How to find a qualified surgeon
Whether you are referred to a physician for surgical care, or you make the choice yourself, don't take your surgeon's qualifications for granted. Make sure your operation is performed by a competent physician whose specialty is surgery. It could be the most important decision you make.

If you or someone you know is considering elective surgery, you should be aware that there are some ways to objectively evaluate your surgeon. The American College of Surgeons--the largest international organization of surgeons in the world--recommends that you look for the following qualifications:

(1) Board Certification. A good indication of a surgeon's competence is certification by a surgical board that is approved by the American Board of Medical Specialties (ABMS). In order for a physician to become board certified in a surgical specialty, he or she must complete the designated years of residency training in that specialty, and then demonstrate his or her knowledge by successfully completing a rigorous examination. When you choose a surgeon who is certified by an ABMS-approved board, you select a physician whose specialty is in surgery.

(2) Practice in an accredited hospital or outpatient surgery center. Your surgeon will arrange for your operation to be performed in a hospital where he or she has staff privileges. It is a good idea to make sure that the hospital has been accredited by the Joint Commission on Accreditation of Healthcare Organizations, a professionally sponsored program that stimulates a high quality of patient care in health care facilities. There is also an accreditation option that is available for ambulatory surgery centers.

If your operation is scheduled to be performed in one of these facilities, you can check to see if the center has been accredited by a nationally recognized organization such as the Joint Commission or the Accreditation Association for Ambulatory Health Care. When a hospital or ambulatory surgery center has voluntarily sought accreditation, it is a good indication that the facility is committed to providing the best possible care for its patients.

(3) Fellowship in the American College of Surgeons. The letters FACS after a surgeon's name indicate that he or she is a Fellow of the American College of Surgeons (ACS). Fellows of the College are almost always board-certified surgeons whose education, training, professional qualifications, surgical competence, and ethical conduct have been reviewed and evaluated and have been found to be consistent with the high standards of the American College of Surgeons.

Not all surgeons are accepted into Fellowship in the College. And there are some surgeons who may, for other reasons, choose not to become Fellows. However, the letters FACS after a surgeon's name indicate that he has volunteered to have his credentials and performance evaluated by his peers; they serve as an additional indication that a physician is competent to perform surgery, and that he has pledged to place the interest of his patients above his own.
Now that you know what qualifications to look for in selecting a surgeon, how do you check on those qualifications? In most cases, a surgeon who is board certified and/or a Fellow of the American College of Surgeons will have certificates verifying these credentials on display in his or her office. If not, another way is to simply ask the surgeon for his or her credentials yourself. Or you can phone your state or county medical association for assistance.

There is also a reference book--The Official ABMS Directory of Board Certified Medical Specialists--that lists all surgeons who are certified by approved boards. This publication also contains brief information about each surgeon's medical education and training, and it can be found in many libraries or through state and county medical associations. The ABMS Directory is also available on the Internet. If none of these resources are available to you, you can request a list of Fellows of the American College of Surgeons in your area by calling 312-202-5391; or you may refer to the Fellowship Database on the American College of Surgeons' Web site. The Directory of Surgeons on this website provides a listing of local practicing ACS surgeons.

(4) Surgery by Surgeons
A fully trained surgeon is a physician who, after medical school, has gone through years of training in an accredited residency program to learn the specialized skills of a surgeon. One good sign of a surgeon's competence is certification by a national surgical board approved by the American Board of Medical Specialties. All board-certified surgeons have satisfactorily completed an approved residency training program and have passed a rigorous specialty examination.

The letters F.A.C.S. (Fellow of the American College of Surgeons) after a surgeon's name are a further indication of a physician's qualifications. Surgeons who become Fellows of the College have passed a comprehensive evaluation of their surgical training and skills; they also have demonstrated their commitment to high standards of ethical conduct. This evaluation is conducted according to national standards that were established to ensure that patients receive the best possible surgical care.

Remember, if you're considering an operation, make sure that the procedure is performed by a competent physician whose specialty is in surgery. It could be the most important decision you make.

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When you need a second opinion
There are no hard-and-fast rules to tell you when consultation (or second opinion) is needed, but before you agree to an operation, you should discuss the following questions with your surgeon:
 
- What are the indications for the operation?
- What, if any, alternative forms of treatment are available?
- What will be the likely result if you don't have the operation?
- What are the risks?
- How is the operation expected to improve your health or quality of life?
- Are there likely to be residual effects from the operation?

If, after discussing these questions with your surgeon, you feel confident that a surgical procedure is the best treatment for your condition, you probably don't need a second opinion. If, however, you have doubts about whether the operation should be performed, or if the doctor recommending the operation is not a qualified surgeon, you may want to seek consultation.

Consultation has always been a part of good medical practice, and a competent physician should not be insulted if you decide to get further advice. If you do want a second opinion, here are some things to remember:
 
(1) Seek Qualified Advice. A consultation is not worth much unless it is given by someone with the knowledge of and expertise in treating your condition. Always seek consultation from a surgeon who is a qualified surgical specialist. A good way to judge a surgeon's qualifications is to find out if he or she is certified by a surgical board that is approved by the American Board of Medical Specialties. By choosing a consultant who is board certified in the appropriate surgical specialty, you know that he or she has completed years of residency training and practice in his specialty and has demonstrated his competence by successfully completing a rigorous examination.

And, if the surgeon is a Fellow of the American College of Surgeons (F.A.C.S.), you will know that he or she has passed a thorough evaluation of both professional competence and ethical fitness. Fellows are board-certified surgeons, or, in unusual circumstances, have met other standards comparable to those of board certification.

If you are unsure of a surgeon's qualifications, contact your family doctor, your local or state medical society, the hospital where the surgeon practices, or the surgical department of the nearest medical school. They should be able to tell you if your surgeon is board certified and/or a Fellow of the American College of Surgeons.
 
(2) The Decision is Yours. Remember, a second opinion is not necessarily better than a first opinion and, whether there is agreement or disagreement, the final decision will be yours. It's a decision that should be made with all the facts, so don't hesitate to discuss with your surgeon any questions or concerns you may have.

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(Reprinted with permission, American College of Surgeons, 2004)