Three Points About Scope of Practice


Scope of practice and the role of “non-core” cosmetic providers is a contentious topic whenever it comes up among the various specialties involved.  This is evident by perusing any “Doctor Message Board” website and following relevant posts.  Often the commentary quickly denigrates in quality and becomes venomous.

A refreshing view of the topic is Jeffrey Frentzen’s editorial in Plastic Surgery Practice.  He correctly points out the multispecialty contributions in the development of plastic surgery as a discipline.  These influences were essential, but there are important differences between the World of Medicine in that earlier time and now.

Today, “non-core” practitioners do not enter the field to make new contributions, or to solve previously opaque medical problems.  They do it mostly to improve their economic viability, which is very understandable.  I think there are three points to keep in mind in order to have an intellectually honest discussion about scope of practice:

1) It’s about patient safety (partly)

The public deserves properly trained practitioners, yet there are many ways this training can be provided.   There is no one foolproof method of training.  As in insurance-based fields, many new procedures are learned after leaving residency.  Training meant as an adjunct to an already competent practitioner is different from training designed to circumvent not having done a formal residency in a given area.

2) It’s about economic domain (turf)

There are some scope of practice battles in the coverage of hand and facial trauma, depending on the specifics of the community.  There are far fewer battles over low remuneration reconstructive areas.  If patient safety was the only concern, these would be contested as well.

3) It goes both ways

Each specialty has its area of core competence, and additional skills can be developed with training and experience.  No specialty has maximal expertise over every area, and anyone can get outside of their “comfort zone” if they are not careful.

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