AHPRA has today (1st September 2022) published the long-awaited final report Independent review of the regulation of medical practitioners who perform cosmetic surgery. The report followed a six month examination of the cosmetic surgery industry, and specifically the regulation of cosmetic surgeons. The review was led by Andrew Brown (former Qld Health Ombudsman), and was commissioned by AHPRA and the Medical Board in response to a concerning series of media reports highlighting issues within the industry. We also note the background of recent class actions against cosmetic surgeons and clinics – some still on foot.
A key finding of the report is the acknowledgement that universal minimum standards for education, training and qualifications of those performing cosmetic surgeries are non-existent in Australia. In a summary of findings, the review said:
“The Medical Board’s codes and guidelines place the onus on the individual medical practitioner to ensure they practise within their skills, knowledge and competence, and therefore it is up to the practitioner themselves to decide this, without reference to any minimum standards or other more specific guidance. In these circumstances, it is possible for any medical practitioner to offer and perform invasive cosmetic surgical procedures without having undertaken appropriate training or having amassed sufficient supervised experience to reach an acceptable level of competency.”
“Against this background consumers are largely left on their own when it comes to selecting a practitioner to perform cosmetic surgery. Often they are required to sift through a plethora of advertising and marketing material, seek to understand various titles and try to make sense of numerous qualifications, all in an attempt to identify a qualified and competent practitioner. This is an unacceptable situation.”
The review acknowledges that while in accredited specialities, the associated use of ‘surgeon’ in a title is protected (for example, ‘specialist plastic surgeon’), but that there is no prohibition for the standalone use of ‘surgeon’ by the National Law. Therefore, it is found that use of the term ‘cosmetic surgeon’ by practitioners who are not specialist surgeons is not in breach of the title protection provisions in the National Law. Despite this, and the many submissions advocating for protection of the ‘surgeon’ title, the report did not make recommendations to this effect:
While the problem is easy to identify and define, the solutions are much more complex and controversial. They are complex because the Health Practitioner Regulation National Law (the National Law), governing Ahpra and the Medical Board’s powers and responsibilities, is based largely on a title protection model (that is, it seeks to regulate what practitioners are allowed to call themselves) and less on a model that directly regulates scope of practice (that is, what practitioners are allowed to do). The solutions are controversial because they require navigating some disputed territory that is at the core of a very public battle between groups representing specialist surgeons (and in particular those that have a plastic surgery subspecialty) and those who are not specialist surgeons.
In the 16 recommendations, a key focus was instead establishing an area of practice ‘endorsement’ for cosmetic surgery. However, the report acknowledges that it is unable to make findings regarding the suitability or unsuitability of any program of study for cosmetic surgery for existing practitioners, and did not further indicate what the minimum training, experience or qualification of a cosmetic surgeon would look like under the ‘endorsement’ model.
The report also recommended a sweep of regulations over advertising, social media and testimonials in the context of cosmetic procedures.
The Medical Board and AHPRA acknowledged in a media conference that they would accept all 16 recommendations made by the report.
However, early media reports have noted that the Australasian Society of Aesthetic Plastic Surgeons (Asaps) has criticised the changes, saying they don’t prioritise patient safety and more needs to be done. Dr Robert Sheen, president of Asaps told the media “Ahpra has chosen to protect those who call themselves cosmetic surgeons, instead of protecting patients…It is reckless and irresponsible. The government must step in to tighten the law so a practitioner who is cutting a patient’s body has completed Australian Medical Council-accredited surgical training.”1
Health Minister Mark Butler has foreshadowed a meeting with state and territory health ministers this Friday to consider review of protection the ‘surgeon’ title as matter of priority, as part of the parliamentary inquiry into the industry, established by Greg Hunt in November 2021.
You can read the full report and the recommendations made here.
1Australian Associated Press, ‘‘Irresponsible’- regulator accused of not doing enough to protect patients in cosmetic surgery reform’, The Guardian (online, 1 September 2022) https://www.theguardian.com/australia-news/2022/sep/01/cosmetic-surgery-in-australia-to-be-monitored-by-enforcement-unit-to-improve-patient-safety].