Focused Practice Designation in Metabolic Bariatric Surgery

| January 1, 2022

by Eric J. DeMaria, MD

Dr. DeMaria is Professor and Chief, Division of General/Bariatric Surgery; Department of Surgery Brody School of Medicine at East Carolina University in Greenville, North Carolina.

Funding: No funding was provided for this article.

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

Bariatric Times. 2022;19(1):16.


With the advent of Focused Practice Designation (FPD) in Metabolic Bariatric Surgery (MBS) by the American Board of Surgery (ABS), we enter a new era of recognition, acceptance and credibility as a subspecialty of surgery. The FPD in MBS is proof that we are being recognized for our special knowledge, skill, and ability, as we formally join the ranks of other surgical specialties, and as such, we should all pursue FPD designation.

With the advent of Focused Practice Designation (FPD) in metabolic bariatric surgery (MBS) by the American Board of Surgery (ABS), on behalf of the American Board of Medical Specialties, we enter a new era of recognition, acceptance and credibility as a subspecialty of surgery. This noteworthy recognition, decades in the making, is the culmination of countless efforts and the accumulation of many small victories along the way. The obesity epidemic remains the most significant chronic disease of our time, and bariatric surgery offers the most effective therapies to combat it. A certificate might not change the actual delivery of those therapies, but it does let the doubters know that those who proudly take part in it are recognized as surgical specialists.

I was privileged to sit at the helm of American Society for Metabolic and Bariatric Surgery (ASMBS) leadership when we were awarded the FPD for MBS. The efforts of other surgical leaders were also critical in this process, including key contributions and hours of work by Drs. Ninh Nguyen, Stacy Brethauer, Matt Hutter, and Samer Mattar. It is important to note that the FPD is not just recognition for our specialty by the ASMBS, but, perhaps even more importantly, became possible because we received strong support from the ABS. In other words, the leadership of mainstream and academic surgery in the United States supported our specialty in pursuit of the FPD and, in doing so, validated our specialty along with the hard work and contributions of so many who came before us. I have continued to work toward making the FPD a reality by serving as the inaugural Chair of the ASMBS Board Certification Committee, which has worked closely with the ABS to develop the application process and the exam itself. 

The FPD is testimony to the fact that we don’t simply perform a surgical procedure, but rather we comprehensively manage complex patients using our specialized knowledge and surgical skill, interact on equal footing with multiple other specialized disciplines, and ultimately provide the very finest high-quality care to patients battling obesity. The FPD in MBS is proof that we are being recognized for our special knowledge, skill, and ability, as we formally join the ranks of other surgical specialties.

Although we help many people through surgery each year, many more patients need our treatments. It is my strong feeling that we should all embrace the FPD and individually pursue this designation. It will be well worth the expense and effort required. Most importantly, this recognition within the greater medical community is likely to lead to more patients coming forward, with confidence in our specialty, to seek the treatment they need, and which we provide.

The following will provide a brief overview of what the criteria are for application to the ABS to take the first FPD exam, which will be given on April 1, 2022.

First, any bariatric surgeon in practice can qualify for the examination and designation.  No specific fellowship training is required, although postgraduate fellowship training in bariatric surgery is one mechanism to qualify.  However, the FPD recognizes surgeons who have achieved excellence in specialization through clinical practice after training.  Thus, fellows who have not yet practiced independently in the specialty are not able to sit for the examination, as a minimum of two additional years of clinical practice experience is required.

Criteria include:

  • Must be an ABS diplomate to be eligible. Diplomates must have primary certification in surgery from the ABS, and they must also meet the ABS Continuous Certification program requirements.
  • A surgery diplomate must have a minimum of three years of clinical practice experience with a focus in MBS. Those diplomates who have completed 12 months in a MBS fellowship training program may count the length of their fellowship program toward the focused practice requirement. 
  • Diplomates must document the following:
    • 100 lifetime stapling cases; 75 stapling cases can come from an accredited fellowship, and at least 25 stapling cases must occur after fellowship, including primary, revisional, and management of complications.
    • 100 stapling procedures, which must include 50 cases with a surgical anastomosis (same requirement as bariatric fellowship)
    • An average of 25 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-approved stapling cases annually

Diplomates must also have completed a minimum of 24 MBS-specific American Medical Association (AMA) Physician’s Recognition Award (PRA) Category 1 Continuing Medical Education (CME) credits every three years.

Additionally, diplomates must practice within a MBSAQIP accredited center and either be a “MBSAQIP verified surgeon” (most MBSAQIP center directors are verified surgeons) or provide confirmation from their MBSAQIP accredited center that the surgeon practices at their center and that their cases meet requirements.

It is particularly easy to complete the application process for MBSAQIP-verified surgeons since the verification process includes all of the components required for completion of the application. Others will have a few extra steps required to successfully complete the application process. 

To access the application process, surgeons should log in on the ABS website using their established sign-in information. The hot link to the FPD exam application process is found under the left-hand tab “ONLINE APPLICATIONS.”

Note that Step 1 is the application process. Step 2 is registering to sit for the exam itself and can not be completed until the candidate’s application has been approved in Step 1. The application requires that the surgeon submit all required information and pay the nonrefundable $275 application fee before they are able to register for the actual examination on April 1, 2022, which will be given at Pearson Testing Centers throughout the United States. The fee for the examination is $725, bringing the total cost to apply and take the exam to $1,000.

There will be two ASMBS FPD review courses—the first will be held at the ASMBS re-UNITED meeting on January 20 in Las Vegas, and the second will be at the SAGES 2022 Annual Meeting (specific day and time of the course TBD), which will be held from March 16 to 19 in Denver, Colorado. Board certification committee member Dr. Ann Rogers has been appointed to lead ASMBS’s board review efforts and will direct both courses.

Have a Question about the Focused Practice Designation?

You can submit any questions you might have about the Focused Practice Designation to Bariatric Times Managing Editor Austin Vitelli ([email protected]), and the experts will answer them in a follow-up Q&A in the February 2022 issue of the journal.

For more information about the Focused Practice Designation, view the corresponding video interview by Bariatric Times Co-clinical Editor Rich Peterson with the Chair and Co-chair of the Board Certification Committee and the current President of the ASMBS.

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