Review recommends ‘endorsement model’ for cosmetic surgeons

Filip Vukasin

1/09/2022 5:14:48 PM

AHPRA has accepted all 16 recommendations from an independent review into Australia’s cosmetic industry, in a bid to improve patient safety.

Patient undergoing plastic surgery
Many patients seek procedures from cosmetic surgeons because their costs are lower than that of plastic surgeons.

Findings from an independent review into the cometic surgery industry have been released, providing 16 recommendations ‘to improve patient safety’.
The recommendations, all of which have been accepted by AHPRA and the Medical Board, will take 2–3 years to implement and follow extensive media regarding ‘cosmetic cowboys’, which ballooned in 2021 and still continues.
Aiming to address reports of unhygienic surgical practises, the use of social media and misleading before-and-after pictures, complications and unsafe surgical procedures, the recommendations include:

  • establishing an endorsement model for cosmetic surgeons
  • a public education campaign to assist consumers to understand an endorsement
  • supporting consumers to make notifications against cosmetic surgeons, considering there were zero between July 2019 and December 2021 compared to other medical fields, which may be impacted by non-disclosure agreements
  • addressing advertising, including AHPRA obtaining legal advice on the matter and undertaking an industry-specific audit.
A $4.5 million Cosmetic Surgery Enforcement Unit will also be established to implement all of the recommendations.
But while the final report comes in at 132 pages, it contains little detail on how endorsement will work and the ways in which doctors who perform cosmetic surgery will be impacted. 
Many patients seek procedures from cosmetic surgeons because their costs are lower than that of plastic surgeons.
And although most in the medical profession would agree anyone with only an MD or MBBS qualification should not be performing invasive surgical procedures, a broad cohort of doctors can call themselves cosmetic surgeons.
This can include accredited ophthalmologists, as well as general, orthopaedic and ENT surgeons.
There are also many GPs who perform cosmetic surgery, some who have trained as surgeons overseas before specialising in general practice in Australia and continue to use their skills. Others have learnt on the job under the guidance of other surgeons.
Meanwhile, the Australian College of Cosmetic Surgery and Medicine (ACCSM), which has existed for more than 30 years but is not Australian Medical Council-accredited, also provides a training pathway for doctors in cosmetic surgery.  The independent review specifically named four doctors, including two GPs in their report:
  • Dr Daniel Lanzer, who is no longer registered to practise since AHPRA and the Medical Board’s response to complaints against him, has specialist dermatologist credentials
  • Dr Ryan Wells, whose registration is currently suspended, and has MBBS training but no further specialist training
  • Dr Daniel Aronov, who has restrictions placed on his registration to stop him performing cosmetic surgery, has specialist general practice training. He must be supervised to work as a GP
  • Dr Mohammad Reza Ahmadi, who is also restricted from practising cosmetic surgery, specialised as a GP. He must be supervised to work as a GP
Under the current regulatory system, doctors are currently not required to obtain ACCSM Fellowship or undergo additional training in order to call themselves ‘a cosmetic surgeon’.
This is where the terminology is important. As per the report, while the title ‘surgeon’ is part of several 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, ‘cosmetic surgeon’ is not a protected title and therefore it is unlikely medical practitioners who are not specialist surgeons would be breaching the title protection provisions in the National Law by using the term.
The report also made no recommendation regarding the use of ‘cosmetic surgeon’, stating that it is currently under consideration by the Ministerial Council and outside the scope of this review.
Nonetheless, the ACCSM has welcomed the findings.
‘The college has been fighting for 20 years to introduce real reform that will protect patients by ensuring doctors performing cosmetic surgery are properly trained and qualified and we are now seeing them,’ ACCSM President Dr Anoop Rastogi said.
‘The reforms are practical, sensible and enforceable and when implemented have real power to protect patients and prevent the disturbing outcomes we have seen in the recent media.

‘Any doctor, or organisation, that is serious about protecting patients will support these reforms.’

newsGP spoke to several cosmetic surgeons who preferred to remain anonymous, but uniformly welcomed the review findings, particularly the implementation of endorsement as a means of improving patient safety.

According to the report, endorsement will aim to establish ‘minimum qualifications’ for medical practitioners wishing to perform cosmetic surgery.
‘It would recognise this practitioner has extended scope of practice and they have obtained specific qualifications approved of by the Medical Board,’ the report states.
‘Thereby it would be easy for consumers to identify whether a practitioner is qualified to perform cosmetic surgery as the endorsement would be listed on the AHPRA public register.’
There will also likely be a ‘grandfathering’ provision for those who have extensive years’ experience, similar to what happened to GPs before the implementation of training-accredited Fellowship.
However, for many plastic surgeons, reforms do not go far enough.
Dr Robert Sheen, President of the Australian Society of Aesthetic Plastic Surgeons was critical of the review findings.
‘AHPRA has chosen to protect those who call themselves cosmetic surgeons, instead of protecting patients,’ he said.
‘It is reckless, and irresponsible.
‘The [Federal] 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.’
Cosmetic surgeons who spoke to newsGP worry this is partly to do with a turf war and that plastic surgeons would like all cosmetic procedures to be performed by them, as accredited by the Royal Australian College of Surgeons.
An alternative, less restrictive solution could see AHPRA collaborate with professional organisations such as the RACGP on endorsement requirements, in particular regarding who is trained and qualified to practice surgery.
The college has accredited training pathways and requirements for GPs in cosmetic surgery, and in its submission to the review called for the adoption of ‘cosmetician’ for these doctors, as opposed to ‘surgeons’.
But regardless of the terminology used, the issue of regulating cosmetic surgery is not specific to Australia’s $1 billion dollar industry.
Nordic countries, France and the US have had similar issues, while it is also easy for people to fly to another country with poor regulation to have cosmetic surgery, thereby still impacting Australian patients.
There is clear consensus that regulation is needed in cosmetic surgery to prioritise patient safety, just like any other field of medicine.
What is less clear is the effect on patient access were costs to become prohibitive, thereby leading them to look for alternatives that may be similarly, if not more dangerous such as seeking cheap procedures overseas.   
The flow on effects of this independent review will continue to be discussed and analysed in medical circles and the wider media as implementation proceeds, but as several cosmetic surgeons told newsGP, the foremost thought should be patients and doing no harm.
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