Who is Eligible for Focused Practice Designation?

| April 1, 2022

by Adrian Dan, MD, FACS, FASMBS

Dr. Dan is Medical Director, Weight Management Institute at Summa Health in Akron, Ohio, and Associate Professor of Surgery at Northeastern Ohio Medical University (NEOMED) in Rootstown, Ohio.

Funding: No funding was provided.

Disclosures: The authors have no conflicts of interest relevant to the content of this article.

Bariatric Times 2022;19(4):8–9

By the time this column hits the printing press and the digital screens of the Bariatric Times readership, the American Board of Surgery (ABS) will have administered the first written examination toward the new Focused Practice Designation (FPD) for metabolic and bariatric surgery (MBS). But at this moment, many surgeons with extensive experience and expertise in MBS do not have the opportunity to obtain such valuable recognition for their dedication to our specialty.

Doctors of osteopathic medicine (DOs), whose general surgery certification is through the American Osteopathic Board of Surgery (AOBS), and military surgeons, who might practice outside a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited center, make up the greatest percentage of MBS surgeons in this predicament. These individuals are home-grown talent, trained in United States (US) general surgery residency programs sustained by American tax dollars. Many have completed Fellowship Council (FC) fellowships and have satisfied the requirements for the American Society for Metabolic and Bariatric Surgery (ASMBS)-endorsed certificate of specialized training in MBS. They represent a substantial percentage of the bariatric surgery workforce, and many are leaders among our specialty and professional societies.

The American College of Osteopathic Surgeons (ACOS) has a rich history of providing excellent continuing medical education resources. For decades, the AOBS has also bestowed certification for general surgery and other surgical subspecialties, mirroring those of the ABS. Board certification for members who meet the high standards and educational requirements are available in several specialties, which include general, cardiothoracic, neurological, plastic/reconstructive, and urological surgery. Surgeons who may achieve these certifications do so by demonstrating distinction in their specialty and by passing required examinations. As the ABS rolls out its first FPD, the osteopathic leadership should consider a similar pathway to recognize the commitment and dedication of their own diplomats to excellence in MBS. Similarly, pathways to include military surgeons who do not have the option of obtaining MBSAQIP designation should also be explored. Joining me this month to provide perspectives on achieving this important goal from the early- and mid-career viewpoints are Dr. Logan Mellert and Dr. Carl Pesta.

Guest Perspective

by Logan T. Mellert, DO

Department of Surgery, Akron City Hospital Summa Health, Akron, Ohio; Northeast Ohio Medical University, Rootstown, Ohio

As an early-career osteopathic physician, I represent some of the last of the AOA-residency trained surgeons who are board certified through the osteopathic pathway. With the implementation of the Single Graduate Medical Education System in 2020, the ACGME and AOA unified their respective training systems into a single curriculum. With this merger, all US medical school graduates (DO and MD) enter a uniform graduate medical education surgical pathway, allowing them to seek board certification through the ABS. Unfortunately, legacy osteopathic trainees like myself are not currently eligible for the FPD, as our primary board certification is through the AOA, not the ABS. Currently, there is no recognition of certification equivalency between the two organizations, despite similar training standards, high-stakes examinations, and maintenance recertifications.

I, like many of you, take pride in the high-quality, life-changing outcomes we deliver to our MBS patients. Just as the FASMBS is a distinction within the society of the ASMBS, the FPD is a commensurate reflection of a surgeon’s dedication to MBS patients by the ABS. The FPD will set a standard for bariatric surgeons, acknowledging the extra surgical training, standards of practice, participation, and specialized knowledge in the treatment of obesity beyond that of other general surgeons. For patients, it provides transparency and assurance. By seeking out FPD surgeons, they will hope to maximize their outcomes and quality of care. 

Like our allopathic colleagues, osteopathic recognition of this additional training is important.

Though we might be years away, one day the FPD (or FPD equivalency) could be a determinant for insurance coverage, center certification, privileging, call schedules, referral patterns, malpractice, and reimbursement. Though the FPD will drive quality, it might simultaneously reduce access to surgeons who have dedicated their life to the field of MBS. This might not affect many of my late-career colleagues. However, with over 25 years of practice to go, this could be a long-term issue for surgeons like myself. I join with my other osteopathic colleagues committed to the practice of MBS in calling for the development of an osteopathic subspecialty or FPD equivalency pathway for osteopathic trained surgeons. Without this, it places osteopathic surgeons at a distinct disadvantage, despite their dedication to MBS.

Guest Perspective

by Carl Pesta, DO, FACOS, FASMBS

McLaren Macomb Hospital in Mount Clemens, Michigan

Though I still feel like one of the young guys in the society, my 21 years as a proud osteopathic surgeon and 18 years in the field of metabolic and bariatric surgery might say otherwise. To refute the age-old adage, you actually CAN teach an old dog new tricks! 

 I’m excited to witness the advancement of our society to the point of a Focus Practiced Designation (FPD) through the hard work of Drs. Eric DeMaria, Jaime Ponce, Rich Peterson, and countless others who have sat in meetings, written questions, and have given review sessions prior to the exam. 

I remember in the early days of my membership of what was then the American Society of Bariatric Surgery (ASBS) as a DO. I did not qualify for full membership. DOs were relegated to “associate” members. Fortunately, a lot has changed to allow full membership, committee participation, and beyond. Like any minority, unfamiliarity drives perceived disparity. The combination of all surgery training programs under the Accreditation Council for Graduate Medical Education (ACGME), which culminated a five-year transition period in June 2020, will continue to unite the two educational pathways into a solid cadre of practicing surgeons eligible for accredited fellowships, and examinations.

For osteopathic surgeons outside of this union, the pathway will be a bit different. With the help of our bariatric colleague Adam Smith, DO, who is a Past President of the American College of Osteopathic Surgeons (ACOS) and others passionate about a similar pathway for DO bariatric surgeons toward an FPD, we have begun discussions with the American Osteopathic Association (AOA.) The AOA oversees our American Osteopathic Board of Surgery (AOBS), who will then designate a similar FPD. We might be a few steps behind, but with the support of the greater than 150 ASMBS osteopathic surgeons, and others practicing bariatric surgery, we hope to deliver a parallel FPD in the upcoming years. For those interested in participating in forging the path, please get in touch with me via email or phone. 

Please join me in congratulating the first batch of surgeons who successfully passed the examination and now possess the coveted FPD. Well done my friends! Well done!

Address for correspondence: Email: [email protected]; Phone: (586) 596-8885 

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