In a move that has been cautiously welcomed by ophthalmologists and oculoplastic surgeons, medical regulator Ahpra has vowed to clampdown on rogue medical practitioners using the title ‘cosmetic surgeon’ by introducing an endorsement process to establish minimum qualifications.
However, details remain unclear on how the endorsement process will work, with RANZCO and other medical colleges believing the ‘surgeon’ title should be restricted to those who have received full surgical training from an Australian Medical Council-accredited college.
In November 2021, the Australian Health Practitioner Regulation Agency (Ahpra) and the Medical Board of Australia commissioned a review into the cosmetic surgery industry following media reports and discovered unsafe practices, misleading advertising and substandard marketing across the cosmetic industry.
Within the ophthalmic sector, some oculoplastic/periocular procedures, such as endoscopic brow lift and blepharoplasty, can be cosmetic in nature and are performed by highly trained medical specialists.
Ahpra also found that universal minimum standards for education, training and qualifications are non-existent for cosmetic surgery in Australia, meaning it is possible for any medical practitioner to offer invasive cosmetic procedures without appropriate training or sufficient supervised experience.
In these circumstances, Ahpra said consumers are largely left on their own when selecting a practitioner to perform cosmetic surgery, having to sift through a plethora of advertising material to make sense of numerous qualifications, to try identify a qualified and competent practitioner.
The inquiry – led by former Queensland Health Ombudsman Mr Andrew Brown and released on 1 September – made 16 recommendations accepted by Ahpra, with the most notable being that the regulator will use the ‘endorsement’ process to establish minimum qualifications for medical practitioners wishing to perform cosmetic surgery. A similar approach is used for therapeutically-endorsed optometrists.
“An ‘endorsement’ recognises that a person has an extended scope-of- practice in a particular area because they have obtained a specific qualification that has been approved by the Medical Board,” Ahpra stated.
“The training program(s) leading to the qualification also must be accredited by an independent accreditation authority. Once established, 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.”
Australian Society of Ophthalmologists vice-president Dr Peter Sumich said it remained uncertain whether Ahpra and the Medical Board wanted to set the qualification standards itself, or defer to the medical colleges.
“First of all, we need to hammer down what constitutes a cosmetic surgeon, but Ahpra has left that ambiguous because of this endorsement process and who will administer it,” he said.
“I don’t think Ahpra is qualified to determine who is qualified, if that makes sense, especially when there are very few doctors amongst them, most of them are bureaucrats.”
In its submission during the consultation phase, RANZCO said the standards required for surgical procedures should be determined by the body or college whose curriculum most comprehensively covers the anatomy and management of the relevant body part, and by any other college that covers the techniques used most commonly in cosmetic procedures in that region.
“Hence for periocular cosmetic surgery, this would fall into the scope-of-practice of ophthalmologists, oculoplastic surgeons, and plastic surgeons, and for those outside those specialities, practitioners can seek accreditation for certain procedures from the two respective colleges, RANZCO and Royal Australasian College of Surgeons (RACS),” RANZCO stated.
Dr Charles Su is past president of the Australian and New Zealand Society of Ophthalmic Plastic Surgery who has been practising eyelid, lacrimal, and orbit surgery for more than 25 years in the public and private sectors.
He said whoever was performing surgery whether for aesthetic reasons or not, the public would expect someone with complete specialty training in the procedures done on that part of the body, and to have had a full and formal education in the anatomy of that site.
“As ophthalmologists our specialty college is the peak body which confers this for the region of the eye, eyelids, orbit, and lacrimal system. It is clear in the latest report that there is no such safeguard for cosmetic surgery. Any movement toward proper accreditation is good, but I am sure there is still a long way to go,” he said.
In a joint statement, RACS, the Australian Society of Plastic Surgeons (ASPS), Australasian Society of Aesthetic Plastic Surgeons (ASAPS), and the Australian Society of Otolaryngology Head and
Neck Surgeons (ASOHNS) said any “grandfathering” of existing cosmetic surgeons would need to be carefully considered under the new endorsement framework as some unscrupulous operators may continue to operate.
“It would also take years to implement. What can be done quickly is to restrict the title of surgeon to those who are registered in a surgical specialty,” they said.
Dr Robert Sheen, president of ASAPS, said that many so-called ‘cosmetic surgeons’ used various training programs as proof of expertise, but some of these required almost no specific surgical training.
Ahpra responds
In other recommendations, Ahpra will establish a targeted Cosmetic Surgery Enforcement Unit – with an immediate injection of $4.5 million.
It also will enforce a ban on testimonials in cosmetic surgery advertising as they are “likely to mislead, deceive and trivialise the risks”.
Medical Board chair Dr Anne Tonkin said it was clear that stronger action was needed now, but she warned setting the standard would be a hotly contested issue.
“There are fiercely different opinions about what qualifications guarantee safe care. Patient safety will be our core focus as we consult with our stakeholders and develop the endorsement,” she 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.”
Ahpra CEO Mr Martin Fletcher said he was “appalled by the tragic stories of patients who were harmed by doctors taking advantage of them”.
“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,” he said.
“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.”
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