The Competition

There is fierce plastic surgery competition between hospitals and physician-run outpatient centers, with the debate focusing on safety.

Officials of outpatient centers say they provide personal care in a less stressful environment than hospitals and the procedures are less costly. It has become increasingly common for women to have breast reduction surgery at an outpatient surgery center.

Hospital leaders insist there are questions about the ethics of some of the outpatient programs and their reliability.

"We are at risk of blurring the line between commercial businesspeople and medically ethical doctors," says Terry Myckatyn, MD, director of breast and cosmetic plastic surgery at the Washington University School of Medicine in St. Louis. Too often, providers are offering BOTOX and other cosmetic procedures that are not regulated by national plastic surgery organizations, he says.

The dispute has been ongoing for years, with patient care and economics at the crossroads.

Concerns over improper practices in plastic surgery clinics have prompted some states to crack down on such outpatient programs. A series of deaths prompted Florida officials years ago to require plastic surgeons to have proper board certification to ensure they have the proper training.

More recently, reports in Virginia about patients seriously injured during outpatient cosmetic procedures done by those without board certification prompted the Virginia Board of Medicine to recommend a crackdown.

But even accredited outpatient facilities and hospitals have stepped up competition, and are raising questions over some clinics' competencies.

Those disputes prompted Grant Stevens, MD, medical director for Marina Plastic Surgery, a Beverly Hills, CA, outpatient facility, to conduct an extensive study of breast reduction procedures at outpatient and hospital facilities. He says his 11-year study of breast reduction procedures of more than 400 patients at his center showed they can be accomplished as safely as a hospital. The report, published in the Aesthetic Surgery Journal, supported the "safety and efficacy of outpatient reduction mammoplasty performed in an accredited facility."

Stevens said it was important to show that there were similarities between accredited outpatient facilities as well as hospitals for patients as well as physicians. "For various reasons a number of people were reluctant to do outpatient procedures," he says. "But we found there was no downside and a huge cost savings."

From Health Leaders MediaJoe Cantlupe, for HealthLeaders Media, April 13, 2012