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Health professionals practising cosmetic surgery will need to meet tougher regulations from 1 July 2023.
New guidelines released by the Australian Health Practitioner Regulation Agency (Ahpra) and the Medical Board of Australia (MBA) will put stronger regulations on health professionals practising cosmetic surgery.
The guidelines require higher standards for practitioners, will enforce stronger restrictions on advertising, as well as establishing a new model of accrediting cosmetic surgery known as an “endorsement of registration”. This would introduce new minimum standards for the education, training and qualification of Australian medical practitioners seeking to practise as cosmetic surgeons, and will require them to provide evidence of their qualifications to the MBA in order to be approved.
The changes follow a report from an independent inquiry commissioned by Ahpra and the MBA into the cosmetic surgery industry published in September last year, followed by a public consultation in December.
Dr Anne Tonkin, MBA Chair, said that there was a clear need for a higher quality information and accreditation available to the public.
“What we released this week is part of carrying out all 16 recommendations made by the inquiry,” said Dr Tonkin.
Dr Tonkin said that the guidelines give practitioners more guidance on how they must practise in cosmetic surgery.
“Firstly, we require these procedures to be done in a licenced facility, with proper clinical governance, proper hygiene and infection control systems,” said Dr Tonkin.
“We are requiring cosmetic surgery patients to get a referral from a GP and a longer, mandated cooling-off period between the patient giving informed consent and the procedure,” said Dr Tonkin, who outlined extra requirements into the informed consent process.
“We’re also making it clear that it needs to be the practitioner themselves giving the patient the information at the beginning, and responsible for appropriate care after the procedure.
“It is also up to the practitioner to be up-front about their training, expertise and experience, and to be up-front about the total costs.”
Responsible advertising
Advocacy group Operation Redress and its cofounder Maddison Johnstone have been a driving force behind the public call for changes.
“One day we got a call from a nurse whistle-blower,” Ms Johnstone said.
“It became clear there were significant issues. We started looking at the social media of doctors.
“We were alarmed from the outset. We were seeing essentially live surgeries happening on Tik Tok and Instagram, both of which have such large [percentages] of children watching, and impressionable and vulnerable people,” Ms Johnstone said.
“The first questions we had were, ‘Is this even legal? Is this standard practice, and are a lot of doctors doing it?’”
Dr Tonkin said the changes crack down on advertising that downplays risks and exaggerates benefits.
“We are giving practitioners a better sense of [what’s acceptable in advertising],” Dr Tonkin said.
According to figures released by the Cosmetic Physicians College of Australasia (CPCA), Australians spend up to $1 billion on cosmetic procedures annually.
“If consumers go to somebody with a surgical specialty training, then it’s likely to be safe. The College of Surgeons is going to mount an education campaign along those lines, which is great,” Dr Tonkin said.
“There are a number of people who offer cosmetic surgery without being specialist-trained surgeons, however. For these people we’re creating an endorsement,” said Dr Tonkin.
“The endorsement is the strongest action we can take under national law.”
A new endorsement
The new guidelines have met with controversy within the medical community; in particular, the new area of endorsement, which has been approved at the 24 February 2023 Health Ministers’ Meeting, which brings together federal, state and territory health Ministers.
In commenting on the changes, President of the Royal Australasian College of Surgeons (RACS) Dr Sally Langley said she had concerns with the endorsement process.
Dr Langley, a plastic and reconstructive surgeon, is concerned that an accredited qualification for cosmetic surgery would be held to a lesser standard than the qualifications which are currently required to be registered as a specialist surgeon.
“[RACS] does not support the endorsement process,” Dr Langley said. “Our main concern is that surgeons should be doing surgery,” she said.
Dr Langley emphasised that those surgeons need be trained to RACS standards.
“They are virtually always surgeons trained by RACS,” Dr Langley said.
“At least five years, on top of being a hospital doctor and achieving competency, not just medical and surgical skills, but teamwork, collaboration, decision making, and professionalism etc. We can’t see that a shorter, more limited training program for the endorsement process can be safe, or acceptable, for the public,” Dr Langley said.
Dr Langley also said that, in addition to concerns about professionalism, the prospect of training is not feasible.
“How will [other medical professionals] do the training? What sort of clinics or hospitals will these trainees go to? It’s just unfathomable to me,” Dr Langley said.
“We at RACS know what a big job Australian Medical Council (AMC) accreditation is. It takes a lot of staff and it’s very expensive. I can’t see an AMC accredited endorsement program being achievable.
“We know that cosmetic procedures have become rampant in the United States and countries in Asia.
“But we’ve really got to try to stop this endangerment of the community,” said Dr Langley.
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Wait a minute,
Is not plastic surgery: plastic and reconstructive surgery?
And why are there so many public spots to be filled for Plastic Surgeons? Why do 80% of plastic surgeons move on to do cosmetic procedures? Lipo is a safe profitable
Procedure, and is being classed as a heart transplant. Plastic surgeons are being teained with public money in public hospitals to provide private cosmetic treatment. And the money they earn is ridiculous if you think of the level of complexity of such procedures. They have no leg to stand on this one. Its a fight for money not for patient care. I’m a GP and have no intentions of being part of this world but like we all, we know what the fight here is for. And its not for patients.
The first Anonymous is a cosmetic surgeon, who, is likely a non-surgeon, with ‘certification’ in surgery. And also likely that their attempt to blur lines by using the current ‘education model’ is ignoring the actual issue. Cosmetic surgery is surgery. Surgery is performed by trained surgeons. Current ‘cosmetic surgeons’, are trained by non-surgeons. Thus, please explain how this makes any logical sense?
