What is the (ABHRS) American Board of Hair Restoration Surgery?

[Pat - Community Publisher]

Both patients and ethical physicians share the common goal of elevating the standards of the hair restoration profession. While this patient based community provides a forum for sharing and analyzing real results and the physicians who provide them, many physicians have worked to establish educational standards for the hair transplant profession.

 

The most prominent effort by physicians to set standards and criteria for state of the art hair transplantation and practices has been the American Board of Hair Restoration Surgery (ABHRS) . This non profit organization is managed by hair restoration physicians and certifies physicians as "Diplomates" after they successfully demonstrate a high degree of knowledge about current hair transplantation by passing an extensive written and oral examination.

 

Dr. Bernie Nusbuam Dr. Bernie Nusbuam, who is a very respected member of the Coalition of Independent Hair Restoration Physicians, will be assuming the Presidency of the ABHRS. I asked him to provide our community with more information about the ABHRS certification process and what it means. As he himself states, the ABHRS certification does not insure competence. But it does at least certify that ABHRS Diplomates have a demonstrated high level of understanding of current hair transplantation techniques and practices.

 

The information Dr. Nusbuam provided to me is presented below:

 

American Board of Hair Restoration Surgery (ABHRS) Update

 

As a Coalition Physician and the incoming president of the ABHRS, I would like to inform the members of this community about this organization. Ten years ago, representatives from societies whose members perform hair restoration surgery (the American Academy of Cosmetic Surgery, the International Society of Hair Restoration Surgery, the American Academy of Facial Plastic and Reconstructive Surgery and the American Society of Dermatologic Surgery) established their commitment towards a process which would measure physicians' knowledge with regard to the safe and aesthetically sensitive practice of hair restoration. Their goal was to create a relevant, credible, unbiased examination that would help the profession and the public identify physicians who had attained a particular fund of knowledge in this regard. These founders selected a group of experienced hair transplant surgeons who were granted AB HRS certification and composed the first written and oral examinations which were administered in 1997. Since then, with the help of physicians who have passed the exam, a yearly oral and written examination has been developed and administered under the direction of a psychometric consultant (a Ph.D. who specializes in examining the reliability of standardized tests).

 

The written examination consists of 200 questions and the oral examination presents the candidate with three difficult cases in front of two examiners. Topics covered include not only general principles and surgical technique, but , among others, proper aesthetics, repair techniques, medical therapy, management of complications, safe administration of anesthesia, identification of hair loss diseases that should not be transplanted as well as emergency management in the hair transplant setting. To date, 124 candidates representing 12 countries have been certified (given Diplomate status). Board certificates are time- limited, meaning that Diplomates, (including those who wrote the original test and did not take the examination) have to recertify every 10 years with strict Maintenance of Certification requirements in order to maintain their certification status. These requirements involve: 1) maintaining an unrestricted medical license and notification to the board of any current or past disciplinary actions 2) continuing medical education of at least 100 hours every three years of which 50% must be specifically hair related 3) passing a recertification exam (the first recertification exam is being given in September of this year and I will be one of the Diplomates who passed the exam in 1997 and will be taking the recertification exam this year) and 4) evaluation of practice performance by providing patient records for peer review.

 

The ABHRS has also implemented regulations about how Diplomates can present their certification status in advertising or promotional materials. Diplomates have to comply with their local and state medical board regulations and cannot embellish their certification in any way. Diplomates who have misused their certification status in this regard have received notification demanding that they stop, or otherwise forfeit their certificates.

 

There was some initial negativity towards the ABHRS and some criticism still exists. Some feel that the term "Board" was not a good choice because the ABHRS is not an ABMS (American Board of Medical Specialties) recognized board. Perhaps "subspecialty certificate" would have been a better choice but at least "board certification" is a term that everyone understands. Examples of ABMS recognized boards are the American Board of Dermatology, the American Board of Plastic Surgery and the American Board of Facial Plastic and Reconstructive Surgery. The ABMS system involves a minimum three year residency program and a subsequent examination. In a residency program, faculty members can evaluate a candidate for three years or more prior to the examination process. Unfortunately, at the present time, there are no residency programs devoted to hair restoration that can train and produce a competent hair restoration surgeon. In addition, there are no ABMS boards with an examination dedicated to hair restoration. I should mention that meetings have taken place with the ABMS and the American Board of Dermatology to discuss board certification in hair restoration surgery that would be ABMS recognized. While this may never be achieved, initial discussions were encouraging and efforts towards this goal will continue.

 

A responsible field should stimulate its members to reach a higher educational level and knowledge base and then identify these physicians to the public .Since we do not have this option through the ABMS, the ABHRS is the best possible solution at this time. I have great respect for many of my colleagues who are excellent surgeons and leaders in the field of hair restoration who may or may not be certified by an ABMS board and do not feel the need to take the ABHRS exam. Many of us, however, who are ABMS board certified in other fields, felt that, achieving ABHRS certification was an important way to demonstrate our dedication and commitment to our patients and to the field of hair restoration. I can frankly state that the extensive time that I spent studying and preparing to take the ABHRS exam was one of the most rewarding educational experiences during my 25 year career with respect to gaining knowledge in this field and becoming a well-rounded hair restoration surgeon.

