It became too apparent during the conference that if ever the Philippines wants to get serious about medical tourism, it faces the serious task of institutionalizing this novel segment of medicine. It can start by integrating the disjointed (and at times haphazard) efforts of DTI, DOH and DOT.

BOARD CERTIFIED PLASTIC SURGEON: WHAT DOES IT MEAN

"Trained in the USA" is a must-have in the promotional materials of clinics and companies involved in medical tourism. Nothing to do with colonial mentality!

Training in the USA is a very complicated, graduated and regulated process. Being one, and passing the specialty boards literally grant one a ticket to treat/perform surgery anywhere in the world.

The training program is often referred to as a residency program. Residency in Plastic Surgery is one of the most coveted and competitive residency positions in the world. One has to lock horns with products of such prestigious universities as Harvard, Princeton, Vanderbilt, Pittsburgh, New York, Philadelphia, and other top universities of the USA - not to mention, graduates from the major universities of Europe, Asia and South America. The prerequisite is training in the USA in General Surgery, or certification in other specialties such as ENT, Orthopedics, Urology and Neurosurgery. By themselves, getting into the prerequisite residencies in the USA is now next to impossible for Filipinos and other Asians.

For graduates of Philippine and other non-USA medical schools, and being foreign nationals, to become a true "USA Trained" plastic surgeon is akin to the proverbial "camel going through the eye of a needle".

The next big step is passing the American Board of Plastic Surgery Part I (Written). As if this is not hard enough, then one has to pass Part II or the dreaded Oral Examinations where one goes mano-a-mano against the world's acknowledged leaders in the field of Plastic Surgery. (When I took my Oral Exam in 1983 in New Orleans, I found myself in a hotel room at the Omni, sitting on the bed, facing a panel of examiners headed by Dr. Tom Krizek, arguably the terror of the Plastic Surgery Boards).

Only when one passes the Oral Boards can one truly call himself/herself a Diplomate or a US-certified Plastic Surgeon.

A certificate of residency training in Surgery (Years I and II at Kings County Hospital Center - State University of New York is not shown)

American Board of Surgery certificate granting the Title: Diplomate, American Board of Surgery

A certificate of residency training in Plastic Surgery

American Board of Plastic Surgery certificate, granting the title: Diplomate, American Board of Plastic Surgery

[Dr. Alfonso Y. Amores belongs to an exclusive group of US Plastic Surgeons who are "double boarded"]

On the next issue: FELLOWS AND FELLOWSHIPS

WHAT DOES "TRAINED IN THE USA" MEAN

The gold standard by which one’s training in any specialty is measured by is the stamp “Trained in the USA”. This is the precise reason why in many promotional brochures and websites of individual clinics and medical tourism companies, the phrase “Trained in the USA” is invariably mentioned, pretty much with the same weight as the stamp of “ISO Certified” in non-medical establishments.

Many of these are outright misinformation and border on deceptive advertisement.

In the medical specialty and subspecialty fields, the training in the USA is a very long and arduous process under very strict regulation by national agencies. The umbrella agency is the American Board of Medical Specialties. Any Boards of medical specialty not included in the ABMS list is a bogus board (and there are many in the USA, created as corporations with an incorporation fee of $50).

Because of the very competitive nature of specialty training positions, and because of the drastic changes in the immigration and visa policies of the USA, acquiring the stamp “Trained in the USA” has been very scarce for Philippine professionals. And it has been so since the mid 70’s.

When one sees “Trained in the USA” stamped on any clinic and medical tourism professionals here in the Philippines, and for that matter in Thailand, India and other Asian countries, beware! Chances are it is deceitful and fraudulent.

How can one tell? Simple:
1. Ask the doctor who is going to do the treating where and when did he/she train.
2. Ask to see the certificate of training. If it is less than 5 years (for general surgery and some other specialties), and does not say “Chief Resident” somewhere in the certificate, it’s not valid. It also helps if the certificate is issued in the name of a university medical school. If the certificate is for a super specialty such as Plastic Surgery, the duration of training in the certificate should be stated no less than 2 years. (By the way, training in Plastic Surgery requires previous training in other specialties, most commonly General Surgery).
3. Ask to see the Board Certificate. It will say “American Board of _ _ _ _ _”. Taking and passing any American Specialty Board is a major endeavor and is not for the faint of heart. Some specialists from countries other than the USA elect to go home without taking the American Specialty Board. Nonetheless, these are true “Trained in the USA” just as long as #1 and #2 are satisfied.
4. The crowning glory of these all is the Fellowship Certificate such as “Fellow, American College of Surgeons” (FACS).

