Would you pay 12 to 20 percent more to ensure you had the safest possible care you can receive, especially when it comes to surgery? “Your life is certainly worth more than that!” states Birmingham, plastic surgery doctor Michael S. Beckenstein, M.D. “It amazes me how a person will lie down on someone’s operating table simply because that surgeon is cheaper than others. Patients do not always focus on a surgeon’s experience, capabilities, and what facilities he/she utilizes.” Dr. Beckenstein added, “New patients must thoroughly research any surgeon who you are pondering operating on you. The surgeon’s training, experience, and where the surgery takes place is of utmost importance.”
We have written a lot about surgeons so let’s discuss the other aspects of surgery that patients must consider. The facility where you are having your procedure should be certified by American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) or other sanctioning entities. Facilities must meet rigid standards to perform general anesthesia and meet safety standards. If a surgeon is operating in their office, such stringent requirements are not always met.
For example, a surgeon’s office often utilizes nurse anesthetists to perform your general anesthesia. While they are competent and meet certification requirements, they are not doctors (anesthesiologists). If there is an emergency in the operating room at a hospital, the nurse anesthetists call the anesthesiologists and several qualified individuals respond to handle the situation. That alone should be a comforting thought about having your surgery in a hospital or AAASF certified facility! In a surgeon’s office facility there is no anesthesiologist, just the nurse. This is “not the best circumstance,” Dr. Beckenstein said, adding, “You want the best physician on the scene to take care of you right there. It can be life saving. In a doctor’s office they have to call an ambulance to take you, like a trauma patient, to the nearest hospital. Think hard about that for a minute!” The recovery nurses at accredited facilities are also certified, while nurses in a surgeon’s office are often the staff nurses who may not have any critical care experience.
The staff at hospitals or AAASF facilities have to be credentialed to work there. They meet the stringent criteria, for their respective fields. This requires each being credentialed by their fields. Nurses and scrub techs all go through training, must pass examinations, and rotate through training in the operating rooms before being considered for hire. This includes nurses, scrub technicians, nurse anesthetists, physicians, surgeons, etc. A surgeon’s office facility, as explained in this New York Times article, does not meet any criteria, except what the physician dictates. “It is well known that some surgeons allow their nurses or scrub techs to close wounds when the surgeon is not present. This does not happen in certified facilities, as the nurses and surgical assistants have to be approved by the rigid standards to do so. I have two surgical first assistants who went to school and passed the criteria to assist and close wounds. The hospital credentialed them and they can only assist in wound closure when I am present. Chances are that in an office, non-certified personnel are closing incisions, unsupervised. Think about who you want to assist with your surgery and close your wounds.
You can see a distinct difference in accredited facilities and office settings when it comes to the rigid rules in credentialing operating room staff and safety. Now, guess how this translates into cost. You guessed it: Office-based surgery is less expensive. But as Dr. Beckenstein adds, “Is this difference in cost worth your safety, or possibly, your life?”
For breast augmentation, the cost different is really not that much more. We researched the current fees, and the least expensive, office-based breast enlargement costs around $4200. Our breast augmentation costs are 12 to 20% higher, because Dr. Beckenstein operates only in hospitals where safety standards are high. So you must ask yourself, is 12 to 20% worth it?