Recently, I have seen and heard about cosmetic surgery being done by physicians that are performing the procedures in their offices in the local area that I do not know. Definitely there are going to be new surgeons moving to Austin to practice and older ones retiring. However, after investigating these new practices they are not what they seem. They are offering deals that seem great to the consumer but do we know their credentials. Some of the practices are using physicians that do not live here and are flying them in to do the services-itinerant type surgery. Who is responsible if the patient has a complication if they have flown away in an airplane? Where does the patient go if there is a problem? What are their qualifications to perform the surgery and what is the safety of their facility? Does the facility have certification to the appropriate level? I respect the fact that there is some overlap of surgical specialities to perform certain procedures. However, when physicians have no formal surgical training it is placing the patient at risk. Why do you think there are formal residency training programs and board certification that take many years to complete? One might be able to learn a technique going to a weekend course but clinical judgment is not learned overnight. Unfortunately, profit can take a backseat to safety. Cosmetic medicine is becoming more and more competitive and lucrative to the provider. Insurance reimbursement continues to decline and physicians are looking to cosmetic medicine since it is done on a cash basis prior to surgery. Also, technology companies are complicit in the problem as well. They are providing equipment and surgical material to these physicians with little oversight on their training. Their bottom line is to make a profit and sell their product. I have seen the consequences from patients having had surgery or treatments done by some of these businesses. Some patients have paid significant amounts of money without results or they have had complications that are not easily corrected. The bottom line is that no one is monitoring surgery that is done in the office and there are no penalties to the physicians. There is some oversight by the American Society of Plastic Surgeons in that if you are a member you sign an affidavit each year concerning what level of anesthesia is done in your office and that you have the appropriate level credentialing for surgery.