[On the next post: In Cosmetic Surgery, what does “USA Board Certified” mean; and what does “FACS” mean]

AN EMAIL FROM PHIL OF PRIMECARE-CEBU

Hi doc,

I really had a good time reading your blogs... Since we are handling Lear Clinic - biggest company in MEZ, I usually forward your blogs to our nurses assigned there and they also send this thru e-mail to all employees as health and community updates. More than 4,000+ employees there gets a copy of your blogs. hehehe

More Power to you!

THE ISSUE OF COMPETENCE IN COSMETIC SURGERY - A COMMENT

Great edition. I hope more people read this, including,perhaps more specifically gov't policy makers.

THE ISSUE OF COMPETENCE IN COSMETIC SURGERY

The phenomenon of the worldwide boom in cosmetic surgery in general and cosmetic surgery in medical tourism in particular is fueled by the constant concern of people about their physical imperfections. Riding on this crest of popularity, individuals and institutions are constantly jockeying and positioning themselves to take advantage of the demands of the patient mass.

Oftentimes, one will find in the promotional materials (brochures, websites, etc.) of the cosmetic clinics and centers such catch phrase as: "Trained in the USA".

This brings into focus the issue of competence in cosmetic surgery. I frequently speak in hospital conferences and medical society conventions on the broad topic of Cosmetic Surgery. One that always generates plenty of to-and-fros is the issue of competence.

I break down this issue into: a) Cosmetic Surgery by Non-physicians, and b) Cosmetic Surgery by Non-surgeons.

Cosmetic surgery by non-physicians is outright illegal and falls under the category of serious physical assault. The Philippine Medical Act of 1959 is the law of the land concerning medical practice. The Act simply states that anytime one diagnoses and treats any illnesses, it constitutes medical practice. And, the only ones allowed to practice medicine are licensed physicians. To be licensed, one has to graduate from an accredited medical school and pass the Philippine Medical Board Examinations.

Diagnosis and treatment of warts, melasmas, eyebags, and of congenital deformities of the nose, breasts and buttocks constitute medical practice. Anytime the integrity of the skin is broken in the pursuit of corrections of blemishes and deformities, it is already medical practice.

And yet, how many shops do we see in malls and other business centers offering these practices - without a physician involved? We know of high-school level beauticians going around the country doing injections for nose, breast, buttocks, etc. These are clearly criminal acts, and therefore should be treated as such.

In the issue of Cosmetic Surgery by Non-surgeons: By definition, if one wants to do surgery he/she must be a surgeon. A lot of eyebrows are raised in professional and social circles regarding Doctor so and so offering and doing cosmetic surgery. Nothing illegal about this!

When one graduates from an accredited medical school, he/she earns the title "Physician-Surgeon". The Medical Act of 1959 does not distinguish special training in different specialties. There is no legal prohibition against a freshly licensed physician to open a clinic in any field of medicine, notwithstanding is/her training. For cosmetic surgery patients out there, it is "Buyers Beware". It is the patient's responsibility to check the particular physician's training and experience.

[On the next issue...What Does "Trained in the USA" Mean]

SERVICE FACILITIES AT COSMETIC SURGERY CENTER OF ASIA (CSCA)

Cosmetic Surgery Center of Asia stands out among the cosmetic surgery facilities in the Philippines in that the servicing plastic surgeon (Dr. Alfonso Y. Amores) may be the only one in the country who is a Fellow of the American College of Surgeons.

Dr. Amores is Board Certified, American Board of Surgery, having trained extensively at the Kings County Hospital Center - State University of New York, Downstate in Brooklyn, New York and at the Charleston Area Medical Center - West Virginia University School of Health Sciences. He is Board Certified, American Board of Plastic Surgery, having trained at the University of Kansas Medical Center, Kansas City, Kansas.

He had an extensive practice in plastic surgery in Charleston, West Virginia and in Pittsburgh, Pennsylvania beginning in 1982.

Dr. Amores was formerly Clinical Associate Professor in Surgery (Plastic Surgery) at the University of West Virginia School of Health Sciences. He has steered quite a number of his students into the field of Plastic Surgery. Their practices are now scattered all over the USA.

While in the USA, Dr. Amores' Plastic Surgery Associates of West Virginia held the distinction of the being the only facility in the state certified by the American Association for the Accredition of Ambulatory Plastic Surgery Facilities (Quad A), the most strictly discriminating accreditation agency of its kind in the US. Central to the accredition are the qualification of the plastic surgeon and the equipment in the facility.

These two above are now the cornerstone of the Cosmetic Surgery Center of Asia. With the opening of his practice here in his native Philippines, Dr. Amores has brought home with him all the equipment from Plastic Surgery Associates of West Virginia...including the sink, so to speak.

More importantly, Dr. Amores has brought the concept of confidentiality to his practice here in Cebu, having designed his consultation set-up and operating room facility with precisely that in mind.

Almost all cosmetic surgery procedures are done at CSCA. Only tummy tuck, which requires general anesthesia, is done in a hospital setting.