Why do boards certify doctors can do surgeries they are not trained to do on anatomy they don’t know?

Specialty board certification is a racket that does more to ensure patients are put preventably at risk than receive competent care.

The American Board of OB/GYN (ABOG) certifies that OB/GYNs are qualified to do labiaplasties and clitoral hood reductions, despite the fact that OB/GYNs are not adequately trained in techniques or the surgical anatomy during residency. Older OB/GYNs especially have not been adequately trained. Surgery providers base privileging policies largely based on board certification. Granting privileges to doctors who are not adequately trained puts patients at risk.

Earlier this year, I asked ABOG to put clitoral neurovascular anatomy on their board exams and they neglected to do so. The nerves of the clitoris, which are absent from their board exams, are put at risk during clitoral hood reductions. Why would they certify that OB/GYNs are qualified to do surgery on anatomy they won’t even put on their boards?

The answer is for financial reasons, of course.

The more surgeries ACOG certifies that OB/GYNs can do, the more value there is in their board certification. Female genital cosmetic surgeries are especially profitable for OB/GYNs, as it is not every day they get to make a plastic surgeon’s salary. Board certification in OB/GYN costs $3365. This does not include subspecialty certification. Maintenance of certification costs several hundred each time if taken within every 5 years after that.

Under their “Objectives and Purposes” they claim the following:

Attain and continuously maintain the highest professional standards in Obstetrics, Gynecology, and Women’s Health Care by establishing standards of evaluation that assure that physicians certified by this organization are able to provide high quality Obstetrical and Gynecological Services, and Women’s Health Care.

However, what incentives do they actually have to do this? Are they liable when board certified physicians harm patients? No. Even if they tell surgery providers that OB/GYNs are qualified to do certain surgeries and OB/GYNs are granted privileges based on ABOG’s recommendations, only the doctor and maybe surgery provider can be held legally accountable.

ABOG claims to ensure OB/GYNs are capable of providing competent care, but their actions have actually made it more difficult for me to get surgery providers to change their privileging policies to ensure that OB/GYNs doing labiaplasties and clitoral hood reductions have actually been trained. Rather than helping to ensure patient safety, ABOG is actually helping ensure doctors can do surgeries without making the effort to seek training — an endeavor that would cost them time and money.

Other boards are guilty as well. ABPS certifies plastic surgeons can do female genital cosmetic surgeries despite the fact that the anatomy isn’t even yet taught at the best plastic surgery residency program in the country.

I only know about this particular case. But given the misaligned incentives structures, I’d imagine this happens with other surgeries as well.