 

Does ABHRS certification insure competency? Absolutely not! Also, as I mentioned earlier, there are top-flight physicians who are among the best hair restoration surgeons who are not ABHRS certified. Interestingly, 24 of the recommended surgeons on this site are ABHRS certified and 8 of us sit on the ABHRS Board of Directors. In 2005, the ISHRS, which is the largest educational society in hair restoration, conducted a survey of its members who were NOT ABHRS certified. With a 30% response rate, 70% of the responders felt that board certification is important to the field of hair restoration surgery and 72% indicated that they would like to be certified. 90% indicated the ABHRS is trying to serve the public and the profession.

 

Just as the ISHRS provides the educational "arm" of this field, the ABHRS, through its efforts in providing a credible examination, serves as one component of the overall process and goal which we are all striving towards , that is, to improve the quality of our results and, in turn, help prospective patients.

 

Thank you,

 

Bernard Nusbaum, M.D.

[Pat - Community Publisher]

Both patients and ethical physicians share the common goal of elevating the standards of the hair restoration profession. While this patient based community provides a forum for sharing and analyzing real results and the physicians who provide them, many physicians have worked to establish educational standards for the hair transplant profession.

 

The most prominent effort by physicians to set standards and criteria for state of the art hair transplantation and practices has been the American Board of Hair Restoration Surgery (ABHRS) . This non profit organization is managed by hair restoration physicians and certifies physicians as "Diplomates" after they successfully demonstrate a high degree of knowledge about current hair transplantation by passing an extensive written and oral examination.

 

Dr. Bernie Nusbuam Dr. Bernie Nusbuam, who is a very respected member of the Coalition of Independent Hair Restoration Physicians, will be assuming the Presidency of the ABHRS. I asked him to provide our community with more information about the ABHRS certification process and what it means. As he himself states, the ABHRS certification does not insure competence. But it does at least certify that ABHRS Diplomates have a demonstrated high level of understanding of current hair transplantation techniques and practices.

 

The information Dr. Nusbuam provided to me is presented below:

 

American Board of Hair Restoration Surgery (ABHRS) Update

 

As a Coalition Physician and the incoming president of the ABHRS, I would like to inform the members of this community about this organization. Ten years ago, representatives from societies whose members perform hair restoration surgery (the American Academy of Cosmetic Surgery, the International Society of Hair Restoration Surgery, the American Academy of Facial Plastic and Reconstructive Surgery and the American Society of Dermatologic Surgery) established their commitment towards a process which would measure physicians' knowledge with regard to the safe and aesthetically sensitive practice of hair restoration. Their goal was to create a relevant, credible, unbiased examination that would help the profession and the public identify physicians who had attained a particular fund of knowledge in this regard. These founders selected a group of experienced hair transplant surgeons who were granted AB HRS certification and composed the first written and oral examinations which were administered in 1997. Since then, with the help of physicians who have passed the exam, a yearly oral and written examination has been developed and administered under the direction of a psychometric consultant (a Ph.D. who specializes in examining the reliability of standardized tests).

 

The written examination consists of 200 questions and the oral examination presents the candidate with three difficult cases in front of two examiners. Topics covered include not only general principles and surgical technique, but , among others, proper aesthetics, repair techniques, medical therapy, management of complications, safe administration of anesthesia, identification of hair loss diseases that should not be transplanted as well as emergency management in the hair transplant setting. To date, 124 candidates representing 12 countries have been certified (given Diplomate status). Board certificates are time- limited, meaning that Diplomates, (including those who wrote the original test and did not take the examination) have to recertify every 10 years with strict Maintenance of Certification requirements in order to maintain their certification status. These requirements involve: 1) maintaining an unrestricted medical license and notification to the board of any current or past disciplinary actions 2) continuing medical education of at least 100 hours every three years of which 50% must be specifically hair related 3) passing a recertification exam (the first recertification exam is being given in September of this year and I will be one of the Diplomates who passed the exam in 1997 and will be taking the recertification exam this year) and 4) evaluation of practice performance by providing patient records for peer review.

 

The ABHRS has also implemented regulations about how Diplomates can present their certification status in advertising or promotional materials. Diplomates have to comply with their local and state medical board regulations and cannot embellish their certification in any way. Diplomates who have misused their certification status in this regard have received notification demanding that they stop, or otherwise forfeit their certificates.

 

There was some initial negativity towards the ABHRS and some criticism still exists. Some feel that the term "Board" was not a good choice because the ABHRS is not an ABMS (American Board of Medical Specialties) recognized board. Perhaps "subspecialty certificate" would have been a better choice but at least "board certification" is a term that everyone understands. Examples of ABMS recognized boards are the American Board of Dermatology, the American Board of Plastic Surgery and the American Board of Facial Plastic and Reconstructive Surgery. The ABMS system involves a minimum three year residency program and a subsequent examination. In a residency program, faculty members can evaluate a candidate for three years or more prior to the examination process. Unfortunately, at the present time, there are no residency programs devoted to hair restoration that can train and produce a competent hair restoration surgeon. In addition, there are no ABMS boards with an examination dedicated to hair restoration. I should mention that meetings have taken place with the ABMS and the American Board of Dermatology to discuss board certification in hair restoration surgery that would be ABMS recognized. While this may never be achieved, initial discussions were encouraging and efforts towards this goal will continue.

 

A responsible field should stimulate its members to reach a higher educational level and knowledge base and then identify these physicians to the public .Since we do not have this option through the ABMS, the ABHRS is the best possible solution at this time. I have great respect for many of my colleagues who are excellent surgeons and leaders in the field of hair restoration who may or may not be certified by an ABMS board and do not feel the need to take the ABHRS exam. Many of us, however, who are ABMS board certified in other fields, felt that, achieving ABHRS certification was an important way to demonstrate our dedication and commitment to our patients and to the field of hair restoration. I can frankly state that the extensive time that I spent studying and preparing to take the ABHRS exam was one of the most rewarding educational experiences during my 25 year career with respect to gaining knowledge in this field and becoming a well-rounded hair restoration surgeon.

