Questions to Ask…
1. Are you a diplomate of the American Board of Ophthalmology?
The American Board of Ophthalmology requires completion of an accredited residency and evaluates each candidate’s cognitive skills through both vigorous written and oral examinations. Certification by the American Board of Ophthalmology is the best guarantee that your eye surgeon is well trained in the diagnosis and treatment of eye disease.
2. Are you a member of the Society for Excellence in Eye Care?
The Society for Excellence in Eye Care is a voluntary educational organization, open only to surgeons who have practiced several years that are highly recommended by their peer group. Along with the American College of Eye Surgeons, the Society for Excellence in Eye Care presents an international perspective on the latest development in eye surgical technology and technique. Membership in this elite group of anterior segment surgeons is a mark of the surgeon’s willingness to embrace new technologies for the betterment of his or her patients.
3. Are you certified by the American Board of Eye Surgery?
Although the qualifications for the American Board of Ophthalmology include a completed residency with 25 cataract cases performed, the American Board of Eye Surgery (ABES) actually reviews 50 consecutive surgical procedures and assesses the indications, appropriateness, and the visual outcomes of surgery. Qualified candidates then have 5 videotaped surgeries evaluated by a panel of surgical examiners to confirm that the surgeon is using contemporary techniques and is skillful in his surgical approach. The reviewers have no knowledge of the surgeon’s identity, eliminating bias and underlining the objectivity of the process. In addition, the American Board of Eye Surgery requires each surgeon to be recertified every 7 years to ensure that the surgeon has updated his surgical skills and has kept pace with technological advances.
ABES CERTIFICATION …VITAL FOR O.D.s, AS WELL?
John A. Jones, O.D.
Jackson, KY
An ophthalmic surgeon wrote to me recently and stated, “I would like to clarify your obvious misunderstanding with regards to the American Board of Eye Surgery.” He “took exception” to the letter which I wrote to a patient. I had referred the patient to an ABES certified ophthalmic surgeon for cataract evaluation, but she failed to keep her appointment. I was not surprised, because the patient was very anxious regarding the need for eye surgery, and I wanted to reassure her. In my letter, I praised the surgeon’s considerable expertise and mentioned that he is the only ophthalmic surgeon in our area who is certified by the ABES. I had been aware of the surgeon’s superlative surgical skills for several years prior to his ABES certification, so being able to describe that accomplishment simply reinforced my sincere opinions. For some reason, my patient decided to seek an opinion from another surgeon who was not ABES certified. Evidently she asked the doctor about ABES certification and also showed my letter to him. Her questions must have bothered him a lot. His letter stated, “The important point is that the American Board of Eye Surgery is not recognized by the American Board of Ophthalmology and, to this date, is still considered a board created by several ophthalmologists to try to corner the market of cataract and implant surgery.”
I prefer to use simple and common examples and analogies when explaining what can be difficult to convey via other methods. When discussing ABES certification with a patient, I often explain the difference between generic “board certified ophthalmologists” and ABES with an analogy that is intended to avoid negative connotations. I compare surgeons who have standard board certification to collegiate level athletes. I explain that most collegiate athletes must be very talented to participate at that level of competition. In the same way, most board certified surgeons are very good surgeons. Few of the many very talented collegiate athletes can make it into the “pros”. I recently heard the number who do is less than 2%. ABES certified cataract surgeons are the “pros” among ophthalmic surgeons. They share the profession with a larger, very talented group of practitioners, but differ in that they have the necessary skills and willingness to voluntarily submit to a certification process which goes a very significant step beyond the standard cognitive-based certification. ABES certification includes evaluation of surgical ability and results.
I was genuinely surprised when I first learned the generic “board certification” does not include some type of practicum. The residency program does that, you say! Maybe, but the residency programs are certainly not all equal regarding quality or quantity of the surgical experience. Most of my patients are amazed when they hear that generic board certification does not involve a process similar to ABES certification. An optometrist has no right to say such things, you say! But I do, you see. I underwent squint surgery at the age of four, and remain a potential patient for future ophthalmic adventures, such as cataract surgery in a couple of decades or so-if cataracts are not treated medically by then. Even more to the essence of the discussion, I have eighteen years experience looking through a slit-lamp and have provided co-managed, true post-op care (no “add-on” visits) for approximately nine years. I know the difference between excellent surgery, fair surgery, and assault with a surgical weapon.
There are other analogies which I find useful and experiences which have influenced my opinions. I have experienced the very important difference between cognitive-based tests and those which test both knowledge and actual skills. I “qualified” on a Sturgeon class nuclear attack submarine in 1970. Becoming a qualified submariner is comparable to the military pilot earning his wings, except the submariner earns “dolphins”. Because the sea forgives even fewer errors than the air, a novice crew member’s shipmates take his certification process very seriously. When certified, you not only KNOW, but you can DO, in amazing circumstances, where mistakes can be fatal for oneself and ninety-nine others.
In 1986, I earned my private pilot license. Following ground school, a pilot-to-be has to pass a written examination. After a certain amount of requisite flying experience, a student pilot must pass the “check ride” or final flight test. The flight examiner who accompanied me during my flight test evaluated both my aeronautical knowledge and actual PERFORMANCE. Again, cognitive ability was important and necessary, but of little value without proof of the necessary skills. The practicum was an actual flight, and nearly flawless performance was required to pass.
Hopefully, these examples demonstrate why I think the ABES certification is truly meaningful. Some reasons are theoretical, but experience has consistently confirmed the results. The patients who take my advice regarding my referral to an ABES certified cataract surgeon generally demonstrate much quieter and prettier-looking post-surgical eyes, with faster healing and minimal complications compared to those who decide to obtain their surgery elsewhere. Those who decided to go elsewhere for their surgery seem to base their decision on a referral that a friend or relative made, due to emotional and illusory factors, such as, “I like Dr. Smith and my neighbor’s daughter-in-law works in his office.” Dr. Smith certainly has charisma and outstanding marketing ability, but tragically, he is a mediocre cataract surgeon. Too many of his patients seem to suffer significant post-op complications, yet he is able to maintain a large following. I think the “Dr. Smiths” out there probably blanch at the thought of a third party, such as the ABES, reviewing the records of fifty consecutive surgical patients.…
I have wondered how the surgeon who wrote me to, “clarify my obvious misunderstanding regarding ABES certification,” would feel if he heard the following announcement just after take-off aboard a commercial jet:
“Ladies and gentlemen, this is your pilot, and we welcome you aboard flight 666, which is supposed to land in Dallas later today. This is going to be a real experience for me because it is actually my first time to fly an airplane all by myself. I spent the last three years watching other pilots flying airplanes, and I got to help some. I did pass my written test with a very good score, so now I’m a certified airline pilot. The authorities have never figured out how to test our actual flying ability – for one thing, it is difficult to find passengers who are willing to pay to ride on airplanes flown by student pilots. This system has been used to teach flying since 1903, and most of the pilots do just fine, so relax and enjoy the flight. We will try to get you to Dallas, unless I forget some of the complicated navigation stuff, which was way back in the first year of our training, now that I think of it … Oh well, have a nice day.”
If the doctor would be uncomfortable as a passenger aboard chat mythical aircraft, and he would be, then why should he be upset when the patient asked if HIS certification process included a practicum following his residency program! He just doesn’t get it.
