Truth in Advertising on the Web: A cross-sectional analysis of a "plastic surgeon" patient search simulation
Anmol Chattha, BA1, Austin D. Chen2, Malcolm Z. Roth, MD1.
1Albany Medical Center, Albany, NY, USA, 2Kaohsiung Medical University, Kaohsiung, Taiwan.
BACKGROUND: Recently, there has been an increase in the number of non-board certified plastic surgeons performing cosmetic procedures despite some states passing Truth in Education laws. This can be detrimental to patient safety and have an impact on board certified plastic surgeons by increasing competition. We aim to access regional & city, population, and American Board of Plastic Surgery (ABPS) board certification status of physicians marketing themselves as plastic surgeons.
METHODS: In April of 2017, a systematic search using the Internet search engine Google was performed to evaluate the qualifications of providers who are marketing themselves on the internet as plastic surgeons. The top 50 cities in the United States by population were selected, as according to a 2015 online ranking. An online search for the term "plastic surgeon [city name]" was performed in order to simulate a patient search of online providers in their city, and the first 20 practice websites for each city were identified. Websites were analyzed for board certification and practice setting. Comparisons were made using Pearson Chi-Square and Mann-Whitney U tests.
RESULTS: A total of 1484 unique practitioners were extracted. 1228 practitioners (82.7%) were ABPS certified plastic surgeons. Out of the remaining 256 (17.3%), 122 (47.7%) were otolaryngologists, 38 (14.8%) were ophthalmologists, 28 (10.9%) were general surgeons and 20 (7.8%) were dermatologists. Of note, there were also nuclear medicine physicians, pediatricians, chiropractors, anesthesiologists, and orthopedic surgeons all practicing outside of their core training and marketing themselves online as "plastic surgeons". The four cities with the highest rate of ABPS certified plastic surgeons on our google search were Atlanta, Georgia (96.8%), Houston, Texas (95.7%), Dallas, Texas (95.2%) and Denver, Colorado (94.7%). The four cities with the lowest rates of ABPS certified plastic surgeons were Arlington, Texas (50%), New Orleans, Louisiana (54.8%), Colorado Springs, Colorado (60.9%) and Albuquerque, New Mexico (64.7%). There were significant regional differences with board certification (Northeast: 87.7% versus West: 78.1%; p=0.007). When comparing states with "Truth in Advertising" laws compared to states with no "Truth in Advertising" laws we found no significant differences in board certification rates among "plastic surgery: practitioners (80.9% versus 83.9%; p=0.174). When comparing the mean population of cities in which ABPS certified plastic surgeons practiced when compared with non-ABPS "plastic surgeons" we found significant differences (1,041,669 versus 854,473; p<0.001).
CONCLUSIONS: A multitude of different practitioners continue to market themselves as plastic surgeons online. The introduction of "Truth in Advertising" laws over the past few years has had no apparent impact yet on the way the multitude of non-ABPS certified practitioners market themselves online. However, these non-ABPS certified practitioners tended to practice in cities with smaller populations. In this digital age, it is imperative patients are not misled regarding core training as there are many non-ABMS providers marketing themselves as "plastic surgeons".
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