“Physician Drift”: A New Term For Practicing Out-of-Specialty


I used to be Snow White, but I drifted” –Mae West

There is an informative article on the North Carolina Medical Board’s website concerning “Physician Drift”, or the phenomenon of doctors practicing medicine far outside their areas of residency training.  The article highlights many key points including:

-States do not issue specialty specific licenses.
-Doctors frequently must update learning within their specialties to keep up with advancing medical knowledge and procedures.
-More doctors try to develop cash-based services due to changes in medical economics.
-No 21st century doctor can or should be able to practice in every area of medicine.

The concept of physician drift is old news for those in highly competitive medical markets, which tend to be saturated with physicians.  Drift occurs towards specialties with a high percentage of cash-paid discretionary procedures; cosmetic dermatology and surgery.  I don’t know of any plastic surgeons that have opened cash-only concierge medical practices to do family practice.  But there are internal medicine doctors rebranded as “cosmetic surgeons”, performing liposuction and other surgeries.

The public is easily fooled with non-residency training certificates, good-quality marketing and sharp websites.  A fancy office decor never hurts either.

In the defense of non-surgeon practitioners, I don’t think many of them ever thought they would have to switch specialties in order to make ends meet.  Most nonsurgical residents are not envisioning the day when they will be doing breast augmentations.  It’s only when they encounter the realities of 21st century medical practice – market-based overhead faced with arbitrary, non market-based fee schedules – that they realize they need to raise revenue from somewhere.  I theorize that with a more transparent and market-based system, physician drift would be a non-issue.

I expand on the NC article by subdividing “drift” into two varieties:  upstream drift and downstream drift.  Upstream drift is the more dangerous variety, where a lesser-trained doctor tries to take on procedures in which they had no formal residency training.  A family practice doctor doing liposuction is one example.  Downstream drift is where someone with substantial training takes on out-of-specialty work which is not difficult.  A cardiothoracic surgeon doing Botox and facial fillers is not a significant patient-safety issue.

Plastic surgeons seeking to defend their specialty with legislation are sometimes derided for using the patient-safety argument to protect turf.  They are trying to do both, because protecting turf also aids patient safety.  And plastic surgeons are not above scrutiny, as many have discarded reconstructive practices (or never started them) in favor of better remunerated cosmetic practices.

Concerning patient safety, there are training programs which advertise to non-core physicians, offering weekend training courses in liposuction, breast augmentation, and more.  Some were once advertised in official publications of the American College of Surgeons (ask me about that sometime).

Breast augmentation is relatively straightforward, right up to the point where someone puts a hole in the chest cavity – which can happen even by a properly trained plastic surgeon.

Liposuction is relatively straightforward, right up to the point where someone puts a cannula through abdominal organs – which can happen even by a properly trained plastic surgeon.

Physician drift is not likely to change anytime soon.  If anything, it will become more prominent, as the move towards outpatient surgery continues.  It is far more difficult to “drift” when hospital credentialing boards review physician backgrounds prior to granting clinical privileges.

Drift is not a major item on the healthcare radar-screen, and there are currently bigger issues to be sorted out as the new health-reform act begins to take effect.  But the implications for patients are clear:  do your homework when researching any cosmetic procedures, and don’t forget to research the doctor as well.

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2 responses to ““Physician Drift”: A New Term For Practicing Out-of-Specialty”

  1. λιποαναρροφηση says :

    I really cant agree more, for an acceptable level of security, we should ONLY trust a well trained plastic surgeon.

    • Thomas Pane says :

      Thank you for your comment. Although I am a plastic surgeon, I have to acknowledge the history of cosmetic surgery. This has shown that some cosmetic procedures have been pioneered by other specialties. Historically, this has been seen in other areas of surgery which grew out of more broad specialties; hand surgery developing from three fields is one example.

      In the prior century though, business interest probably was secondary to the clinical interest of those entering (developing) new fields. Today the converse is true.

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