ASPS President Pens Response to Sen. Sanders' Health-Care Debate Comment Regarding Plastic Surgeons

Sen. Ted Cruz (R-Texas) and Sen. Bernie Sanders (I-Vt.) met on CNN on Feb. 7 to debate the future of health care in the United States. Some plastic surgeons watching the debate felt that Sen. Sanders mischaracterized the specialty when he brought up the cost of medical school and the shortage of primary care physicians.

During the debate, Sanders stated: "We need tens of thousands more doctors in this country. We have a major crisis in primary care. There are areas in urban America and in rural America where people literally can't find a doctor to serve their needs. And one of the reasons – there are a number of reasons for that – one of them is, you go to medical school, you can come out hundreds of thousands of dollars in debt. And then you're going to become a plastic surgeon, not doing primary care in an urban area or rural America.

The segment occurs at roughly the 1:13 mark of the debate video.

ASPS President Debra Johnson, MD, sent the following letter to Sen. Sanders' office on behalf of all board-certified plastic surgeons. The goal of this response is to educate the lawmaker about the true depth and breadth of the specialty – and perhaps open the door to further discussions about plastic surgery's vital role in the health-care system.

The Honorable Bernie S Sanders
332 Dirksen Office Building
United States Senate
Washington, DC 20510

Dear Senator Sanders,

As president of the American Society of Plastic Surgeons, I represent more than 7,000 board-certified plastic and reconstructive surgeons in the United States.

I thank you for your recent debate with Senator Ted Cruz regarding the fate of Obamacare and the future of American medicine.

Some of my members were offended by your remarks regarding plastic surgery. You were stressing the need for more primary care physicians, and bemoaning the fact that because medical school is so expensive, recent graduates refuse to enter primary care and instead choose "to become plastic surgeons."

You may be stereotyping plastic surgeons as cosmetic "nip/tuck" doctors who cater to the wealthy. While some of my members do have practices that are cosmetic and lucrative, the vast majority of plastic surgeons are providing both aesthetic and reconstructive services in our communities.

We are the doctors called when a dog bites your child, when your brother-in-law accidently sticks his hand in the lawnmower, when your wife gets breast cancer and wants to consider her reconstructive options. We have been at the forefront of helping our wounded warriors reintegrate into society, by making their damaged limbs more functional, their faces more recognizable, their scars of war less noticeable.

Plastic surgeons have been and will continue to be incredible innovators in medicine, beginning with kidney transplantation (first performed by Nobel Laureate Plastic Surgeon Joseph Murray) and now moving into face and hand transplantation. Within our regenerative medicine laboratories, we are trying to grow whole body parts from stem cells, such that children born without an ear can be reconstructed more easily and effectively. We are working to solve the riddle of aging, to try and keep our human bodies healthy and viable as long as possible.

I firmly agree with you that healthcare is a right and not a privilege. A majority of my members believe in universal healthcare. I served in the National Health Service Corps, providing primary care to Native Americans, and I believe that medical school should be free in exchange for graduates providing primary care in underserved communities. Like many of my members, I volunteer free reconstructive surgery around the world, as it is an obligation to "pay it forward" for the privilege of having such a fabulous vocation.

Because I take care of some cash-paying cosmetic surgery patients, I can afford to continue operating on a three-month old infant with a cleft lip, doing my best to give her a result that she can carry without shame for the rest of her life. I do this despite the fact that I am rewarded only $210 by MediCal for this service. It is a sad state of affairs that despite spending twice as much on healthcare in this country, the vast majority is not spent on physician services. Burdensome regulation, overpricing by Pharma, one-time use waste in our hospitals, inappropriate overutilization of testing and imaging, as well as the for-profit health insurance system are all areas that should be evaluated for improved cost-effectiveness.

Members of the American Society of Plastic Surgeons are proud to serve as aesthetic and reconstructive surgeons. We are proud of the creativity and innovation we have brought to medical care. We hope to partner with you in the task of improving American medicine, and we would like to start that partnership through a conversation. If you would be willing to sit down and meet with leaders from the American Society of Plastic Surgeons, we will gladly come discuss the best path forward for American health care.

Thank you for shining a bright light on this issue.

Sincerely,

Debra J. Johnson, MD FACS
President, American Society of Plastic Surgeons
Past-president, California Society of Plastic Surgeons
Director, American Board of Plastic Surgery
Clinical Professor of Plastic Surgery, UC Davis School of Medicine
Director, Sutter Cleft Lip, Palate, and Craniofacial Anomalies Panel