 

Does ABHRS certification insure competency? Absolutely not! Also, as I mentioned earlier, there are top-flight physicians who are among the best hair restoration surgeons who are not ABHRS certified. Interestingly, 24 of the recommended surgeons on this site are ABHRS certified and 8 of us sit on the ABHRS Board of Directors. In 2005, the ISHRS, which is the largest educational society in hair restoration, conducted a survey of its members who were NOT ABHRS certified. With a 30% response rate, 70% of the responders felt that board certification is important to the field of hair restoration surgery and 72% indicated that they would like to be certified. 90% indicated the ABHRS is trying to serve the public and the profession.

 

Just as the ISHRS provides the educational "arm" of this field, the ABHRS, through its efforts in providing a credible examination, serves as one component of the overall process and goal which we are all striving towards , that is, to improve the quality of our results and, in turn, help prospective patients.

 

Thank you,

 

Bernard Nusbaum, M.D.

[Dr. Alan Feller]

Dr. Nusbaum, I would like to congratulate you on your appointment as president of the ABHRS. I have little doubt that your members enjoy great fellowship and physician education. Any organization that pushes us to excel is a worthwhile one, but I must ask that you, as current president, to finally change the name of your organization.

 

As you pointed out, the American Board of Hair Restoration Surgery (ABHRS) is not recognized as a true Board by the American Board of Medical Specialties (ABMS) . As such, the inclusion of the word Board is misleading, unnecessary, and confusing to the public you seek to serve and protect.

 

Furthermore, referring to your members as "Board Certified" or "Diplomates" further confuses the public by falsely conferring a professional status they did not earn and is not even available.

 

Since the ABHRS has no power, no authority, and no recognition, and is really just a club of volunteers willing to take an initiation test, wouldn't it be less confusing to rename yourselves the American Club of Hair Restoration Surgery (ACHRS)?

 

I'm not quite sure what the purpose of the ABHRS actually is because it has never been adequately articulated. Personally, I've always seen it internally as an excellent forum for the exchange of medical information by motivated doctors, but outwardly as nothing more than a marketing gimmick and an attempt to somehow make members seem "elite" to a lay public. If the word "Board" were not in the name, then I would have no such criticism and would join the organization myself (assuming I could pass the initiation requirements of course).

 

For the ABHRS to have purpose as anything other than a marketing tool, in my opinion, it would have to offer something the other established organizations don't already. We all know that fellowship and medical education are covered by at least four other organizations, so nothing exclusive there. So what is exclusive to the ABHRS?

 

At best an argument for "watchdog" status could be made, but even here the ABHRS falls way short by virtue of the fact that they don't physically watch members perform surgery and then evaluate them. Academic knowledge and testing is nice, but it doesn't translate into technical skill. I've read books on tennis and memorized them, but I am still a lousy player on the court. I could pass any test on paper, but not necessarily in the real world.

 

What the public needs is not a self proclaimed elite organization dedicated to teaching what is already available in other venues; but a watchdog group that quantifies the skills of each doctor and make that information public on a consistent basis. A pass/fail test on paper every ten years will not give the public the information it needs to make truly informed decisions. Consistently good results will, and it is websites like HTN that provide the platform for such consistent evaluation. No "Board" needed.

 

The Coalition of Surgeons, in my opinion, can do more to evaluate good physicians than any psychometric test ever could, and it is in this direction that a qualifying body (like the ABHRS is attempting to be) should proceed. I mean this sincerely.

 

The regular posting of patient photos and commentary is far more valuable to the public than any oral exam given in the conference room of a hotel, because now the public and potential patients are actually part of the process. Because such evaluations are constantly occurring in near real time, the Coalition doctors will always stay on their toes and give each surgery their very best. Add to this the fact that as a Coalition member your door must always be open to Pat for on site inspection and you now have a layer of evaluation that simply doesn't exist in the most elite and selective of organizations.

 

I hope as the new president of the ABHRS you will give these comments sincere thought and move to strike the word "Board" from the name. I look forward to any comments or reply you may want to make as this is an important topic for me and the other doctors who, although qualified, have resisted joining your organization thus far.

 

All the best,

 

Dr. Alan S. Feller

[Bill - Seemiller]

From a patient perspective...

 

Though I am the Associate Publisher and Co-Moderator of this community, I am still a patient first having been through 3 hair transplants myself. So when I read the information above I think like a patient above all else.

 

In my opinion...

 

This ABHRS certification seems to demonstrate physician dedication to the hair restoration industry and I am glad of this.

 

But if these written and oral tests don't assure competence (which Dr. Nusbaum admitted as an ethical and sound physician would) ??“ these credentials mean absolutely nothing from a patient perspective.

 

What concerns me is that it's one more "credential" that can be used by incompetent hair restoration surgeons as a form of self validation.

 

Quality and poor hair restoration physicians alike can pass these tests and obtain a certificate. So if this credential does not necessarily separate the good, the bad, and the ugly - indeed it becomes meaningless.

 

What saddens me more is the thought of novice perspective patients being taken in by this. It looks good on a doctor's resume but in reality from a patient perspective doesn't mean anything.

