Sanabria, breast implant

Colombian plastic surgeons answer back


Chairman of International Society of Aesthetic Plastic Surgery questions the ethics of medical tourism, Colombia responds.

Colombia is now 11th in the world for plastic surgeries by volume according to the International Society of Aesthetic Plastic Surgery (ISAPS) but that may change if Dr. Igor Niechajev, Chair of the Government Relations Committee of that same organization gets his way.  ISAPS, who ranked Colombia among the top 25 countries for plastic surgery also printed an article by Niechajev in the spring edition of its newsletter condemning medical tourism.

Chairman discourages medical tourism, stating that medical tourists are victims of inferior care

The strongly-voiced piece accused surgeons outside of European and North America of providing inferior medical care, inadequate pre-operative evaluations and operating in substandard facilities.

States bad outcomes wouldn’t happen at home

In his editorial, Dr. Niechajev provides anecdotal evidence of a botched procedure that occurred in Asia, and stated that “such a tragic outcome” of [procedure cited] “is highly unlikely had the patient not been a medical tourist.”  Dr. Niechajev cites these concerns, not as a surgeon losing business to his competitors but states that he is concerned about the costs of caring for patients with possible complications once they return home.

Not limited to national borders

His concerns don’t stop at national borders, Dr. Niechajev also suggests that surgeons limit themselves to their immediate local vicinity.  What this may mean for a rural patient requiring extensive reconstructive surgeon is not addressed by Dr. Niechajev.

 Statements based on limited data

He bases the majority of his opinions on the shoulders of Dr. Ritz, the Australian National Secretary for Health, who cites one specific incident as the trigger for changing Australian legislature to prohibit this practice.  Additional evidentiary support of gross episodes or a mass epidemic of malpractice by international surgeons appears to be limited to 11 cases in the United Kingdom.  No other data was cited.

International Society debating the issue; Niechajev recommends financial sanctions against patients

These concerns have the officers of ISAPS considering changing the code of ethics of the organization to discourage the practice of medical tourism by its member surgeons.  However, Dr. Niechavej does not seem content to stop there, instead he advocates for governmental announcements advising the public about “increased risks associated with medical tourism” and that “surgery overseas practically means that they [patients] are giving up all their rights.”  He also advocates for financial penalties for patients who experience post-operative complications after surgery overseas, stating, “No preventative measure is as effective as hitting someone’s purse.”

 Colombian plastic surgeons respond

In an exclusive interview with the President of the Colombian Society of Plastic Surgery, he answered many of the allegations by Dr. Niechajev.

Regarding Dr. Igor Niechevaj’s statements on the lack of regulations and substandard facilities in countries that are popular medical tourism destinations, the President of the Colombian Society of Plastic, Esthetic and Reconstructive Surgery, Dr. Carlos Enrique Hoyos Salazar replied that, “All facilities, and hospitals in Colombia are regulated by the Ministry of Health. There are minimum standards that must be met.  Any facilities that are interested in participating in the medical tourism business have additional standards and qualifications for certification by national agencies.  Anesthesiologists, and medical doctors are required to have additional training to perform pre-operative evaluations for International plastic surgery patients”.

 Reports safety and patient protections for medical tourists

He refutes claims that patients receive minimal post-operative care before returning home. In addition to medical advice from Colombian physicians, he cites agreements with Colombian and international airlines to encourage international patients to stay a minimum of 15 days after their surgical procedures to ensure optimal recovery.

Additionally, several plastic surgeons specializing in medical tourism and medical tourism companies offer ‘complication policies’ to pay for any expenses a medical tourist may incur in both the destination and home country should they develop complications post-operatively.  In fact, an advertisement for one of these policies shares space with Dr. Niechevaj’s article.  These policies effectively negate one of Dr. Niechevaj’s (and Dr. Ritz’s) strongest arguments, that medical tourism incurs costs in the home country when patients develop post-operative infections or other problems after returning home.

