U of T training program lets patients cut a deal on plastic surgery - Globe and Mail

For two years, Irene Tombolini, a 61-year-old sales consultant for a hair-cosmetics company in Hamilton, Ont., interviewed a series of plastic surgeons before finally settling on Toronto?s Tom Bell as the doctor she would entrust to lift her face.

?He was the best one by far, the only one I met with who explained the procedure to me in a way I could understand and feel comfortable with,? says Ms. Tombolini, who works in an industry where, she says, ?looks really matter.? She?d lost close to 40 pounds over two years, and her face still bore the signs of having carried the extra weight.

The procedure would cost $30,000 if she booked it directly through Dr. Bell, a Canadian-born and -trained cosmetic surgeon of international renown.

But during the consultation, she learned she could get the work done for $17,000, almost half-price, if she did it under the auspices of the academic training program that the University of Toronto?s division of plastic surgery operates out of Dr. Bell?s offices at 199 Avenue Rd.

Home to the Toronto Institute of Aesthetic Plastic Surgery, it?s an upscale clinic that Dr. Bell shares with fellow surgeons Trevor Born, Derek Ford, Dimitrios Motakis and Lawrence Tong.

Founded in 1986 by Arnis Freiberg of Toronto Western Hospital as an apprenticeship program for medical doctors in their fifth, or final year, of a plastic-surgery residency, the academic training program (ATP)?s mandate is ?to provide training in plastic surgery and especially cosmetic surgery and to provide affordable aesthetic surgery to the community.?

Modelled along the lines of the patient clinic at U of T?s school of dentistry, which similarly offers discounted services to the public, the ATP is unique to Toronto in being a dedicated surgical site offering cosmetic procedures at up to 70 per cent off what most specialists charge in their own clinics.

?Residents are not let loose on the patients,? stresses Dr. Bell, an associate staff member of U of T?s medical school who has been the ATP?s director of resident training since 1994.

?This is a very controlled situation.?

Typically, Dr. Bell and his colleagues oversee a resident who has come to ATP on a compulsory four-month rotation as a prerequisite to writing final exams for the Royal College of Physicians and Surgeons, the governing body that assigns surgical certificates.

In addition, they mentor a senior fellow, usually a plastic surgeon wanting to extend his or her training beyond a requisite residency program.

The fellow and the resident get experience they would not otherwise get in a classroom setting, participating in patient interviews and doing the surgeries under the guidance of Dr. Bell and his mentoring colleagues.

The discount price for professional services is meant to be an incentive to get patients to agree to get work done by apprentices as opposed to a practising plastic surgeon.

?If money weren?t an object this place wouldn?t exist,? says Dr. Bell, in practice since 1987. ?Why would a patient come to this clinic if not to get a treatment at a reduced price??

For Ms. Tombolini, saving money was an incentive, but she says she ultimately chose to go the ATP route because she liked the fact that her surgery would be strictly supervised by trained professionals every step of the way, from initial consult to post-op.

?Safety was foremost on my mind. Saving money was just a bonus,? she says.

She had taken two years researching clinics, she adds, after becoming aware of the disciplinary hearing involving Behnaz Yazdanfar, the Toronto doctor who in May was found guilty of professional misconduct and deemed incompetent by the College of Physicians and Surgeons following the death of one of her patients and the bungled surgeries of others she performed while practising plastic surgery from 2005 to 2008 without the requisite credentials.

At the ATP, three tiers of supervision are built directly into all treatments, from Botox to breast augmentation.

Performing her cheek lift was ATP fellow Trefor Nodwell, a 35-year old McGill- and Dalhousie-trained plastic surgeon on staff at Carleton Hospital in Ottawa since 2005.

He applied to and was accepted to attend ATP under Dr. Bell?s supervision as a senior fellow from January until the end of June. ?It?s like a mentorship,? he says of the program.

Working alongside him was senior resident Mary-Helen Mahoney, 31, who recently wrote and passed all her exams, and who now is ready to practice cosmetic surgery on her own.

During her course of study, Ms. Mahoney participated in Ms. Tombolini?s surgery.

She knows the patient got the procedure at a huge discount. But in her opinion, that?s not entirely the point.

?You have an ability to make such a significant impact on a person?s appearance but it?s important to do so safely, and that?s what this residency rotation teaches you,? Ms. Mahoney says.

?When training as we are training, focused and dedicated on doing what?s best for the patient, there are no holes in the treatment being given, and I think that?s in the public?s best interest.?

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