Lets go down the lawsuit path. There are 5 (five) outstanding class action lawsuits in Australia against cosmetic surgeons. These will amount to 10’s of millions of dollars (if not more), against our collective medical indemnities that will have to be paid. You attempt at trying to grey this area, holds no logic. Lawsuits are not a good standard of care. If your standard of care is ‘how many lawsuits are against your specialty’, sir, your standards are corrupt. Just to reiterate, 5 class actions in Australia against cosmetic surgeons. None against plastic surgeons.
The practice of medicine is based on high quality data. Please spend some time reading the extensive volumes of data generated and applied by RACS to its training, governance, and high international standards.
Your attempt at trying to legitimise your lack of skill, knowledge, insight, and reason is every cause why cosmetic surgery should be given no oxygen. Especially your morally corrupt argument with its lack of actual substance.
The practice of medicine is based, or at least should be based, on high quality evidence.
Where is the rigorously analysed evidence to support the MBA Chair’s assertion that “If consumers go to somebody with a surgical specialty training, then it’s likely to be safe”?
Where is the cohort-matched comparative evidence to support RACS’ position that RACS Fellows can practise cosmetic surgery to a “higher standard” (whatever that means) than non-FRACS doctors?
The answer is: there is no such evidence. Or at least, none which is publicly available – yet.
There is, however, plenty of anecdotal evidence that RACS-trained surgeons do not always practise cosmetic surgery safely. One only need look as far as the death of a Melbourne patient in the early 2000s after a liposuction procedure performed by a FRACS surgeon at the private facility of another FRACS surgeon – still to date the only such death from a cosmetic procedure performed by an Australian-registered doctor (that we can be sure of – there may have been others).
Indeed, Dr Tonkin, as quoted above, appears to have contradicted her own recent statements that “…the ‘cowboy’ reputation of cosmetic surgeons was not reflected in the the AHPRA/board data” and that “complaints around cosmetic procedures were spread evenly among cosmetic surgeons, plastic surgeons, and other specialties, so there was no simple dichotomy between ‘bad’ cosmetic surgeons and ‘good’ plastic surgeons.”
As a matter of fact, there does exist high-quality, comprehensive data from which evidence-based conclusions about safety in cosmetic surgery could be drawn. I refer to the large body of actuarial data on cosmetic procedure litigation held by the various medical indemnity organisations. Why have the relevant Government bodies not subpoenaed this data? That data is where the real evidence is to be found. And I suspect that rigorous analysis of that data may prove unsupportive of any of the self-serving statements made by representatives of the various vested-interest groups in this field.
Until such time as a rigorous comparative analysis of actuarial data about risks in cosmetic surgery can be conducted and published, all of the current hysteria surrounding this field just amounts to politics and turf protection. It’s certainly not good medicine, and it does nothing to protect patients.
Endorsement, in the area of practice of Cosmetic Surgery, will be accredited by the AMC .
Therefore these practitioners will be AMC accredited surgeons. At least they have procedure specific training in cosmetic surgery that is AMC accredited. Plastics have no such formal training in the public hospital system .
The draft AMC cosmetic surgery standards are very comprehensive and if achieved by a college or education provider would be the gold standard for someone practicing invasive cosmetic surgery in Australia.
The multiple anonymous opinions that better regulation of Australian clinical services will just drive customers overseas suggest that those opinions might be driven by vested interest. Australia is a wealthy and safe society where we can afford to maintain standards. The fact that some people may choose to travel to less regulated areas should not stop us regulating our own services.
Let surgery be done by trained surgeons. It’s important to ensure that we retain enough access to plastic and reconstructive surgery for those who require it for functional and/or mental health reasons. Beyond that, it’s not health care.
Not enough. To call your self a surgeon you need to have a surgical fellowship. The term surgeon needs to be a protected term under the national law, and the board could do that. But that would be too hard for the little petals would’t it.
The idea that some Mickey Mouse endorsement of „ training“ will allow these people to practice surgery safely is so laughable that it could only have been dreamed up by AHPRA
Surgical training requires doing real surgery in a proper facility under the supervision of proper surgeons.
There us a pathway to achieve this. It is called the FRACS or equivalent
Anybody willing to perform major surgery without proper training is telling us all we need to know about their ethics and probity. We need to remember that when fishing for a cosmetic surgeon one is fishing in the shallow end Fichte medical and moral gene pool
Please do not put AHPRA on the same level as the Medical Board. The Medical Board sets the guidelines and registration requirements. AHPRA maintains the register and provides administrative assistance to the Board.
They are fundamentally and statutorily different entities.
For the moment. 😳
Patients are already traveling overseas to Thailand and elsewhere for cheap Cosmetic surgery. I think this creates a huge gift to them. Most of them have rubbish qualifications.
A more appropriate crackdown would have been to endorse the local surgical facilities to enhance standards of care and to promote training standards for surgical procedures. Plastic surgeons do not get specific training in cosmetic surgery as it is not performed in public teaching hospitals but can obtain it as a fellowship or observership after completion of surgical training.
The Medical Board is making knee jerk decisions to save its own back because they have been asleep at the wheel. They will just enhance the cosmetic tourism industry over which they have no jurisdiction.
(I do not perform Cosmetic procedures).
all this will create is exodus of patients overseas for cosmetic surgeries as costs will skyrocket for procedures due to
plastics being able to charge more .Liposuction /funsculpting is done all over the US in the office for example .Having dealt with disasters from overseas ,there will be a lot more invariably taking up precious time in the public sytem .Its my impression that social marketing and youtube channels showing procedures should be censored .No where in the world do such policies exist of this nature .SECONDLY I have not seen one statistic of absolute risk and disfiguring numbers.Most of this would be unexpected outcomes.One also needs to remeber plastic surgeons get unerxpected outcomes -is this endangering the public .