ISAPS Chairman defending his own wallet?

When asked about Dr. Niechevaj’s position on medical tourism and possible changes to the ISAPS code of ethics, Dr. Hoyos stated, “This is not right.  This has nothing to do with the quality of surgery in Colombia and other countries.  This is about the expensive costs of surgery in Europe and the United States.  If a surgery costs $6,000 (USD) over there and only $3,000 – $3,500 in Colombia, then those doctors are losing money due to medical tourism.”

Good and Bad is a global phenomenon

As we’ve pointed out here on our site (and related work) – good and bad surgical outcomes are certainly not limited by geography, and Dr. Niechajev certainly seems to paint the rest of the world with a wide brush with his call to action.

A more reasonable, and fair response would be continue to encourage work such as mine – using outside, independent and unbiased observers to evaluate surgeons wishing to participate in medical tourism.

In an ideal world, companies such as Blue Cross/ Blue Shield who wish to broaden their international physician base would hire independent medical professionals to review surgeons who wished to be included under their health plan.  This way both consumers and third-party payers would have more information before patients went ‘under the knife’ so to speak.

Patients wouldn’t be shuttled to surgeons who submit the lowest bid (to insurance companies, and private parties) but to surgeons whose qualifications had been authenticated.  All parties would know about the quality of hospital facilities, anesthesia, pre-operative evaluation and post-operative care.

Doing my part

Readers know that I do what I can, in a very small way, to add to the body of knowledge about the quality and care of patients who receive treatment from the surgeons who consent to let me observe, evaluate and report my findings.

Now we just need this on a large-scale, multi-national level.

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Colombia ranked 11th in the world for plastic surgery: who says so??


No, not the World Health Organization (WHO), but another entity entirely, ISAPS.

Plastic surgeons in Mexico gather for a demonstration of techniques for breast reconstruction

Plastic surgeons in Mexico gather for a demonstration of techniques for breast reconstruction. Mexico is currently ranked #5 for number of plastic surgeries

 International Society of Aesthetic Plastic Surgery (ISAPS) recently published survey data ranking Colombia at 11th for volume according to the most recent statistics (2011) available.   211,879 total procedures were reported.  Colombia currently ranks #27th globally in population with a 2013 estimated population of 47 million.   Considering the modest population size of Colombia this statistic may reflect both Colombian cultural expectations and the growing trend of medical tourism.

Countries that perform the most cosmetic surgery procedures***:

1. United States: 1,094,146

2. Brazil: 905,124

3. China: 415,140

These top three nations also represent a total population of 1.86 billion people.  Brazil, in particular is also widely known as the medical tourism destination of choice for plastic surgery.

Plastic surgery in Colombia

Of the 211, 879 procedures, 65,075 or 30.7% were breast enhancement procedures.  Liposuction accounted for 23% of all cosmetic surgical procedures.

Dr. Reyes, a plastic surgeon in Bogota, Colombia operates on a patient

Dr. Reyes, a plastic surgeon in Bogota, Colombia operates on a patient

Questionable study results due to lack of participation

However, the accuracy of the data collected by a joint American – Brazilian team is questionable given the low percentage of participation by licensed member surgeons.  Out of 20,000 eligible ISAPS member surgeons, only 996 participated in the organization’s survey.  Additionally, of the .04 percent of surgeons reporting their surgical practices, 43% (431 surgeons) were based in the United States.  Of the remaining 565 surgeons represented the remainder of the worldwide plastic surgery community, 172 of these participants were from Brazil.  The final statistics provided for each country are based on estimates extrapolated from a representative sample from survey responses received.

Are the results any surprise, given the players?  But then again, maybe these results will encourage more Latin American surgeons (and surgeons in other countries) to participate more fully in the academic activities of their specialty societies.

*Mexico was also in the top five with 299,835 procedures.

***As an interesting aside, the island nation of Japan ranked fourth.