 

I fear this "credential" will be marketed by unethical physicians as a means solely to draw in prospective patients.

 

That nice thing is that I know that Dr. Nusbaum (as well as the other well respected physician members of our coalition) are dedicated to patient satisfaction by continually improving their surgical techniques. So I am sure that Dr. Nusbaum will do everything he can to assure this certification's proper use.

 

Cheers,

 

Bill

[Michaellovesnyc]

The real thing that discredits the HT industry is that Bosley guy. Here is a guy who actually lost his medical license and if you ask anyone for the name of a HT doctor his is the first name to always come up (his clinician doctors do the operations since he can't). He was the first I went to and thanks to this board and Bosley's sleazy and degrading sales pitch, I didn't do it with him. Why can't something be done about him (besides the massive amounts of lawsuits against him)? Can't his business be sanctioned by the medical industry somehow? Its great that we have the Hair Transplant Network and others to provide some certifications, but how do we get the monsters out of business that really ruin people's lives?

[erldette]

What is the difference between the ABHRS and the American Board of Hair Transplant Surgery ?

[Dr. Alan Feller]

Both the ABHRS and the ABHTS are CLUBS founded by doctors. Neither of these clubs has any power, recognition, or authority of any kind.

 

By improperly using the word "board" in their name, the ABHRS set out to create an entity that would be perceived by the public as "elite". It's founding members shamelessly and arrogantly "grandfathered" themselves into their club, but expected others to jump through their hoops to attain an unrecognized status of "board certification"-and to pay for the privilege as well. Several of this group's first members produced some of the most horrific results in hair transplant history. In my view, the ABHRS represented nothing more than a power grab by group of "good ole boys" that had to be opposed.

 

I founded the American Board of Hair Transplant Surgeons (ABHTS) as a direct response to New York ABHRS member's who practiced deceptive advertising and fraud by falsely advertising "Board Certified" in their advertising. Their favorite phrase was "Board Certified Hair Transplant Surgeon" and it was meant to imply that they had greater training and ability than supposed non-board certified doctors.

 

As I predicted, and made clear to the founding president of the ABHRS, the use of the term "Board" would be abused by their members and used as a marketing tool to imply an unearned "elite" status. Sure enough this came to pass right after the first ABHRS club members were initiated. Two of my closest competitors at the time illegally placed "Board Certified" on their advertising in an effort to con the public. I reported them.

 

When I contacted the New York State medical authority and reported this abusive practice they told me that these doctors would be stopped...but not entirely. What you are about to read is the only reason the ABHRS has been able to keep the word "Board" in their name and continue misleading the public.

 

According to New York State authorities, it is NOT illegal to form an organization and call it a "Board". The person I spoke to said that it is not ETHICAL to do so, but it is also not illegal. What WAS illegal was simply placing the phrase "Board Certified" on their advertisements without specifying what organization they were talking about. So all ABHRS members had to do was include in their advertising the following: "Board Certified by the American Board of Hair Restoration Surgeons" and they couldn't be touched. As long as they included the organizations name, they were fine to claim "board certification" status even though they were not and are not American Board of Medical Specialties(ABMS) recognized.

 

Since there was nothing stopping ABHRS members from using the "Board" terminology, I was left with no choice but to create my own "Board" to level the playing field. The only difference was that members of my "Board" would be accepted and evaluated on their actual technical skill DURING actual surgeries. I would travel to their offices, or they would travel to mine. Eventually, our members traveled to each others offices.

 

I founded the ABHTS with 3 Board Certified facial plastic surgeons and one board certified general surgeon. I founded it as a CLUB, but used the word "Board" just as the ABHRS does.

 

A few years ago I received an email from an anonymous doctor who was part of a group of doctors who regularly emailed each other about various hair transplant issues. Several of them were ABHRS club members who learned of my ABHTS club. I almost fell off my chair with laughter as these hypocrites were sniping to each other about how what I was doing was illegal and unethical and how they were going to report me to the New York State medical authorities and take me into civil court. I say I was laughing because all I did was to copy exactly what they did. I knew they couldn't levy any charge at me that they themselves weren't guilty of so I looked forward to the confrontation. In fact, I couldn't wait for it.

 

I phoned the biggest instigator in the email group, he knows who he is (an east coast doctor), and asked him why he was concerned with anything I do in the first place. Did he think I was such a competitive threat? When he tried to insinuate that the use of the word "Board" in my club's name was illegal I informed him, to his surprise, that it was the New York State medical authorities who gave me the green light for the formation of my club in the first place. I informed him that what gave the ABHRS the right the use the term "board" in their club's name was exactly the same thing that allowed me to do the same for the ABHTS. I reminded him that while he may succeed in fooling the public that his organization was a recognized subspecialty "board", I knew it was really just a bunch of doctors who formed a club trying to pretend they were something they were not.

 

So if he wanted to stir up some trouble with the state to have the word "board" removed from my organizations name, then it would also have to be removed from their name as well. I offered to dissolve my club, or change the name, if they would simply change their name. That was the last time I had any trouble with the ABHRS and the last time I heard from them. They obviously have NOT changed their name, even though incoming president Nusbaum knows it is still a major point of contention.

 

I spent the next few days reporting to the medical authorities of several states the severe abuse and fraud being practiced by ABHRS members and they responded by contacting members and stopping them from the illegal practice. It was this effort on my part and that of many other doctors that put the ABHRS on the run as far as using it for marketing tactics. Dr. Nusbaum even noted in his post that they keep a lid on their members misuse of their club's name. This is the direct result of our efforts.

