When it comes to cosmetic surgery, there are no universal minimum standards for education, meaning that any medical practitioner can perform invasive procedures even if they don’t have the right training or experience, an independent review into the sector has found.
Commissioned by the Australian Health Practitioner Regulation Agency (Ahpra) and the Medical Board of Australia in November 2021, in the wake of widespread public concerns regarding the alleged conduct of some medical practitioners who peform cosmetic surgery, findings and recommendations were handed down last week.
The review confirmed the complexities within the sector and risk posed to consumers under the current regulatory approach. Calling for action to address consumer safety issues, it made 16 recommendations for reform, including the use of an endorsement model to establish minimum training standards for those who perform cosmetic surgery, improving the management of cosmetic surgery related notifications, taking stronger action against inappropriate advertisers, and developing clearer practice guidelines for the sector.
According to independent reviewer Andrew Brown, the former Queensland Health Ombudsman, the unique nature of the cosmetic surgery sector poses regulatory challenges not typically experienced in other areas of medical practice. While problems are easy to identify and define, solutions are far more complex, he added.
“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 [then] try to make sense of numerous qualifications, in an attempt to identify a qualified and competent practitioner. This is not good enough,” Mr Brown said.
The review undertook public consultation, including releasing a consultation paper seeking written submissions from stakeholders, as well as an online survey aimed at consumers of cosmetic surgery. It garnered 249 written submissions and 595 survey responses.
The Australian Nursing and Midwifery Federation (ANMF) submission raised a number of issues that nurses, a growing cohort of the cosmetic procedures workforce, face when providng care for people undergoing cosmetic surgery. They included professional regulation, the need for more education to support nurses and medical practitioners to understad their obligations regarding mandatory notifications, nurses working outside of their scope of practice due to employers’ drive for profits, and informed consent.
“The ANMF has identified a number of issues facing nurses providing care for people undergoing cosmetic procedures. These issues relate to the legal and ethical responsibilities, professional regulation and the power imbalance between health practitioners and the employer and employees in private services. Nurses and their health practitioner colleagues need to be supported to clearly understand their role and obligations while working in this expanding area of practice,” the submission stated.
Altogether, the review made 16 recommendations for action that Ahpra and the Medical Board can take to improve patient safety within their sphere of influence and under the current legislative framework.
For example, under the proposed endorsment model to establish minimum qualifications for medical practitioners wanting to perform cosmetic surgery, it is hoped consumers will be able to more easily identify whether a doctor is appropriately qualified.
Other recommendations include undertaking a targeted education campaign aimed at health practitioners to address the significant underreporting of safety issues in the sector, taking action against practitioners who breach advertising guidelines, including on social media, and clearer practice expectations for medical practitioners, including across areas such as informed consent and preoperative screening.
Responding to the review, the Medical Board and Ahpra accepted all 16 recommendations to improve patient safety in the cosmetic surgery industry. They will also welcome any action from Health Ministers to protect the title of ‘surgeon’.
After the review highlighted unsafe practice, misleading advertising and substandard marketing across the cosmetic surgery industry, Ahpra have established a targeted Cosmetic Surgery Enforcement Unit, injecting $4.5 million for extra resources to accelerate action.
The unit’s key aims include making it easier for consumers to know who is trained and qualified to perform cosmetic surgery safely, cracking down on advertising, tackling underreporting, and strengthening existing guidelines. Ahpra and the Medical Board will also work to strengthen patients’ voice, having already set up a confidential hotline so consumers can make cosmetic complaints.
“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,” Ahpra CEO Martin Fletcher said.
“We want everyone who chooses to have cosmetic surgery to be better informed and protected. We want the 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.”
Mr Fletcher warned registered practitioners in the industry to expect a relentless focus on safety, with Ahpra set to use its full legal powers to better protect consumers who choose cosmetic surgery.
Governance and oversight of the work will be refined by a Cosmetic Surgery Oversight Group who will report publicly on progress and assure the community, governments and professional stakeholders that action is being taken.
The Oversight Group will be established by Ms Gill Callister PSM, Chair of the Ahpra Board, and will include an independent member who is a recognised expert in consumer protection.
Medical Board Chair, Dr Anne Tonkin, said it was clear stronger action was needed.
“A number of practitioners in the cosmetic surgery industry have forfeited the trust of the community and the respect of the medical profession,” Dr Tonkin said. “An area of practice endorsement will set standards and make cosmetic surgery training and qualifications clearer. It will empower consumer choice, by identifying who is trained and qualified, and who is not.”
Read the final report here