Before a hospital lets a surgeon operate in its building, a committee of physicians reads the file. They review training, board certification and track record, then decide which procedures, if any, that surgeon may perform on their premises.
That approval is called hospital privileges, and few cosmetic surgery patients ask about it. Much elective surgery now takes place in office-based operating suites, so a surgeon can build a busy cosmetic practice without a hospital reviewing the work. For anyone comparing surgeons, that gap makes privileges worth a direct question.
A look at one example of plastic surgery credentials in the Houston area shows how privileges sit alongside board certification, facility accreditation and years of practice in a single profile.
A credential granted by peers
Most credentials on a surgeon’s wall come from schools, training programs or certifying boards. Privileges come from a hospital’s own medical staff. Doctors who work in that building take part in the review, and they approve the surgeon for a defined list of procedures rather than a blanket license to operate.
Hospitals also revisit those approvals on a recurring cycle. A surgeon who has held privileges for years has gone back through that review more than once, in front of colleagues who can see complication reports and case histories that the public does not. A committee can also narrow or withdraw privileges, which gives that review real consequences for the surgeon.
That outside view is the point. A practice website shows the photos and reviews the practice chose to publish. A hospital appointment means a separate group of physicians examined the same surgeon and said yes.
The case for privileges in office-based surgery
An accredited office surgical facility can be a sound setting for elective procedures. The privileges question applies there too, for a practical reason. If a patient needs a higher level of care after an operation, a surgeon with admitting privileges can bring that patient into a hospital and keep directing the case.
Without privileges, the patient may end up in an emergency department under a team meeting them for the first time. Every operation carries risk, and a practice’s plan for a complication tells you a good deal about it.
Privileges also narrow a problem that runs through cosmetic medicine: physicians trained in other specialties can offer cosmetic procedures. A hospital that grants plastic surgery privileges has matched the surgeon’s training to the procedures on the list.
One Houston profile, read through this lens
Leo Lapuerta, MD, FACS, is triple board certified, by the American Board of Plastic Surgery, the American Board of Surgery and in Surgery of the Hand. He owns and operates a QuadA (AAAASF) accredited surgical facility and works with physician anesthesiologists, not nurse anesthetists or anesthesia assistants.
He also holds hospital privileges across the region. They include the Memorial Hermann network, HCA hospitals including The Woman’s Hospital of Texas, and St. Luke’s Houston Medical Center. He also serves as Chairman of Plastic Surgery at St. Joseph Hospital in Houston.
Dr. Lapuerta has more than 30 years of experience and more than 30,000 surgical and non-surgical procedures behind him. In his view, the number of cases a surgeon has performed and the years spent doing them, paired with board certification, do more than any other factor to predict an outcome patients are happy with. Privileges are one way an outsider can see that experience vetted by people other than the surgeon.
Questions to bring to a consultation
- Which hospitals have granted you privileges, and are they current?
- Do those privileges cover the procedure I am considering?
- If I needed hospital care after surgery, where would I go, and would you continue to manage my care there?
- Which organization accredits the facility where you would operate on me?
A surgeon with nothing to hide will answer each one in a sentence or two. Board certification can also be confirmed directly with the certifying board, which can tell you whether a physician’s certification is current and in which specialty.
This article is for general information only and is not medical advice. Results vary from patient to patient. Consult a board-certified plastic surgeon or your physician about your own situation. Written in partnership with Joseph Lambert, a publicist working with Leo Lapuerta, MD Plastic Surgery.