 

Since then the ABHRS have reined in the abuse of the word "board" and so I allowed my club to fade into the background. Our current members are still close friends and we still visit each other to update our skills and test each other. The formation of organizations like the Coalition of Surgeons and the International Alliance of Hair Restoration Surgeons (IAHRS) picked up where the ABHTS left off because their platforms could do a far better job of exposing a surgeon's TRUE abilities to the public.

 

So the question should not be what the difference between the two clubs are, but rather why the ABHRS insists on continuing to use the term "board" in their name?

[something]

No offense doctor, but you must also understand the hypocrisy of your own actions. To form a club to counter another while still using the word "board" which you find offensive might level the playing field, but nevertheless, works counter to your own argument.

[Dr. Alan Feller]

Something:

 

You are correct, it is very hypocritical, but this action took some of the wind out of the sails of the ABHRS by showing the public that ANYONE can form a supposed "qualifying body" and simply call themselves a "board". My activities also alerted the states to the deceptive advertising practices used by ABHRS members. The only way to fight fire, I found, was to use fire.

 

Since the members of my board were qualified based on demonstrated surgical skill I felt my organization had a significant advantage if we were ever to be compared by an official body. In time, however, such official comparisons were not to be made and a new and powerful force came into it's own to eclipse us both: the internet. In fact, the internet made the ABHRS obsolete as a marketing gimmick and thus also obviated the purpose of my ABHTS.

 

The internet gives the public the power to truly and substantively judge each doctor for themselves, and believe me, there are many doctors who run from the light of the internet-ABHRS members included. Nothing, and I mean nothing, has cleaned up the HT field more than the internet.

 

Proof of this position is provided by the very members of the ABHRS themselves who've sought to join the ranks of the Coalition of Surgeons and the IAHRS in droves. These doctors have realized that a designation of "board certified" after their name is simply not as credible as having the backing of one of these internet consumer organizations-at least not anymore.

 

I want to make it clear that I am NOT anti-ABHRS. I am just against the use of the word "board" in their name. As I've written elsewhere, any organization that allows for fellowship and exchange of ideas is inherently good and one I would normally want to be a part of.

 

I think most of the ABHRS members are motivated doctors who truly want to be great at what they do. When I was asked by a high profile ABHRS member to open my office to a visiting "fellow" so that he may learn FUE as well as my strip method, I threw the door open wide and invited him in. The experience was an enjoyable one for both of us and I look forward to offering what I can to other members in the future.

 

The bottom line is that the public must understand that letters at the end of a doctor's name does not necessarily mean they are competent. Dr. Nusbaum noted that in his post. Rather, each doctor should be judged on his RESULTS as demonstrated by regular photos and patient commentary on sites such as HTN.

 

The public can rest assured that all doctors practicing medicine have proved both academic and surgical competency and that the power of the state will continue to watch and regulate doctors throughout their careers. There is no need for the formation of a body like the ABHRS whose goal is simply to attain such power just to do the same thing.

 

If you want to talk about hypocrisy, all you have to do is look to the ABHRS. They purport to be working to better the field of hair transplantation, but their main goal is to obtain recognition from the ABMS in an effort to grab power. THEY want to become the main authority in the field and dictate the way THEY think hair transplantation should be performed. Such power placed into the hands of those who seek it will only strangle the field and mire it down.

 

If you are not sure of this, go and look at some of the hideous work that was being produced by some of the founding members of this group and realize that they would make THAT the forced standard in the industry. With such men in power there would be no dense packing, no megasessions, no FUE and no participation on the internet.

 

You read that last line right, internet participation on the part of it's members would be forbidden. Several of the founding members were quite vocal about prohibiting not just their own members, but ISHRS members as well from using the internet chat forums. See what happens when a small group even thinks it will get power...free speech is throttled. I'm sure Pat remembers this time very well.

 

If the ABHRS does not prove competency, has no method to prove competency, and does not even have a plan to demonstrate a physicians ability any better than the internet does right now, then what is the point of this organization. Furthermore, why are they still looking to grab power?

 

There is no need for a "board" of hair transplant surgery and it should be thrown off before it gets a chance to take root. Any group that seeks to reduce the freedoms of practicing physicians and thereby cause stagnation in the hair transplant field should and must be opposed. Thankfully, the ABMS has rejected the ABHRS and hopefully they will continue to do so.

[erldette]

Dr. Feller,

If there is no need for a hair restoration board, is there a need for other medical speciality boards?

[Dr. Alan Feller]

erldette,

 

YES, there is a need for other medical specialty boards because unlike the case for cosmetic surgery, the public can't see or evaluate individual patient results for themselves.

 

You may have to be a doctor who is specially trained in a field like general surgery or radiology to accurately critque a physician's ability because it takes specialized knowledge to know what to look for.

 

However, in cosmetic surgery physician ability should be self evident. Either the patient looks good or he doesn't. Nothing else really counts as long as the good health of the patient is maintained.

[beachair]

It's really common sense for the consumer: "let the buyer beware."

Take yourself back 20 years, and your being led by flashy advertising, false promises, and blind hope.

With internet discussion groups, such as this, there is no reason for someone to have unsatisfactory results. That is, unless one has unrealistic expectations.

