I currently live in Israel where there is much confusion as to who is a surgical specialist. Here, every general surgeon is labeled as a specialist i.e. a מומחה בכירורגיה. However, when a patient is seeking a specialist in who has advanced training and certification of knowledge and skills, in this field, they are not looking for a general surgeon or a proctologist. Unfortunately, in Israel the field of Colon and Rectal Surgery is not an officially recognized surgical specialty by the health ministry; as it is in the USA.
Most people have never heard of a colorectal surgeon. However, many are familiar with the outdated title “proctologist” or פרוקטולוג . In addition, the lay public is under the misunderstanding the “proctology” is a non-surgical field. One surgeon once told me that I should become known as the “Pelta-log” i.e. Pelta Proctologist. But, I proudly insist that I am not a proctologist, I am a Fellowship trained Board Certified, Colon & Rectal Surgeon. To get this title took me 10 years of advanced training after my Biology degree in college. In addition, I passed a battery of written and oral exams after all my training in order to verify the achievement of excellence in the field of colorectal surgery. Once I passed my training and exams and my experience was reviewed; only then did I receive the privilege to be labeled a Fellow of American Board of Colon and Rectal Surgeons.
What does it take to be listed as a specialist in Proctology in Israel?
Once a doctor completes his general surgery training in Israel he/she is known as a specialist in general surgery. If they want to become a specialist in proctology or colon and rectal surgical problems then they advertise that they are a proctologist. That’s it!
There are several highly trained and skilled colon and rectal surgeons in Israel. They obtained advanced training in the USA or England. To the best of my knowledge they do not take the USA colon and rectal board exams.
Some surgeons attend a year of “Clinical Fellowship Training” in the USA. By USA standards this is purely a research year and thus does not entitle the applicant to advertise as a trained colorectal surgeon.
What does it take to be known as a Board Certified Colorectal Surgeon in the USA?
One must first graduate college with a college degree, which usually takes four years. After this, via a very competitive selection process, one needs to get accepted to a medical school. After four years of medical school one receives a Medical Doctor degree and then applies for a general surgery residency. I was one of four applicants in a pool of 2,000 medical students who was accepted to general surgery residency at Long Island Medical Center in 2001. After five years of intensive general surgery training, the candidate takes a written and oral exam in general surgery. At this point one is a board certified general surgeon. I applied to for fellowship training in Colon and Rectal surgery. At the time there were about 80 applicants for a total of 60 available training positions in the entire USA . Some states like Georgia, only had 2 fellowship positions available. I got accepted to the Georgia Colon and Rectal Clinic in 2006. After a very intensive year of performing advanced colon and rectal operations and didactic training, one gets a diploma in colorectal surgery. After this stage one is eligible to take the written colorectal boards, followed by the oral colorectal boards; which are only given once a year. According to the statistics, 20% of the applicants do not pass the boards. This means, if a surgeon does not intensively study the mandated material, he will not pass. Once a colorectal surgeon is board certified is actively practicing colorectal operation and has letters of recommendation, then one is eligible to become a Fellow of the American Board of Colon and Rectal Surgeons.
This is the program I successfully completed to be known as a Board Certified Fellow of the American Society of Colon and Rectal Surgeons (ASCRS). I am not a proctologist.
With this background, it can be appreciated why certification by the American Board of Colon and Rectal Surgery is considered the ultimate achievement after the conclusion of clinical training in colon and rectal surgery.
What Is A Colon and Rectal Surgeon?
Colon and rectal surgeons are experts in the surgical and nonsurgical treatment of colon and rectal problems. We have completed advanced training in the treatment of colon and rectal problems in addition to full training in general surgery. Colon and rectal surgeons treat benign and malignant conditions, perform routine screening examinations, and surgically treat problems when necessary.
Colon and rectal diseases comprise a broad range of conditions and ailments, the severity of which can vary from mildly irritating to life threatening. Research has demonstrated that early screening and treatment of colon and rectal diseases can significantly improve treatment outcomes and survival rates. Studies have shown that patients treated by colon and rectal surgeons are more likely to survive colorectal cancer and will pay less for surgical care because of the colon and rectal surgeons’ advanced training and the high volume of colon and rectal disease surgeries they perform.
When Was Colorectal Surgery Called “Proctology”?
The formal establishment of the field of proctology was after a meeting in Columbus, Ohio (USA) in 1899 by Dr. Matthews. Dr. Joseph Matthews of Louisville, Kentucky studied at St. Mark’s Hospital in London; he is considered the father of modern colon and rectal surgery in the USA. He established a Department of Proctology in 1883 at the Kentucky School of Medicine.
In 1933 it was decided that there needed to be a clear curriculum of the specialty and a method of identifying individuals qualified to practice and have the title of a specialized surgeon. Israel does not have this. The American Board of Proctology was founded in 1935. There is no official board certification for colorectal surgery or proctology, in Israel. There is an Israeli Colon and Rectal society, which gives a diploma to their own graduates.
In Israel any general surgeon can claim expertise in CRS/proctology because there is no system of validation of expertise. This is unlike the USA, which has a standardized curriculum and training program since 1938. In 1949, the American Board of Proctology was established. It was accepted 68 years ago, that only the passing of a specialized examination would result in the approval to practice colon and rectal surgery. This is the only objective way to determine who is competent to practice this surgical specialty.
Proctology or Colorectal Surgery?
There was a debate whether to name of the specialty board proctology or colon and rectal surgery. Since all surgeons had substantial training in general surgery, they invoked the original definition of 1900 to include the colon as well as the rectum and anus. The board name change was official in 1959! The American Proctologic Society name was officially renamed the American Society of Colon and Rectal Surgeons in 1973.
The Public Wants a Verified Specialist
A fellowship trained board certified colorectal surgeon is the definition of a certified specialist. In this manner, there is no misleading the public and they can be reassured that they are under the care of a true specialist who is aware of the developments in the field and practices the accepted standard of care. Mastering the necessary fund of knowledge is verified by passing the written colorectal surgery boards. Whereas, the oral exam evaluation tests surgical judgment and integrated thinking during patient management.
Under the care of fellowship trained board certified colorectal surgeon, one can be assured that they are under the care of a high specialized and competent surgeon.
Arie E. Pelta MD FASCRS is a fellowship trained colorectal surgeon who has been board certified in colorectal surgery since 2011.
The American Board of Colon and Rectal Surgery: Past, Present, and Future. DJ Schoetz, Clin Colon Rectal Surg 2012;25:166-170.