American plastic surgeons lash out against medical tourism

As I’ve mentioned in a few of our older posts – medical tourism makes many American plastic surgeons very, very unhappy.   While many of their complaints are legitimate (patients could get inferior care, infections etc..) all of these complaints or comments apply to their American peers as well.  (On my sister site, we tackle many of the dubious practices in the USA (eye doctors performing liposuction, ‘fake’ doctors injecting people with fix-a-flat, and all those dentists, and hair salons injecting Botox.)

But today I take issue with Dr. Michael A. Bogdan, a plastic surgeon currently practicing in Southlake, Texas.  (Hope everyone is impressed in his degree in Zoology.) But back to the serious issues..

Dr. Bogdan recently authored an article published on Medscape questioning medical tourism in light of the PIP implant scare.  (The full article is re-posted below.)  While he makes some legitimate points in the article, (points that we have discussed here) about the lack of scrutiny on the medical travel agencies themselves, and the lack of data about complications from medical tourism surgeries – he grossly oversteps when he attempts to place the blame for the PIP implants on the feet of the medical tourism industry.

When you consider the THOUSANDS of medical devices (including different versions of breast implants) that have been recalled in the United States in the past 25 years – it undermines his whole premise.  I also find it somewhat offensive that he a.) dismisses all foreign surgeons as using faulty/ inferior equipment – that’s a wide, wide brush to use, Dr. Bogman.. 

and more importantly, b.) that in a small way – he almost sounds to me like he thinks that people who travel abroad for their surgical care – deserve to have these kinds of problems and complications.  Very uncool, and shame on you, Dr. Bogman.

In reality, Dr, Bogman and many other plastic surgeons here in the USA are lashing out at the bad economy which has dampened the public’s enthusiasm for surgical self-improvement.  (Though this article indicates the economy is recovering.)  It’s likely that as a plastic surgeon in Texas (a border state) that Dr. Bogman, seller of such procedural combinations as the ‘mommy makeover’ is feeling the loss of patients more than, let’s say a surgeon in Virginia..

More tellingly, and surprisingly, he doesn’t suggest that patients should research their surgeon wherever and whoever they are.

But read the article from yourself and decide:

The Cost of Medical Tourism by Michael A. Bogdan, MD

Complications From International Surgery Tourism Melendez MM, Alizadeh K Aesthet Surg J. 2011;31:694-697

Summary Medical tourism (ie, traveling outside the home country to undergo medical treatment) is a rising trend. An estimated 2.5 million Americans traveled abroad in 2011 to undergo healthcare procedures. This results in a significant direct opportunity cost to the US healthcare system. Complications from these procedures also affect the US healthcare system because patients often require treatment and have no compensation recourse from insurance. For cosmetic or other procedures that are not covered by insurance, economic motivators are driving medical tourism because some international clinics offer procedures at significantly lower costs, possibly by compromising the quality of care.

Very little data have been available to assess the outcomes, follow-up, and complication rates for patients undergoing cosmetic procedures abroad. The authors of this study distributed a 15-question survey to 2000 active members of the American Society of Plastic Surgeons about experiences treating patients with complications from procedures that they underwent during medical tourism. The response rate was acknowledged to be low, at 18%. Of the respondents, 80% had treated patients with complications arising from surgical tourism. Complications included infection (31%), dehiscence (19%), contour abnormalities (9%), and hematoma (4%). The majority of respondents reported not receiving any compensation for the care delivered to these patients.

Viewpoint Some patients travel to other states or countries seeking specialized care from surgeons who are experts in their field. In these cases, the patients understand that they will be paying a premium for the expertise, as well as the added expenses incurred for travel and lodging. These patients would be paying significantly more than they would have by undergoing the same procedure locally, but they consider the additional cost worthwhile due to the expected higher level of care.

The majority of patients who are attracted to medical tourism have a different motivation — they are trying to attain an equivalent level of care for a lower cost. Consumers are traditionally driven by price rather than quality and generally do not consider issues regarding follow-up and potential complications. Although reputable international clinics that offer high-quality care do exist, the greater majority that are trying to attract medical tourism patients are doing so by offering low prices. Overhead costs may be lower in other countries, but the level of regulation is also lower. Thus, the accepted standards of care tend to be lower as well.

A recent example of this issue is the current crisis involving breast implants manufactured by Poly Implant Prothèse (PIP).[1] Instead of using medical-grade silicone to manufacture these implants, PIP used substandard industrial-grade silicone as a cost-saving measure. Probably because of this, the implants have a markedly higher rate of rupture than other available breast implants. The International Society of Aesthetic Plastic Surgery recommends removal or exchange of these implants to avoid further health risks.[2]

PIP implants have not been used in the US since 2000, owing to the Food and Drug Administration’s (FDA) decision that the premarket approval application was inadequate.[3] In addition to blocking the use of these implants in the United States, the FDA sent a warning letter to the manufacturer discussing inadequacies in the manufacturing process.[4]

PIP implants have a significantly lower price point than implants approved for use in the United States and are therefore competitive in countries with less stringent regulation. International surgeons trying to entice patients with lower costs could easily justify using PIP implants. In my own practice, I have met patients who were lured overseas for less expensive surgery and ended up with PIP implants. These patients are now faced with additional expenditures for surgery to address complications.

If you have influence over a patient’s decision on where to undergo surgery, advise them of the adage: Buyer beware; you get what you pay for.

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