[rp1979]

There was some initial negativity towards the ABHRS and some criticism still exists. Some feel that the term "Board" was not a good choice because the ABHRS is not an ABMS (American Board of Medical Specialties) recognized board. Perhaps "subspecialty certificate" would have been a better choice but at least "board certification" is a term that everyone understands. Examples of ABMS recognized boards are the American Board of Dermatology, the American Board of Plastic Surgery and the American Board of Facial Plastic and Reconstructive Surgery. The ABMS system involves a minimum three year residency program and a subsequent examination. In a residency program, faculty members can evaluate a candidate for three years or more prior to the examination process. Unfortunately, at the present time, there are no residency programs devoted to hair restoration that can train and produce a competent hair restoration surgeon. In addition, there are no ABMS boards with an examination dedicated to hair restoration. I should mention that meetings have taken place with the ABMS and the American Board of Dermatology to discuss board certification in hair restoration surgery that would be ABMS recognized. While this may never be achieved, initial discussions were encouraging and efforts towards this goal will continue.

 

Alluding to the points bolded in the above quotation:

 

What will it take to start a hair restoration residency program as well as an ABMS board with an examination devoted/dedicated to hair restoration?

 

At the present time, what ABMS-recognized medical specialty is "most" closely related to hair restoration according to the ABMS? The above quote seems to imply that it's Dermatology?

[erldette]

I'm still confused, as long as a doctor produces good results a patient shouldn't care about their training or medical background.

[Dr. Alan Feller]

RP,

There is no point in establishing a residency in hair transplantation because the field as a whole is not as complex as, say, general surgery or radiology. Any doctor CAN do it IF they are detail oriented, disiplined, and a self starter. This is the general profile of all successful HT doctors. No residence or board exam required.

 

HT doctors whose work is posted on the internet are "tested" and graded everyday so there is no need for a powerless board to give a test every 10 years is there?

 

I agree with erldette. In so far as HT is concerned, as long as the doctor is licensed and produces good work it doesn't matter what letters he has at the end of his name. Such is not necessarily the case for other specialties, but for HT I believe it is.

 

I await a response from Dr. Nusbaum concerning this thread and the continued use of the word "Board" in his organization.

[Dr. Michael Beehner]

I respect the opinions of the posters above, but wanted to simply make a few clarifying statements, since I have been closely associated with the American Board of Hair Restoration Surgery since its beginnings and feel I have a pretty good perspective on the role the Board has tried play for our profession. I was in the first class of 40 in 1997 who took the written and oral exams then. The criteria for sitting for the exam were much more stringent then. I was the chairman of the written examination committee for 5 years, and later served as President of the Board in 2005.

As Dr. Nusbaum so well outlined, the Board was started as a good-faith effort on the part of hair surgeons to show to the public and to various governing bodies (this is particularly true in other countries, where we have many diplomates)that we were willing to have some way of certifying that a physician at least possessed a good level of expertise and clinical judgement and was willing to be retested on a regular basis during his practice years.

The first requirement of an ABMS board is that there be a residency program requirement, except for the very first few years of any board, when they would allow men with many years of experience to "grandfather" in by simply taking the exams. The problem with hair transplantation is that almost everyone in the field except for a handful, first were trained in another speciality where they may or may not have achieved Board Certification by an ABMS Board. They then had a mid-career switch to hair surgery after becoming interested in it later in their professional life. It is not practical for a man or woman who is settled with children and a family and financial obligations to suddenly take 2-3 years of his life at very low pay to study hair surgery. The ABHRS thus becomes at least a measuring stick for competence that can be put before the public as some reassurance concerning knowledge and clinical judgement.

My biggest regret with regard to the Board, and one which Dr. Feller amply spoke about, is the mis-use in advertizing that some members of our Board have been guilty of over the years, which has created hard feelings and resentment. This has been clamped down upon severely in the last few years. For example, a doctor is forbidden to say something like "the only Board Certified hair surgeon in the area" or even "Board Certified" with regards to the ABHRS. We recommend following the California rules, by which the term "Board Certified" DOES refer to an ABMS board. Rather, we urge diplomates to simply state: "Diplomate: American Board of Hair Restoration Surgery".

Just like Dr. Nusbaum, the period of time leading up to my taking the Board exam was a wonderful push for me to increase my knowledge and expertise in our field, especially in the area of hair loss diagnosis - with regard to some of the other non-hereditary causes. I am boning up on these once again as I prepare to take my re-certifying exam 10 years later.

With regard to the original group of 15-20 doctors who started the Board and awarded themselves "Board Certification", they are now due to take the re-certification exam in Las Vegas at the ISHRS annual meeting in order to remain Board Certified as do those of us who were certified in 1997.

There is no truth in the statement that ABHRS members can't post on the internet in chat rooms or any thing of the sort. I certainly would have known about such a policy if it existed, since I've been on the Board of Directors or been an officer for most of the past 8-9 years. That has never come up or been mentioned to the best of my knowledge.

Yes, there is a problem in offering training to new doctors or mid-career doctors wanting to make a career change, who want to learn hair surgery. Many of these doctors, like Dr. Feller and myself, came to be interested simply because we went through the experience of being a patient and saw the tremendous self-esteem lifting it offered in our lives to go from a bald guy to one with hair. There does exist a fellowship experience with rigid guidelines which the ISHRS set up several years ago, and 10-15 people have gone through that, including a fellow I trained two years ago. Most of the groups or doctors offering this do so in order to gain a partner or member to their group. It is a very financially draining and exhausting physical task to undertake this for a year. The ISHRS is now working hard on creating a "modular" experience plus an on-line learning center with interactive CD's and live "webathons" for doctors to learn, while still maintaining their practice. In the past, the doctor with a strong desire to learn hair surgery simply read everything he could, went to as many meetings as he could, especially the ISHRS live surgery workshop in Orlando (the best of its kind), and then would visit as many kind-hearted doctors as he could to see how others did it, and then, if he or she was lucky, would persevere to the point that they eventually got the courage up to start treating patients.

