Should Your Thyroid Surgeon Complete a Focused Practice Designation (FPD) in Adult Complex Thyroid and Parathyroid Surgery?

You need to find a thyroid or parathyroid surgeon. You look around, maybe get a referral from your endocrinologist, and now you want to know: who is the best thyroid surgeon? Who will give you all of the options for parathyroid surgery? Who has the experience, and who will make sure to keep you safe when you have thyroid or parathyroid surgery?

As of today, there is a new tool: The Focused Practice Designation in Adult Complex Thyroid and Parathyroid Surgery.

Like the graphic above, this is something above and beyond board certification. A board certification (usually from Surgery or Otolaryngology-Head and Neck Surgery) is a minimal standard to operate at most hospitals in the United States. But Focused Practice Designation in Adult Complex Thyroid and Parathyroid Surgery or FPD, is something more.

For a few surgeons in the United States (those of us who met the minimal case volume requirements), there was an option to test and demonstrate our excellence and focus in the area of Adult Complex Thyroid and Parathyroid Surgery.

What are the requirements to become certified as an FPD surgeon in adult complex thyroid and parathyroid surgery?

1- Surgeons must complete t least 80 thyroid and parathyroid surgeries in the 2 years prior to the test (remember, most thyroid surgeons in the United States do fewer than 5 thyroid surgeries each year!).

2- Surgeons must have completed at least 16 complicated or advanced cases during that time (reoperative cases or advanced cancer).

3- Surgeons must be part of a multi-disciplinary team.

4- They must have completed advanced training in thyroid and parathyroid surgery.

What does it mean for patients to have a surgeon who is certified via FPD in adult complex thyroid and parathyroid surgery?

1- There will be some sort of minimal standard.

2- This surgeon will perform enough cases to reduce their complication rate significantly (although maybe not to the lowest levels).

What do I like about this? Patients can expect that a surgeon who has been certified via a Focused Practice Designation in Adult Complex Thyroid and Parathyroid Surgery will be aware of most new techniques and technologies. That's good. They might not offer the techniques, but at least they should be able to talk about them.

What do I not like about the new  Focused Practice Designation in Adult Complex Thyroid and Parathyroid Surgery? Well, it can imply some level of parity between surgeons. Remember, for much of my career I did more than 500 thyroid and parathyroid surgeries each year. And we know that complications keep going down the more that you do as a surgeon. So doing 80 thyroids over 2 years is a fairly low number! (doing at least 100 each year is the number that most people look to when defining expertise).

The additional concern is that a surgeon who does only 40 cases each year is likely not going to have the bandwidth to learn new techniques such as RFA (radiofrequency ablation) or scarless thyroid surgery. But they may be considered an expert in their region, and so they would be more likely to speak with authority on a topic about which they know little. It's a hard problem.

Maybe this is why some surgeons have opted out of test required for the Focused Practice Designation in Adult Complex Thyroid and Parathyroid Surgery? I spoke to a surgeon today (who has dedicated his entire career to thyroid and parathyroid surgery and is extremely well known for being both knowledgeable and technically excellent) who described it as a "money grab" and something that he "would never do." He even questioned why I did it at all, because MY entire career is focused on thyroid and parathyroid surgery (in fact, both of us had multiple papers that we wrote that were used to create the test!).

I didn't have a great answer for him, actually. But, after considering, for me, I agree that some minimal standard is necessary to help patients who are less informed. While this standard of the Focused Practice Designation in Adult Complex Thyroid and Parathyroid Surgery does not imply TECHNICAL excellence at all, it can at least ensure that there is some baseline knowledge of thyroid and parathyroid surgery and that most significant complications can be avoided.

So when the results come out later in the Summer of 2025, look to see if your surgeon is certified inFocused Practice Designation in Adult Complex Thyroid and Parathyroid Surgery through the American Board of Surgery and the American Board of Otolaryngology-Head and Neck Surgery. While it's not perfect, it's still a tool that you can use to learn more about your surgeon and what you can expect before you have thyroid or parathyroid surgery.