Good doctors used to be identified by fairly standard measures: where they trained, whether they were board-certified and if they were in good standing with the state medical board.
But the explosion of reality TV shows in the last four years has upset that paradigm -- especially in Los Angeles and especially in the ultra-competitive field of cosmetic plastic surgery. Even as shows such as "Doctor 90210," "Extreme Makeover" and "The Swan" have thrust telegenic doctors into the limelight, it remains unclear what standards networks use in selecting the physicians -- or how closely they check credentials. FOR THE RECORD: Plastic surgeon: An article in Section A on Tuesday about cosmetic surgery and TV said that Dr. Jan Adams had been a frequent guest on "Oprah." In fact, he appeared once on "The Oprah Winfrey Show" and once on "Oprah: After the Show" that aired on the Oxygen cable network. —
Now this uneasy partnership between medicine and reality television is getting its own reality check. On Nov. 10, Donda West, the mother of rap star Kanye West, died a day after undergoing cosmetic plastic surgery performed by Dr. Jan Adams, a celebrity doctor in Brentwood who was the host of his own Discovery Health channel show, "Plastic Surgery: Before and After."
The resulting spotlight has been a good deal harsher than the one that celebrity plastic surgeons encounter on the set. Meanwhile, their rank-and-file colleagues and the American Medical Assn. are growing worried that reality-TV doctors and the producers of the shows distort what plastic surgeons do by over-hyping the results and downplaying the pain, complications and risks associated with surgery. The shows and their celebrity doctors, they contend, mislead consumers into thinking cosmetic surgery is not much more complicated than buying a new dress.
"TV is looking for the best doctors who will show well and get ratings. They have to have looks and personality," said Dr. Valerie J. Ablaza, a board-certified plastic surgeon in Montclair, N.J. "But there are no criteria for evaluating their medical credentials. That's a big problem."
West's autopsy has not been completed but preliminary results released by the Los Angeles County coroner last week concluded that the 58-year-old former college professor and businesswoman died "as a result of surgery or anesthesia."
The Discovery Health channel did not return calls seeking comment on what criteria it uses to select physicians to host shows, but a spokesman for the network said Monday that it has decided to pull reruns of Adams' show for the immediate future.
One Los Angeles-based producer for a plastic surgery reality show, speaking on condition of anonymity, said the shows seek doctors with successful practices because they have a larger patient clientele from which cases can be chosen to film. The producer spoke on background for fear of being associated with the West case. He is not associated with the case or with Discovery Health channel.
But TV-star demeanor also matters.
"Doctors are chosen, ideally, for being good doctors and for being comfortable in front of a camera," he said. "There is a lot of care taken in who you select. And there is a lot of care taken in who the doctor selects for the surgery" that will be filmed.
The doctors who do the shows, he said, have to be secure enough in their own skills to allow cameras to follow their every move. The shows, he added, have been "realistic" in showing the pain, complications, costs and emotions surrounding cosmetic surgery; criticism, he said, tends to come from "old school" doctors who think doing television is "lacking in dignity."
The group of doctors who are TV stars is small, but their influence on their peers and the public can't be underestimated. Cosmetic plastic surgery, which includes invasive procedures such as tummy tucks and simple injections such as Botox, has been embraced by Americans from Los Angeles to Little Rock. Almost 11 million cosmetic procedures were performed in the United States last year, according to the American Society of Plastic Surgeons, a 48% increase over 2000.
Even critics of TV celebrity doctors -- and there are many -- concede that the publicity has had benefits. The shows demonstrate technological advances and have helped soften the perception that cosmetic surgery is vain and indulgent. Few patients now claim their refreshed look is simply the result of a long vacation in the south of France.
"It has brought plastic surgery to the mainstream," said Dr. Rod J. Rohrich, chairman of the department of plastic surgery at the University of Texas Southwestern Medical Center and a past president of the American Society of Plastic Surgeons. "It's not just for the rich and famous. It's for everyone."
In the first study documenting the influence of shows such as "Extreme Makeover," researchers found that reality TV shows directly influence first-time patients who decide to have cosmetic plastic surgery. The study was published in the July issue of the journal Plastic and Reconstructive Surgery.
"These folks were really avid watchers and believed what they saw on TV was a reflection of reality," said Dr. Richard A. D'Amico, president of the American Society of Plastic Surgeons and chief of the department of plastic surgery at Englewood Hospital and Medical Center in Englewood, N.J.
