Private practitioners played a major role in the evolu- tion of advanced laparoscopic and bariatric surgery training. Academic physicians were disinterested
in addressing obesity and were confronted with the distressing outcomes that followed the intestinal bypass.
The private sector, with its marked surgeon autonomy
and innovative mindset, was far more ready to accept
early reports describing the successful outcomes of the
gastric bypass operation. In fact, many of the first pivotal
peer-reviewed papers in bariatric surgery were written
by private practice surgeons, and the first certified bariatric centers of excellence (COEs) were private practices.
Private practice surgeons also took the lead in initiating widespread training in bariatric surgery under the
aegis of the American Society for Metabolic and Bariatric Surgery (ASMBS), which was originally the American
Society for Bariatric Surgery.
Ultimately, industry support of private practice training centers for bariatric surgeons decreased, and surgical
fellowship training became centralized in universities.
Diminishing reimbursement, the cost of accreditation,
and exponential increases in private practice overhead also
have contributed to growth stagnation in this sector. The
biggest hurdle has been the lack of referrals by primary
care physicians who remain unconvinced of the value of
metabolic surgical treatment, even though its value is well
• Describes the milestones that metabolic
surgeons in private practice have achieved,
including widespread training and the
establishment of certified centers of excellence
• Outlines key topic areas—including
autonomy, research, education,
accreditation, and income—as they relate
to metabolic surgery in private practice
• Summarizes the challenges of the
private practice setting, including
costs and administrative burden
by Alan C. Wittgrove, MD, FACS; Samer G. Mattar, MD, FACS;
Shanu Kothari, MD, FACS; James Maher, MD, FACS; and Kelvin Higa, MD, FACS
V104 No 4 BULLETIN American College of Surgeons