I agree that Pat's site and the other independent web sites on the internet serve a valuable function in allowing patients to post their experiences and put it out there for people to see when making a decision. Pat takes this one step further by actually getting out in his little home/bus and watches first hand doctors doing their surgery. But, doctors themselves also have to take initiative in having their own educational bodies and certifying bodies. The International Society of Hair Restoration Surgery is the main educational hair body in the world, and does a lot of very worthwhile things for our profession: the annual meeting is open to all hair surgeons, with every manner of transplanting, where they can present their research and ideas in an open forum. We have The INTERNATIONAL HAIR TRANSPLANT FORUM, a every other month professional publication with articles and opinions in it. The American Board of Hair Restoration Surgery, on the other hand, is the certifying body in our field. The ISHRS this past year formally recognized the ABHRS as the only board certifying body for hair restoration surgery.

The last comment that I wished to address was the notion that the ABHRS favored some particular method of hair transplantation or had a bias against "megasessions." This could not be further from the truth and has never been a position I have been aware of. It is true, that as the years have passed and our field has changed, we have had to change a lot of the exam questions to have them reflect the current ways of doing things and to make sure they allowed for the different camps of hair transplant philosophies to be represented, such that an answer was never right or wrong based on whether you subscribed to doing megasessions or not. The exam has never been biased such that someone with a particular philosophy of hair transplantation was negatively affected taking the exam. In the oral portion of the exam in which clinical judgement if tested, as long as the examinee could back up his opinions and plans for a patient, they were valid.

So, in summary, I would simply ask that any of the lay public or physicians who haven't yet taken the opportunity to become part of the ABHRS, have an open, tolerant mind and try to make things better by working on the "inside" along with us. All are welcome. The ABHRS is not perfect, but it is a sincere attempt by hair surgeons to raise the standards of our field. If you go to <http://www.abhrs.org> you will see that the members comprise a great many respected hair surgeons.

Mike Beehner, M.D.

[Bill - Seemiller]

Dr. Beehner,

 

Thank you for your input.

 

I think hearing the other side will help keep this thread well balanced. I hope Dr. Nusbaum will add his two cents as well.

 

I want to reiterate that I think what the ABHRS stands for (a dedication to clinical excellence and patient dedication) is great. I believe this is true while this organization is under the authority of an ethical doctor like Dr. Nusbaum.

 

But patients need to be aware of a few things:

 

1. That this "certificate" does not validate a hair restoration's ability.

 

2. This "certificate" can and may be used as a marketing tool to draw in prospective patients which I think is a bad thing given that it doesn't

 

Unlike all other medical surgeries of necessity, cosmetic surgery is a patient choice driven business.

 

Most prospective patients however, are unaware of what they are getting themselves into and automatically trust a surgeon because they are a doctor. They must KNOW what they are doing if they are a doctor right? Unfortunately as seen a hundred times over on this forum, this is not true.

 

Likewise most prospective patients don't understand what these credentials really mean. But seeing "ABHRS Board Certified" sounds pretty damn impressive to the novice and they can easily be taken in by that.

 

Do you know how many people I've seen on this forum state that their doctor MUST be good because they are a "proud member of the IAHRS"?

 

I think for me...the bottom line is this: if indeed the ABHRS stands for clinical excellent and patient dedication, let's keep it real. I hope not to see doctors self promoting themselves with this certificate but using it as an "internal" means to better themselves rather than an "external" chance to promote themselves.

 

Cheers,

 

Bill

[Dr. Bernard Nusbaum]

I would like to thank those who have posted their views on this topic. To clarify a few points, I would like to state that the ABHRS is NOT dedicated to providing an exchange forum for medical information, or to being a watchdog organization. Those functions are well served by the ISHRS (educational) and the Internet forums. The sole purpose of the ABHRS is to provide a credible examination process to test whether physicians possess a certain body of knowledge in the field of hair restoration. So far, in its 10 years of providing its examination, the ABHRS has not been questioned with regard to the scope and fairness of its exam, or the integrity of the examination process itself. Certainly, there are differing opinions regarding whether this type of examination is necessary in the field of hair restoration and whether the term "board" should be utilized. I would like to assure you that I bring an open mind to any discussion.

 

On the other hand, it is my opinion that physicians who possess certain knowledge will be better prepared to successfully handle situations which might arise in the actual practice of hair restoration, and that, encouraging physicians to acquire this knowledge, in turn, will help patients. That is not to say that EXPERTISE in performing certain surgical techniques can be taught by books or tested with examinations. In this regard, I feel that regular posting of patient results and commentary to the public is crucial in educating patients with regards to physician expertise. I only ask the readers to have an open mind as well, and consider the DIFFERENT contributions that, medical education ,encouraging and testing physicians' knowledge as well as open Internet forums provide towards the common goal of improving patient results.

 

Thank you,

 

Dr. Nusbaum

[Dr. Alan Feller]

Dr. Beehner,

 

I also respect your opinion and comments very much and I hope all is well upstate. I imagine it won't be too long before the leaves begin to turn in your neck of the woods.

