Patient testimonials, minimum hygiene standards and the use of the term “Cosmetic Surgeon” are all on the table in what looks set to become a sweeping overhaul of Australia’s cosmetic surgery industry.
The cosmetic surgery industry is set to undergo significant reform after a new report by the Australian Health Practitioner Regulation Agency (AHPRA) (the medical regulator) and the Medical Board of Australia.
The independent review, released on 1 September 2022, was promptly initiated after a joint investigation by Four Corners, The Age and Sydney Morning Herald into controversial cosmetic surgeons uncovered serious hygiene and safety breaches across various clinics.
The review found unsafe practices, misleading advertising and a need for minimum standards on qualifications.
Under proposed reforms cosmetic practitioners could be banned from using patient testimonials, face minimum hygiene standards and be barred from calling themselves surgeons if they are not qualified.
How is cosmetic surgery in Australia currently governed?
Current regulation of cosmetic surgery is multifaceted, involving multiple state, territory and national regulators. As cosmetic surgery is not recognised as a speciality in Australia, any medical practitioner, whether or not trained and competent in cosmetic surgery, may legally call themselves a ‘cosmetic surgeon’.
The report notes that universal minimum standards for education, training and qualifications in cosmetic surgery have been nonexistent in Australia. Consequently, cosmetic surgery is undertaken by doctors from various backgrounds with varying levels of training and competence, with a spectrum of outcomes for patients.
‘In this environment, consumers are largely left on their own when it comes to selecting a practitioner to perform cosmetic surgery, having to sift through a plethora of advertising and marketing material and try to make sense of numerous qualifications, in an attempt to identify a qualified and competent practitioner,’ said former Queensland health ombudsman Andrew Brown, who led the inquiry.
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.
Medical practitioners who do not hold specialist registration, must not ‘hold themselves out’ as a registered specialist or claim to be qualified to practise in a recognised specialty. Cosmetic surgery is not, however, recognised as a medical specialty. While the title ‘surgeon’ is part of a number of protected specialist titles (for example, ‘specialist plastic surgeon’ and ‘specialist orthopaedic surgeon’), there is no standalone title ‘surgeon’ that is protected by the National Law. As a result, the title ‘cosmetic surgeon’ (which is a commonly used term in the cosmetic surgery sector, irrespective of the level of training and qualifications of the practitioner) is not a protected title.
Key findings from the review
In its Key Findings, the independent review declared bluntly that it has ‘highlighted unsafe practice, misleading advertising and substandard marketing across the cosmetic industry’.
AHPRA chief executive Martin Fletcher pledged to act immediately, in partnership with the Medical Board of Australia. ‘I am appalled by the tragic stories of patients who were harmed by doctors taking advantage of them – the situation is totally unacceptable and must change,’ he said.
‘We want everyone who chooses to have cosmetic surgery to be better informed and protected. We want doctors who undertake cosmetic surgery to be trained to a safe standard. We want the public to feel confident they are going to be well looked after and, if things go wrong, that they will be supported and that their concerns will be acted on.
‘We will use our legal powers in full to better protect consumers who choose cosmetic surgery. Registered practitioners in the industry can expect a relentless focus.’
Proposed new changes to the industry
The review, which follows a six-month examination of the regulation of the sector including through a public consultation, makes 16 recommendations to improve patient safety in the sector. AHRPRA and the Medical Board have accepted all 16 recommendations.
In a bid to improve patient safety, and address reports of unhygienic surgical practises, the use of social media testimonials and misleading before and after photos and unsafe surgical procedures, the recommendations include:
- establishing an ‘endorsement’ model for cosmetic surgeons to establish expectations about minimum qualifications
- a public education campaign to assist consumers to understand an endorsement
- a confidential cosmetic surgery hotline
- a complaints committee revising Advertising Guidelines.
As a result, AHPRA has set up a targeted Cosmetic Surgery Enforcement Unit to ‘accelerate action and step-up enforcement’ as well as a separate Cosmetic Surgery Oversight Group.
In addition, AHPRA announced it ‘will enforce the ban on testimonials in cosmetic surgery advertising as they are likely to mislead, deceive and trivialise the risks.’
An endorsement model
One of the most far-reaching recommendations is the use of an ‘endorsement’ process. An endorsement would recognise that a person has an extended scope of practice in a particular area because they have obtained a specific qualification approved by the Medical Board. The training programs leading to the qualification also must be accredited by an independent accreditation authority. Once established, the report says it ‘will be easy for consumers to identify whether a practitioner is qualified to perform cosmetic surgery’ (as the endorsement will be listed on the AHPRA public register).
A public education program about endorsement will also be necessary; the report notes this is a much simpler message to communicate than the current ‘unacceptable situation’.
The review emphasised that cosmetic surgery, like any other form of surgery, is invasive and carries risks. It should only be performed by highly trained practitioners. The standards set for an education and training program by the Medical Board, in consultation with the AMC, will have to be very high.
‘Only rigorous and robust programs that appropriately train practitioners in the necessary aspects of surgery should be accredited,’ the report said.
Social media testimonials & cosmetic surgery advertising
The review was concerned with tactics employed by some practitioners, particularly on social media, including using images of models who are unlikely to have had cosmetic surgery, to promote a particular surgical procedure, content that actively encourages people to pursue what is promoted as a socially accepted or perfect body type and the use of influencers to promote procedures.
To safeguard against some of the concerning impacts of cosmetic surgery advertising, the review recommended:
- that stronger enforcement action be taken about high-risk matters;
- an industry-specific audit be undertaken to inform future proactive auditing of such advertising, including using technology to assist with this;
- that AHPRA and the Medical Board revise its Advertising Guidelines and/or produce additional material specifically about cosmetic surgery to clarify the standards expected of practitioners.
Aussie docs say the time to act is now
Australian doctors have called on health ministers across the country to quickly detail and act on the proposed changes to the cosmetic surgery sector.
Health Minister Mark Butler has announced that the law will be amended to ensure anyone performing a cosmetic procedure is properly qualified, with the proposed changes focusing on who can call themselves a surgeon and ensuring procedures are carried out in safe, hygienic and accredited facilities.
Health Ministers agreed to implement the following reforms:
- Preventing medical practitioners who are not qualified describing themselves as cosmetic ‘surgeons’
- Ensuring anyone conducting a cosmetic procedure has appropriate qualifications
- Limiting surgery to properly accredited facilities with minimum hygiene and safety standards
- Banning doctors using patient testimonials for cosmetic surgery including on social media
- Better information for patients on the risks and their rights so they can make an informed decision about any treatment.
The title of ‘cosmetic surgeon’, and who can use it, is still a hotly contested issue, with differing opinions on what qualifications guarantee safe care. It is still currently under consideration by the Ministerial Council and is an issue we’re following closely. [A]A