In the less enthralling real world, however, results are not always predictable. A 2004 study published in Plastic and Reconstructive Surgery of procedures performed in office-based surgical facilities found that serious complications occurred in one in 298 cases and deaths in one in 51,459 cases.
"Many of these celebrity doctor-types really don't portray plastic surgery at all," said Rohrich, who is also editor of Plastic and Reconstructive Surgery. "I call it the unreality of reality TV. They don't portray what we do every day as real plastic surgeons -- and that is to be good doctors and not wear flashy suits and do all sorts of funny things in the operating room."
Adds D'Amico about celebrity TV doctors in general: "TV doctors, to me, are the most dangerous, because they may or may not have the true credentials or the expertise. . . . But the public perceives they have credibility because they are on TV."
Some celebrity doctors, for instance, are not board-certified by a member of the American Board of Medical Specialties, a nonprofit organization that oversees 24 medical specialty boards. Member boards develop practice standards and certify physicians who have demonstrated skill requirements in certain specialties. Adams is not a board-certified plastic surgeon. His curriculum vitae does not list any board certification.
Board certification with the American Board of Plastic Surgery is the best way to identify a qualified plastic surgeon, D'Amico said, because any doctor -- a gynecologist, a cardiac surgeon, an internist -- can legally perform cosmetic plastic surgery.
"There are 5,000 plastic surgeons who are board-certified in this country," Ablaza said. "How does someone who is not board-certified get on these shows? It's more of a popularity contest."
Noting that Adams has been a frequent guest on "The Oprah Winfrey Show," D'Amico said: "We take Oprah to task for making this guy a celebrity when he isn't even board-certified."
King World, the company that distributes "Oprah," referred news inquiries to Winfrey's company, Harpo Productions Inc. Harpo did not return calls seeking comment on how doctors are selected to appear on the show.
Star power has somehow risen to the top of the physician's curriculum vitae -- at least for many in Los Angeles. Many television studios are based here and hire doctors who live and work nearby.
"What is so ironic is, for so many of these celebrity doctors, it's their 15 minutes of fame," Rohrich said. "They didn't earn it by being good doctors for many years. They just had good marketing. In Los Angeles, there is always a celebrity doctor of the month that everyone is seeing. Nine times out of 10, I don't even know them, and I know many of the board-certified plastic surgeons in the country."
Some young doctors no longer attempt to build their reputations simply by serving their patients well, obtaining referrals and attending medical meetings to meet and impress established doctors, said Dr. Robert Kotler, a Beverly Hills cosmetic surgeon who participated on "Dr. 90210" in 2004 and 2005. Nor does prestige still come primarily through doing research and publishing papers. As a publicist said to a doctor on a recent episode of the fictional television show "Nip/Tuck": The only publication worth being in is People magazine.
"That is sort of based on reality," Kotler said. "It has become a race to get attention. I only have to mention one word to the media to get on a show: 'Oprah.' It's the magic five-letter word. If you've been on 'Oprah,' you must be OK. [Producers] don't ask me any other questions."
He defends doctors' desires to set themselves apart from the crowd but acknowledges he has grown uncomfortable with some aspects of reality TV. "The programs have changed," Kotler said. "They aren't information as much as entertainment. The doctors and their personalities are taking the stage now."
Dr. Paul S. Nassif, a Beverly Hills cosmetic surgeon who also appeared on "Dr. 90210," similarly defends doctors who make the effort to develop superior media skills.
"You're in Beverly Hills and there are 300 plastic surgeons in a small radius; you have to think, 'How am I going to get patients?' Some colleagues would make comments like, 'Why are you doing that?' The same guy now says to me, 'How can I get on TV?' "
The American Medical Assn. has tried to rein in celebrity doctors. In a sternly worded statement released in 2005, the AMA's Council on Ethical and Judicial Affairs said TV reality shows about cosmetic surgery raise serious ethical questions, such as whether the doctor-patient relationship is portrayed appropriately and the information communicated to viewers is accurate.
The council recommended that doctors refuse to participate on shows that foster misperceptions and that medical societies take disciplinary action against physicians who do participate in such shows.
"I'm not saying TV doctors can't be good doctors," Rohrich said. "But we need to be doctors first and put patient safety first."