 

I do have a few questions I hope you can address, but first I want to make it clear that I had several conversations with a few original ABHRS members who made it clear to me directly that they wanted to prohibit doctors from using internet chat sites like this one. If you wish to you may call me anytime and I will tell you who said it, where it was said, and when it was said. I do not think you will be surprised.

 

I agree that the ABHRS serves an excellent and noble purpose for the reasons you plainly state in your email, but why must the word "board" be used? The ABHRS can offer all the education, testing, and certification it desires without using the word "board" can it not?

 

With respect, I believe the real reason your organization insists on using a word you know disturbs many doctors (and state government officials) is the fact that the ABHRS is seeking ABMS recognition. This concerns me and other doctors deeply. Why would the ABHRS bother to do this? What point does it serve? All the purported benefits that you mentioned in your email can still be offered WITHOUT attaining true board status, so why bother? I believe it's power for power's sake.

 

Here's the problem I see with the ABHRS becoming a TRUE board: The minute the ABMS recognizes the ABHRS many of its members will instantly claim "elite" status and use the now valid credential to "prove" it in MARKETING material. This is exactly what I predicted would happen when the ABHRS was first formed and it WILL happen again, but this time it will actually carry weight.

 

A two tier system of doctors will instantly be created. The "elite" board certified doctors and then the second class non-boarded doctors. This, of course, would exist without regard to actual ability and merit.

 

The next thing to go will be the freedom of established HT doctors to act independently because the board will create a recognized "standards and practices" that will have to then be recognized by the courts. This, in effect, would represent a coup in the field of hair transplantation whereby just a few men would control just how HT should be practiced "properly". By what standard would these men make their decisions? I don't agree with having my practice dictated to me by any collective of supposed "do-gooders" no matter what their initial intentions were, and neither should you.

 

I say megasessions, dense packing, and FUE would be locked out because many of the founding members were vocally against such procedures (again, call me if you want to know who they were). If they had the power to establish "standards and practices" they may have claimed such practices to be experimental, sub-standard, or even medical malpractice. Respectfully, I remember when even you, Dr. Beehner, were not such a proponent of dense follicular unit grafting as late as 2003 when I watched you perform a hybrid surgery of follicular units, minigrafts, and plugs. The method you chose to perform that surgery signified your overall philosophy at the time. When I showed you a photo of a patient I had dense packed you told me it looked impressive but that it wouldn't be thick because of the lack of larger grafts. I argued that because there were even more hairs in total over the bald area that not only would it be as thick, but that the skin would be less scared. You had your position, and I had mine. If you had been a recognized "board certified" hair transplant doctor and we opposed each other in a court room as experts for a lawsuit against a doctor who dense packed a dissatisfied patient, then you're view would have been recognized as dogma and my side would have lost the case. With that precedent set in the books- that would have spelled the end for dense packing. Who would ever perform it if a court case established it as sub-standard or worse? Get my point?

 

The very fact that I as an independent and established HT doctor would even have to concern myself with what some small officially sanctioned "elite" body of doctors thinks of how I run my private practice is anathema to me-and it's un-American. How could I have invented protocols, techniques and instrumentation for the FUE field if I had to waste time obtaining what would amount to "de facto" permission from "the board"?

 

Don't you see how the recognition of such a board could and will stifle innovation?

 

I understand that the ABHRS was founded in good faith by SOME founders, you among them. For others however, I believe it was just a marketing opportunity or some mixture of the two. Had these "others" been truly concerned with setting basic standards for our field they themselves would not have been guilty of producing some of the most hideous results known to the field.

 

I have to disagree that the ABHRS serves a purpose as a measuring stick of physician competence. While this may have become the public perception it just isn't valid. Ours is primarily a "hands on" field, so academic paper and oral tests every ten years are just not going to qualify, much less quantify, a doctor's surgical ability. But the public will THINK that it does and there's the rub. Conversely, an extremely capable and experienced doctor who isn't part of ABHRS might be perceived as less competent compared to a competitor because they are not ABHRS members. It inverts reality and confuses the public.

 

I think it's unfortunate that other countries actually recognize the ABHRS as some sort of qualifying body. In the absence of hands on surgical evaluation I believe these country's medical authorities are being somewhat mislead. They may not understand (or care) that the ABHRS is really just a club. I wonder if they are even aware that there is no actual surgical evaluation for "diplomates".

 

I have no doubt that the ABHRS is a fine organization for education and fellowship, I've written so before, but I think it has overstepped it's boundaries in claiming that it qualifies it's doctors. A written test simply doesn't cut it. I don't want to bother joining the organization to change it from the inside because I don't agree with other aspects of it, but I would suggest that they send a knowledgeable representative to each member's office to watch them perform surgery at least once per year. That doctor AND his staff would be critiqued according to a list of established parameters and be either passed or failed by the end of the day. This, more than anything, would increase the credibility of the organization and put it on par with the Coalition of Surgeons which is already filling this role. Unfortunately I know many current ABHRS members would resist this measure tooth and nail- and that should be very telling to the public.

 

You Dr. Beehner and Dr. Nusbaum didn't convince me that you were excellent doctors because you have ABHRS at the end of your credential list, or even because you both had/have the title of "president" of the club. I became convinced because of the multiple positive and impressive photos and comments that your own patients have posted on this very website for years. To me, that carries far more weight than the ABHRS ever could in it's present state.

[Guest wanthairs]

Dr. Feller....

 

Thankyou for being on the lookout for exposing so many things that would normaly blind your average HT patient (lasercombs/ABHRS etc) into believing all the hype......